Four-arm randomized trial comparing laparoscopic and open hernia repairs.

Aim: To compare four approaches in primary repair of inguinal hernia as regards operative and postoperative outcome.

Methods: One hundred consecutive patients with primary inguinal hernia Nyhus I-III were randomized into four groups. Group I had open pro-peritoneal repair, group II had Lichtenstein tension-free mesh repair, group III had Transabdominal pro-peritoneal (TAPP) repair while group IV had laparoscopic totally extraperitoneal (TEP) hernia repair.

Results: Operative time ranged from 10.71 to 120.61 min. Laparoscopic operations were significantly longer than open operations (54.5+13.2, 34.21+23.5 versus 96.12+22.5, 77.4+43.21; t=3.891, p<0.001). Open pro-peritoneal approach had significantly longer operative time compared to Lichtenstein approach (54.5+13.2 versus 34.21+23.5). Postoperative pain was significantly higher in patients who had open repairs (7.067+1.831, 6.5+3.5 versus 5.8+1.568, 4.8+2.33; t=3.424, p=0.002). There was one case of conversion in each of the two laparoscopic groups. Laparoscopic operations were associated with significantly faster return to normal domestic activities and to work.

Conclusion: Laparoscopic hernia repair offers less postoperative pain and faster recovery on the expense of longer operative time. TEP and TAPP laparoscopic techniques gave similar results.