LAPAROSCOPIC (TAPP) VERSUS OPEN INGUINAL HERNIA REPAIR (LICHTENSTEIN). A COMPARATIVE STUDY

Fater Aliskander*, Samir Kanan and Maan Haidar

ABSTRACT

Introduction: One of the most commonly performed surgery by a general surgeon is inguinal hernia repair. There have been numerous open surgical techniques and two laparoscopic techniques described in the literature for the treatment of inguinal hernias. The treatment outcome of all these surgeries remains the same which is reducing the hernia and preventing recurrence. Our aim was to compare laparoscopic versus open inguinal hernia repair. Methods: One hundred patients with inguinal hernias were randomly divided into two groups. Group one was 68 patients treated by open Lichtenstein repair, while the second group was 32 patients treated by laparoscopic trans abdominal pre-peritoneal (TAPP) mesh repair. The two groups were compared to assess the duration of surgery, intraoperative and post operative complications, postoperative pain, duration of hospital stay, return to normal activity and work, scar size. Results: The percentage of males (87%) was higher than females (13%), and the right side (57%) was more common than the left side (23%).The median age of TAPP patients was 48 years, while the median age of Lichtenstein patients was 43 years. The median duration of surgery was higher in TAPP repair (65.2 min vs 43.5 min with p value = 0.002 in unilateral hernias) and (116 min vs 84 min with p value = 0.001 in bilateral hernias). The intraoperative complication rate in TAPP repair was 4.4%, while in Lichtenstein repair it was 9.3% with a p value of 0.5. The postoperative complication rate was 9.4% in TAPP repair and 10.3% in Lichtenstein repair with a p value of 0.2. The median hospital stay was similar, with 7.3 hours for TAPP repair and 6.45 hours for Lichtenstein repair with a p value of 0.2. The time required to return to daily activities was shorter in laparoscopic repair (9.3 days) compared to open repair (13.8 days) with a p value of 0.0001. The average scar size was smaller in laparoscopic repair (3.6 cm) compared to open repair (7.5 cm) with a p value of 0.0001. The pain level after surgery was lower in laparoscopic repair, with a score of 3.9 on the first day, 1.5 on the second day, and 0.5 after a week, while the pain level was higher in open repair, with a score of 5.7 on the first day, 4 on the second day, and 2 after a week. Conclusion: Laparoscopic TAPP repair offers a significant advantage over open tension free hernioplasty. It was associated with less post operative pain, faster recovery, but higher operative time, with insignificant difference in early post operative complication. Thus, Laparoscopic TAPP repair should be considered for Bilateral and recurrent hernias and for female in view of lesser post operative pain and scar size, with faster recovery.

Keywords: Inguinal Hernia, TAPP repair, Open hernioplasty, Lichtenstein.