Comparing the outcome of laparoscopic (TAPP mesh repair) and open hernia repair

Abstract

Aim: The aim of the study at comparing the outcome of laparoscopic (TAPP mesh repair) and open hernia repair with respect to the duration of surgery, intra and postoperative complications, postoperative pain, recurrence, stay in the hospital and resumption of daily activities. Methods: A comparative study was conducted in the Department of general surgery, AIIMS, Patna, Bihar, India from Dec 2017 to November 2018 to compare laparoscopic hernioplasty and Lichtenstein’s open mesh repair. The study consisted of 140 patients with unilateral or bilateral inguinal hernia and they were randomly allocated into either group. Various parameters like duration of surgery, intra and post-operative complications, post-operative pain, recurrence, stay in the hospital and resumption of daily activities were compared. Results: out of 140 patients of whom 120 were men (85.71%) and 20 were women (14.29%). The mean age group of those who underwent open mesh repair was 53.06 years and laparoscopic technique was 50.45 years. Out of the 140 patients, 35 had bilateral inguinal hernia and the rest 105 had unilateral. 22 patients with bilateral hernia underwent laparoscopic repair and 13 underwent open mesh repair. 48 patients with unilateral hernia underwent laparoscopic hernioplasty and 57 underwent open mesh repair. The mean operative time for unilateral open hernioplasty was 47.55 mins and bilateral was 88.26 mins whereas, for unilateral laparoscopic hernioplasty it was 64.48 mins and bilateral was 122.45 mins. Post-operative complications, like wound infection was noted in 15.71% (11 out of 70 patients) and 18.57% had seroma formation (13 out of 70 patients) in the open hernioplasty group. In laparoscopic hernioplasty group, 2.86%(2) had wound infection but, seroma formation was noted in 14.29% (10 out of 70 patients). Urinary retention was noted 21.43 % of open hernioplasty group (15 out of 70) and 7.14% of laparoscopic hernioplasty group (5 out of 70 patients). Mean pain score was noted on post-operative day (POD), POD 0, POD 3 and POD 7 as show in (table 5). The mean pain score for; laparoscopic hernioplasty (LH) and open hernioplasty (OH) were POD 0: LH– 6.1 and OH–6.7 and POD 3: LH– 4.3 and OH– 5.2 but, on POD 7: pain score for LH was 1.8 and OH was 3.1. Conclusions: Laparoscopic hernia repair is safe and provide less postoperative morbidity in experienced hands compared to open hernia repair.

Keywords: Inguinal hernia, Lichtenstein’s repair, Laparoscopic hernioplasty.