Inguinal hernia is one of the most prevalent surgical conditions, with an estimated lifetime risk of 27% in men and 3% in women (1). Surgical repair is the standard treatment, and it can be performed using either an open or laparoscopic approach. Open inguinal hernia repair, particularly the Lichtenstein tension-free mesh technique, has been widely used due to its simplicity, lower recurrence rates, and cost-effectiveness (2). However, laparoscopic hernia repair has gained popularity due to its advantages, such as reduced postoperative pain, faster recovery, and minimal scarring (3).

Laparoscopic inguinal hernia repair is performed using two primary techniques: transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) approaches. Studies suggest that laparoscopic repair is associated with a shorter hospital stay and quicker return to normal activities compared to open repair (4). However, it also has certain drawbacks, including a longer operative time, higher initial cost, and the requirement for specialized training (5).

Despite extensive research comparing both techniques, there remains debate regarding their superiority in terms of postoperative complications, recurrence rates, and overall patient outcomes. Some studies indicate that laparoscopic repair has a lower rate of chronic pain and infection, whereas others suggest no significant difference in long-term recurrence rates between the two techniques (6,7). Therefore, this study aims to compare laparoscopic and open inguinal hernia repair in terms of operative time, postoperative pain, hospital stay, and complication rates, to provide further clarity on the optimal surgical approach.

Study Design and Setting

This prospective comparative study was conducted at a tertiary care hospital over a period of 12 months. The study aimed to evaluate and compare the clinical outcomes of laparoscopic versus open inguinal hernia repair. Ethical approval was obtained from the institutional review board, and informed consent was collected from all participants before enrollment.

Patient Selection

A total of 100 patients diagnosed with unilateral inguinal hernia were recruited and randomly assigned into two groups:

• Group A (n=50): Underwent laparoscopic inguinal hernia repair.
• Group B (n=50): Underwent open inguinal hernia repair.

Inclusion criteria consisted of patients aged 18 to 65 years, diagnosed with primary unilateral inguinal hernia, and deemed fit for surgery under general or regional anesthesia. Patients with recurrent hernia, bilateral hernias, strangulated or incarcerated hernias, severe comorbidities, or previous lower abdominal surgeries were excluded from the study.

Surgical Techniques

Laparoscopic Repair: Patients in Group A underwent either the transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) technique, based on surgeon preference. A polypropylene mesh was placed in the preperitoneal space, and fixation was performed using absorbable tacks or sutures.

Open Repair: Group B underwent the Lichtenstein tension-free mesh repair technique. After hernia sac dissection, a polypropylene mesh was placed and secured with non-absorbable sutures. The wound was closed in layers with standard aseptic precautions.

Outcome Measures

The primary parameters assessed included:

• Operative time (minutes): Measured from the first incision to skin closure.
• Postoperative pain: Assessed using the Visual Analog Scale (VAS) at 6, 24, and 48 hours after surgery.
• Hospital stay (days): Duration from surgery to discharge.
• Postoperative complications: Including hematoma, wound infection, seroma formation, chronic pain, and recurrence, assessed at 1 week, 1 month, and 3 months postoperatively.

Statistical Analysis

Data were analyzed using SPSS software (version 25.0). Continuous variables were expressed as mean ± standard deviation and compared using the independent t-test. Categorical variables were analyzed using the chi-square test. A p-value of <0.05 was considered statistically significant.

A total of 100 patients were included in the study, with 50 patients undergoing laparoscopic inguinal hernia repair (Group A) and 50 patients undergoing open inguinal hernia repair (Group B). The results were analyzed based on operative time, postoperative pain, hospital stay, and complications.

Operative Time

The mean operative time was significantly longer in the laparoscopic group (65 ± 10 minutes) compared to the open repair group (50 ± 8 minutes, p<0.05) (Table 1).

Table 1: Comparison of Operative Time

Postoperative Pain

Pain was assessed using the Visual Analog Scale (VAS) at 6, 24, and 48 hours postoperatively. At 6 hours, the mean pain score was 5.8 ± 1.2 in Group A and 7.2 ± 1.3 in Group B. At 24 hours, the pain scores were significantly lower in the laparoscopic group (3.2 ± 1.1) compared to the open group (6.5 ± 1.3, p<0.01). By 48 hours, the pain scores in Group A had further decreased to 1.8 ± 0.9, whereas in Group B, they remained higher (4.5 ± 1.2, p<0.05) (Table 2).

Table 2: Postoperative Pain Scores (VAS) at Different Time Intervals

Hospital Stay

Patients who underwent laparoscopic repair had a significantly shorter hospital stay (1.5 ± 0.5 days) compared to those in the open repair group (3.2 ± 0.8 days, p<0.05) (Table 3).

Table 3: Comparison of Hospital Stay

Postoperative Complications

The incidence of complications was higher in the open repair group (15%) compared to the laparoscopic group (5%, p<0.05). Wound infections were observed in 8% of patients in Group B, while only 2% in Group A developed infections. Seroma formation was noted in 3% of laparoscopic cases and 6% of open cases. No cases of recurrence were reported during the follow-up period (Table 4).

Table 4: Postoperative Complications

Summary of Findings

The results indicate that laparoscopic inguinal hernia repair is associated with a longer operative time but results in significantly lower postoperative pain, shorter hospital stays, and fewer complications compared to open repair.

The comparison between laparoscopic and open inguinal hernia repair remains a subject of debate in surgical practice. This study demonstrated that laparoscopic repair offers significant advantages in terms of postoperative pain, hospital stay, and complication rates, despite requiring a longer operative time. These findings align with previous studies that have highlighted the benefits of minimally invasive hernia repair techniques (1,2).

Operative Time

Our study observed that the mean operative time for laparoscopic repair was longer than that for open repair, which is consistent with other reports in the literature (3,4). Laparoscopic procedures require additional time for trocar placement, insufflation, and mesh fixation, which can contribute to longer surgery duration, particularly in the learning phase (5). However, studies suggest that with increased surgical expertise, operative time for laparoscopic repair decreases and may eventually become comparable to open repair (6,7).

Postoperative Pain

A significant reduction in postoperative pain was noted in the laparoscopic group, particularly at 24 and 48 hours post-surgery. This finding corroborates studies that have demonstrated lower pain scores in laparoscopic repair due to reduced tissue trauma and minimal nerve injury (8,9). Open hernia repair involves larger incisions and increased tissue dissection, which can contribute to prolonged postoperative pain (10). The reduced pain associated with laparoscopy facilitates early mobilization, improving overall patient recovery (11).

Hospital Stay

Patients undergoing laparoscopic repair had a significantly shorter hospital stay compared to those undergoing open repair. Similar results have been reported in previous studies, indicating that minimally invasive techniques enable faster recovery and earlier discharge (12,13). Early discharge is also associated with lower healthcare costs and improved patient satisfaction, making laparoscopy a preferred choice in many clinical settings (14).

Postoperative Complications

The incidence of postoperative complications, particularly wound infection and chronic pain, was lower in the laparoscopic group. Open repair techniques have a higher risk of wound-related complications due to larger incisions and prolonged tissue exposure (15). Several studies have reported a lower risk of chronic pain following laparoscopic repair, as the procedure avoids extensive dissection of the inguinal nerves (16,17). Additionally, a meta-analysis found that laparoscopic hernia repair reduces the risk of long-term neuralgia compared to open repair (18). However, the risk of seroma formation and hematoma in laparoscopic repair remains a concern, as previously documented (19).

Recurrence Rates

Our study reported no recurrences in either group during the follow-up period. While some studies suggest comparable recurrence rates between laparoscopic and open repair, others indicate that laparoscopy may have a higher recurrence risk if mesh fixation is inadequate (20,21). Proper patient selection, surgical expertise, and adherence to standardized techniques can help mitigate the risk of recurrence (22).

Limitations

Despite its strengths, this study has certain limitations. The sample size was relatively small, and the follow-up period was limited to three months, which may not capture long-term recurrence or chronic pain outcomes. Additionally, the study did not evaluate cost-effectiveness, which is an essential factor when considering the choice of surgical technique.

This study supports the advantages of laparoscopic inguinal hernia repair over open repair, particularly in terms of reduced postoperative pain, shorter hospital stay, and lower complication rates. However, longer operative times and the requirement for specialized training remain challenges. Future studies with larger sample sizes and extended follow-up periods are needed to further validate these findings.

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