Laparoscopic or Open Inguinal Herniorrhaphy?

Abstract

OBJECTIVE: To determine whether transabdominal preperitoneal laparoscopic hernia repair can equal or surpass an established open method at an acceptable cost. DESIGN: A randomized, prospective comparison with a follow-up of 7 to 18 months (median, 10 months; planned, 5 years). SETTING: Health maintenance organization hospital. PATIENTS: One hundred patients between 20 and 70 years of age were randomized. No patient withdrew from the study after randomization. INTERVENTIONS: Transabdominal preperitoneal laparoscopic and open tension-free repairs using a polypropylene mesh. MAIN OUTCOME MEASURES: Operative and discharge times, costs, recovery, and morbidity. "Return to work" was supplemented by a performance assessment using a panel of exercises. RESULTS: Operative and hospitalization times were not significantly different between the two types of repair. Patients with laparoscopic unilateral repairs returned to work faster (9 vs 17 days). At 1 week postoperatively, performance of straight-leg raises correlated well with time to return to work for patients with strenuous jobs. The laparoscopic repair was more expensive than the open approach ($3093 vs $2494). CONCLUSIONS: Laparoscopic transabdominal preperitoneal hernia repair can be accomplished with operative and hospitalization times and a short-term recurrence rate similar to those of an established open technique. Perioperative exercise testing may be an important adjunct to return to work in the comparison of methods.