Open preperitoneal mesh repair versus laparoscopic transabdominal preperitoneal repair of groin hernia under spinal anesthesia: results of a prospective randomized multicenter trial

Background
It is difficult to decide on which is the best surgical procedure for groin hernia repair. Several studies have compared laparoscopic groin herniorrhaphy with open Lichtenstein repair. The Lichtenstein procedure is premuscular but laparoscopic repair is preperitoneal. This prospective study compared open preperitoneal modified Kugel procedure with transabdominal preperitoneal (TAPP) laparoscopic repair under spinal anesthesia.
Patients and methods
A total of 200 patients scheduled for unilateral inguinal hernia repair were randomly divided into two groups to undergo either laparoscopic TAPP (group A) or open modified Kugel procedure (group B) under spinal anesthesia in our hospitals (three hospitals) between September 2010 and September 2012. Recurrence was the outcome measure in our comparison, and short-term and long-term complications were also assessed.
Results
There was no significant difference between the two groups in terms of their demographic data. Operative time was significantly shorter in the TAPP group than in the open group (37.8 ΁ 18.4 vs. 64.1 ΁ 20.1 min; < 0.001). There was significant difference between the two groups in terms of postoperative pain, hospital stay, and recovery with return to work ( < 0.001), but no significant difference in terms of intraoperative complications ( = 0.54), short-term postoperative complications ( = 0.72), wound infection ( = 1.0), and urine retention ( = 0.62). During the follow-up period of 32 months (range = 22-50 months), there were no cases of mortality and no significant difference in terms of recurrence ( = 1.0). Chronic pain and dysesthesia were significantly higher in the open group ( = 0.03 and 0.02, respectively).
Conclusion
Both open and laparoscopic preperitoneal groin hernia repair under spinal anesthesia are effective and safe with low recurrence rates. The laparoscopic approach is better in terms of operative time, return to normal activity, and chronic pain.