Outcome and cost comparison of laparoscopic transabdominal preperitoneal hernia repair versus open lichtenstein technique

Objectives: To compare the outcome and cost of laparoscopic inguinal hernia repair versus open repair. Methodology: This was a randomized controlled study conducted on 100 patients from January 2011 tillApril 2012, in Surgical ‘A’ unit, Lady Reading Hospital, Peshawar. A total of 100 patients were randomizedand were allocated into two groups i.e. open repair (Lichenstein procedure) & laparoscopic repair (Transabdominalpre-peritoneal mesh repair, TAPP) group using lottery method. Type of hernia, type of proceduredone, total cost of surgery, duration of hospital stay, post operative pain rating by visual analogue scoreand post operative complications were assessed. Results: Significant difference was observed between the two groups in relation to the perioperative complications. Mean operative time was short in open repair 55.40±10.73 minutes compared to TAPP 87.10±11.60minutes but the mean length of hospital stay was less in TAPP (2.78±0.64 days) compared to open (3.5±0.67 days). Regarding postoperative complication urinary retention was 22% and 10%, wound discharge was 20% and 08%, recurrence was observed in 12% and 06% in open repair and TAPP respectively. The difference wasstatistically insignificant. Laparoscopic repair showed significantly less post operative surgical pain comparedto open repair. Conclusion: This trial showed no statistical difference between the open and laparoscopic proceduresregarding post operative complications but laparoscopic repair showed statistically lower post surgicaloperative pain and hospital stay with greater operative time and cost. This study supports the use of thelaparoscopic repair techniques for the treatment of inguinal hernia.

[1]  J. Burke,et al.  A Meta-Analysis of Surgical Morbidity and Recurrence After Laparoscopic and Open Repair of Primary Unilateral Inguinal Hernia , 2012, Annals of surgery.

[2]  H. Kulaçoğlu,et al.  Current options in inguinal hernia repair in adult patients. , 2011, Hippokratia.

[3]  Vimal K. Narula,et al.  A comparison of outcomes between open and laparoscopic surgical repair of recurrent inguinal hernias , 2011, Surgical Endoscopy.

[4]  A. Karthikesalingam,et al.  Meta‐analysis of randomized controlled trials comparing laparoscopic with open mesh repair of recurrent inguinal hernia , 2009, The British journal of surgery.

[5]  M. Śmietański,et al.  European Hernia Society guidelines on the treatment of inguinal hernia in adult patients , 2009, Hernia.

[6]  Zahid Aman,et al.  Pattern of breast cancer: experience at Lady Reading Hospital, Peshawar. , 2008, Journal of Ayub Medical College, Abbottabad : JAMC.

[7]  T. Schmid,et al.  Recurrence and complications after laparoscopic versus open inguinal hernia repair: results of a prospective randomized multicenter trial , 2008, Hernia.

[8]  C. Leijonmarck,et al.  Discomfort five years after laparoscopic and Shouldice inguinal hernia repair: a randomised trial with 867 patients. A report from the SMIL study group , 2007, Hernia.

[9]  C. Leijonmarck,et al.  Recurrent inguinal hernia: randomized multicenter trial comparing laparoscopic and Lichtenstein repair , 2007, Surgical Endoscopy.

[10]  A. Klingler,et al.  Postoperative pain and quality of life after laparoscopic and open inguinal hernia repair: results of a prospective randomized trial , 2006, Hernia.

[11]  S. Shamim,et al.  Trends in the management of inguinal hernia in Karachi, Pakistan: a survey of practice patterns. , 2006, Singapore medical journal.

[12]  D. Rattner,et al.  Laparoscopic hernia in the light of the Veterans Affairs Cooperative Study 456: more rigorous studies are needed , 2005, Surgical Endoscopy And Other Interventional Techniques.

[13]  E. Jaurrieta,et al.  Recurrent inguinal hernia: a ten-year review. , 2004, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[14]  H. Pokorny,et al.  Open mesh versus laparoscopic mesh repair of inguinal hernia , 2004, European Surgery.

[15]  E. Ersoy,et al.  Outcome and cost comparison of laparoscopic transabdominal preperitoneal hernia repair versus Open Lichtenstein technique. , 2004, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[16]  K. Abrams,et al.  Meta‐analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair , 2003, The British journal of surgery.

[17]  G. Champault,et al.  Management of recurrent inguinal hernias: A prospective study of 163 cases , 2003, Hernia.

[18]  N. Scott,et al.  Laparoscopic techniques versus open techniques for inguinal hernia repair. , 2003, The Cochrane database of systematic reviews.

[19]  Papachristou Ea,et al.  Surgical outcome and hospital cost analyses of laparoscopic and open tension-free hernia repair. , 2002 .

[20]  S. Morales-Conde,et al.  The impact of the surgeon's experience on the results oflaparoscopic hernia repair , 2001, Surgical Endoscopy.

[21]  C. Dirksen,et al.  Open or laparoscopic preperitoneal mesh repair for recurrent inguinal hernia? , 1999, Surgical Endoscopy.

[22]  R. Ger.  The management of certain abdominal herniae by intra-abdominal closure of the neck of the sac. Preliminary communication. , 1982, Annals of the Royal College of Surgeons of England.

[23]  L. Jørgensen,et al.  Erratum to: Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients , 2014, Hernia.

[24]  Ke Gong,et al.  Comparison of the open tension-free mesh-plug, transabdominal preperitoneal (TAPP), and totally extraperitoneal (TEP) laparoscopic techniques for primary unilateral inguinal hernia repair: a prospective randomized controlled trial , 2010, Surgical Endoscopy.

[25]  M. Abbas.  OUTCOME OF STRANGULATED INGUINAL HERNIA , 2005 .

[26]  N. Finokaliotis,et al.  Surgical outcome and hospital cost analyses of laparoscopic and open tension-free hernia repair , 2002, Hernia.