A comparative study on short term surgical outcome between laparoscopic inguinal hernia mesh repair vs. open inguinal hernia mesh repair for primary unilateral inguinal hernias


  • Kathirazhagan Thulasilingam Department of General Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India
  • Jameel Akhter Department of General Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India




Laparoscopic hernia repair, TAPP, Inguinal hernia mesh repair, Postoperative outcomes, Complications


Background: Current study was performed to compare the short-term surgical outcome of laparoscopic (TAPP) and open inguinal hernia mesh hernioplasty (Lichtenstein) in primary unilateral inguinal hernias such as time taken by patients to return to routine daily activities and return to work.

Methods: This is a prospective, comparative study done in Apollo Main Hospital, Chennai comparing surgical outcomes between laparoscopic and open primary unilateral inguinal hernia mesh repair in a total of 60 patients with 30 patients in each arm.

Results: Return to Job is 8 median days in laparoscopic group and 9 median days in open group which is significant with a p value of 0.000. Pain score at 12th hour is significantly lesser in laparoscopic group with a VAS score of 3 compared to open group with a VAS score of 4 with p value of 0.015. VAS score at POD 1 in laparoscopic group is 2 and in open group is 3 which is significantly lesser in laparoscopic group with a p value of 0.026. Pain score at POD 3 and 4 is significantly lesser in laparoscopic group with a p value of 0.001 and 0.008 respectively. laparoscopic group takes analgesia for a lesser number of days than the open group with a p value of 0.019.

Conclusions: This study concludes laparoscopic repair for primary unilateral inguinal hernias is superior to Lichtenstein tension free mesh hernioplasty in terms of postoperative pain, early return to job and less consumption of postoperative analgesia.


Fitzgibbons RJ, Forse RA. Groin hernias in adults. New Eng J Med. 2015;372(8):756-63.

Hammoud M, Gerken J. Inguinal Hernia. Treasure Island (FL): StatPearls Publishing; 2021.

Udwadia TE. Inguinal hernia repair: The total picture. J Minimal Access Surg. 2006;2(3):144.

Sain AH. Laparoscopic cholecystectomy is the current "gold standard" for the treatment of gallstone disease. Ann Surg. 1996;224(5):689.

Cooper SA. The anatomy and surgical treatment of abdominal hernia. Int J Surg. 2019;6(2):23-9.

Sudarshan PB, Sundaravadanan BS, Kaarthik VP. Laparoscopic versus open mesh repair of unilateral inguinal hernia: a comparative study. Int J Surg. 2017; 4(3):921-5.

Ansari N, Keshava A, Rickard MJ, Richardson GL. Laparoscopic repair of internal hernia following laparoscopic anterior resection. Int J Colorect Dis. 2013;28(12):1739-41.

Hamza Y, Gabr E, Hammadi H, Khalil R. Four-arm randomized trial comparing laparoscopic and open hernia repairs. Int J Surg. 2010;8(1):25-8.

Neumayer L, Giobbie-Hurder A, Jonasson O, Fitzgibbons R, Dunlop D, Gibbs J, et al. Open mesh versus laparoscopic mesh repair of inguinal hernia. New Eng J Med. 2004;350(18):1819-27.

McCormack K, Scott N, Go PM, Ross SJ, Grant A. Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Data System Rev. 2003;1:32.

Tolba M, Khairi A, Nour-Eldin O, Salem M, Awad A. Tension-free mesh inguinal hernia repair; laparoscopic or open?. Ann Bariat Surg. 2013;2(2):10.

Rathod CM, Karvande R, Jena J, Ahire MK. A comparative study between laparoscopic inguinal hernia repair and open inguinal hernia repair. Int Surg J. 2016;3(4):1861-7.

Pedroso LM, De-Melo RM, Da-Silva-Jr NJ. Comparative study of postoperative pain between the lichtenstein and laparoscopy surgical techniques for the treatment of unilateral primary inguinal hernia. Arquivos Brasileiros de Cirurgia Digestiva. 2017;30: 173-6.

Fujita F, Lahmann B, Otsuka K, Lyass S, Hiatt JR, Phillips EH. Quantification of pain and satisfaction following laparoscopic and open hernia repair. Arch Surg. 2004;139(6):596-600.

Colak T, Akca T, Kanik A, Aydin S. Randomized clinical trial comparing laparoscopic totally extraperitoneal approach with open mesh repair in inguinal hernia. Surg Laparos Endos Percut Tech. 2003;13(3):191-5.

Champault G, Rizk N, Catheline JM, Barrat C, Turner R, Boutelier P. Inguinal hernia repair. Hernia. 1997; 1(1):31-6.

Winslow ER, Quasebarth M, Brunt LM. Perioperative outcomes and complications of open vs laparoscopic extraperitoneal inguinal hernia repair in a mature surgical practice. Surg Endos Intervent Tech. 2004; 18(2):221-7.

Wall ML, Cherian TH, Lotz JC. Laparoscopic hernia repair-the best option?. Acta Chirurgica Belgica. 2008; 108(2):186-91.

Schrenk P, Woisetschläger R, Rieger R, Wayand W. Prospective randomized trial comparing postoperative pain and return to physical activity after transabdominal preperitoneal, total preperitoneal or Shouldice technique for inguinal hernia repair. Br J Surg. 1996;83(11):1563-6.

Schwab J, Beaird DA, Ramshaw BJ, Franklin JS, Duncan TD, Wilson RA, et al. After 10 years and 1903 inguinal hernias, what is the outcome for the laparoscopic repair?. Surg Endos Intervent Tech. 2002;16(8):1201-6.

Mwagiru D, Larkin TA. Open vs. laparoscopic inguinal hernia repair: Influences of patient age and bmi on analgesic requirements and hospital stay duration. Arch Surg. 2007;148(4):295-305.

Christou N, Ris F, Naumann D, Robert-Yap J, Mathonnet M, Gillion JF. Risk factors for surgical site infection after groin hernia repair: does the mesh or technique matter?. Hernia. 2022;26(1):233-42.

Blair AB, Dwarakanath A, Mehta A, Liang H, Hui X, Wyman C, Ouanes JP, Nguyen HT. Postoperative urinary retention after inguinal hernia repair: a single institution experience. Hernia. 2017;21(6):895-900.

Roadman D, Helm M, Goldblatt MI, Kastenmeier A, Kindel TL, Gould JC, Higgins RM. Postoperative urinary retention after laparoscopic total extraperitoneal inguinal hernia repair. J Surg Res. 2018;31:309-15.

Beldi G, Haupt N, Ipaktchi R, Wagner M, Candinas D. Postoperative hypoesthesia and pain: qualitative assessment after open and laparoscopic inguinal hernia repair. Surg Endos. 2008;22(1):129-33.

Nilsson E, Nordin P, Kehlet H. Chronic pain after open mesh and sutured repair of indirect inguinal hernia in young males. J Br Surg. 2004;91(10):1372-6.

Vrijland WW, Jeekel J. Prosthetic mesh repair should be used for any defect in the abdominal wall. Curr Med Res Opinion. 2003;19(1):1-3.

MRC Laparoscopic Groin Hernia Trial Group. Laparoscopic versus open repair of groin hernia: a randomised comparison. Lancet. 1999;354(9174):185-90.

EU Hernia Trialists Collaboration. Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials. Ann Surg. 2002;235(3): 322.

Kumar S, Wilson RG, Nixon SJ, Macintyre IM. Chronic pain after laparoscopic and open mesh repair of groin hernia. Br J Surg. 2002;89(11):1476-9.

Afandiyev F, Celasin H, Culcu S. Factors that predict testicular atrophy in patients who underwent inguinal hernia repair. Int Surg J. 2020;7(11):3550-4.

Wantz GE. Testicular atrophy as a risk inguinal hernioplasty. Surg Gynecol Obstetr. 1982;154(4):570-1.

Gainant A. Where does laparoscopy fit in the treatment of inguinal hernia in 2003?. J Chirurgie. 2003;140(3): 171-5.

Akbulut G, Serteser M, Yücel A, Degirmenci B, Yilmaz S, Polat C, et al. Can laparoscopic hernia repair alter function and volume of testis?: Randomized clinical trial. Surg Laparos Endos Percut Tech. 2003; 13(6):377-81.

Tanphiphat C, Tanprayoon T, Sangsubhan C, Chatamra K. Laparoscopic vs. open inguinal hernia repair. Surg Endos. 1998;12(6):846-51.

Yang C, Zhang H, Pu J, Mei H, Zheng L, Tong Q. Laparoscopic vs open herniorrhaphy in the management of pediatric inguinal hernia: a systemic review and meta-analysis. J Pediatr Surg. 2011;46(9): 1824-34.

O’Reilly EA, Burke JP, O’Connell PR. A meta-analysis of surgical morbidity and recurrence after laparoscopic and open repair of primary unilateral inguinal hernia. Ann Surg. 2012;255:846-53.






Original Research Articles