A comparison of laparoscopic and open hernia repair as a day surgical procedure

Abstract

To evaluate the merits of laparoscopic inguinal hernia repair (LHR) compared to conventional open hernia repair (OHR) a randomized study has been conducted. All patients were day surgical cases, of which 44 were randomized to a standardized OHR under local anesthetic (LA) and 42 to an LHR under general anesthesia (GA). Fifteen LHR patients had bilateral repairs. Operative time for OHR was 30.5 min, for unilateral LHR 35 min, and for bilateral LHR 60 min. OHR patients were discharged after a median of 134.5 min, which was significantly shorter than LHR patients, whose median discharge was 225 min (P < 0.01). Pain scores, activity levels, analgesia requirements, and time taken to return to work were not significantly different following surgery in either group (P < 0.05). There have been two recurrent hernias and one small bowel obstruction in the LHR group. We conclude that both repairs can be successfully performed as day surgical procedures. The added cost of LHR at this stage does not warrant its widespread use in unilateral hernia repairs. Which procedure is adopted should be individualized; however, patients with bilateral hernias on presentation can be successfully managed as day cases, obviating the need for hospitalization or two operations.

A comparative study between laparoscopic inguinal hernia repair and open inguinal hernia repair

“…The earlier return to activity was due to less pain in the postoperative period and less chances of cord edema in the postoperative period. [23][24][25] These findings were comparable to other studies in the literature mainly by Lal. 5 The incidence of wound infection though slightly higher after OH, was not found to be statistically significant.…”

Pain after laparoscopy

“…Furthermore, it is well established that interleukin-6 (IL-6) released during abdominal surgery is a sensitive marker of tissue damage induced by mechanical or thermal injury [4,8,11,14,40]. The injury provoked by insufflation of dry gas might be one reason why there are no overall significantly different trauma response levels between open and laparoscopic surgery [3,11,14,15,18,20,22,41].…”

“…For many, but not all, of these procedures, laparoscopic surgery has displayed advantages over open surgery including lower morbidity and mortality, smaller incisions, reduced length of hospital stay, faster recovery, and earlier return to normal activities and work [3,4,5,16,20,28,36].…”

Minimally Invasive Surgery for Inguinal Hernia

“…Maddern et al in Australia compared TAPP with an open Prolene darn technique [15]. The TAPP was performed with general anesthesia, whereas the open repair was done under local anesthesia.…”