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. (Arch Surg. 1994;129:973-981)