What are for the benefits of laparoscopic inguinal hernia repair over open repair?

Updated: Apr 16, 2020
  • Author: Danny A Sherwinter, MD; Chief Editor: Kurt E Roberts, MD  more...
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Answer

Some reports have listed specific indications for laparoscopy over open repair, including recurrent hernias, bilateral hernias, and the need for earlier return to full activities. [24, 25, 26, 13, 27, 28, 29]

Several studies have demonstrated salutary outcomes for laparoscopic repair of recurrent hernias. [25, 30, 31, 24] Re-recurrence rates may decline to 5% or lower with laparoscopic repair, [25, 32, 33] compared with rates as high as 20% for anterior repair. [34]

The reduced pain after laparoscopic inguinal hernia repair as compared with conventional anterior repair makes laparoscopy the approach of choice for bilateral hernias. [35, 36, 37] A particular advantage of TAPP repair in a patient with bilateral inguinal hernias is that both sides can be repaired via the same laparoscopic port sites.

The choice of repair for primary unilateral inguinal hernias is controversial. A large Veterans Affairs cooperative study reported a 10% recurrence rate for laparoscopic inguinal hernia repair, compared with a 5% rate for anterior repair [9] ; however, multiple authors identified flaws with this study. [38, 39] Other studies from experienced hernia surgeons have reported recurrence rates for laparoscopic repair that range from 1% to 3%. [40, 41, 42]

Although the actual hospital costs of laparoscopic repairs are higher than those of open repairs, the increased cost may be offset by the societal benefits of earlier return to full activities. [8, 43]

Patient preference plays perhaps the greatest role in the choice of one type of repair over another; however, surgical expertise plays a key part as well. Data show that the recurrence rate drops significantly as surgeons gain experience with the laparoscopic technique. Some studies suggest that the learning curve for TEP laparoscopic herniorrhaphy may be as high as 250 cases (as opposed to 25 for open repair). [9] TAPP repair has a learning curve closer to that of the open technique. [44]

A Cochrane database meta-analysis comparing TEP with TAPP found no significant difference in recurrence rates but did find that TAPP was associated with a higher risk of intra-abdominal injury. The authors concluded that further randomized controlled trials are needed for definitive comparison of these two techniques. [45]

Conclusions about inguinal hernias in female patients are difficult to draw because most of the literature involves male patients. Koch et al found that recurrence rates were higher in women and that recurrence was 10 times more likely to be femoral in women than in men. [46] This has led some to conclude that approaches that cover the femoral space (eg, laparoscopic repair) at the time of initial operation are better suited for primary repair in women. [47] Further studies will be needed to resolve this question.

The IPOM technique has fallen out of favor because of reports of unacceptably high rates of organ injury, nerve injury, and hernia recurrence. [26]


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