Prospective trial comparing Lichtenstein with laparoscopic tension-free mesh repair of inguinal hernia

Abstract

A prospective study of 242 patients with inguinal hernia who underwent tension-free mesh repair by the laparoscopic transperitoneal (n = 121) or the open Lichtenstein (n = 121) technique was performed. There was no significant difference in operation time between the laparoscopic (median (range) 35 (20-90) min) and Lichtenstein (40 (20-90) min) procedures. Discharge within 24 h of operation was more common after laparoscopic surgery (89.3 per cent versus 48.7 per cent). Consequently, hospital stay was reduced with this approach (median (range) 1 (1-7) days versus 2 (1-10) days for patients who had a Lichtenstein repair). There was no significant difference in parenteral analgesia requirements or visual analogue pain scores between the two groups. Although use of oral analgesia in hospital was greater in patients who underwent Lichtenstein hernioplasty, this may reflect their longer stay. Rehabilitation to normal activity and return to work was shorter in patients receiving laparoscopic repair (median 7 and 10 days, respectively) than Lichtenstein repair (14 and 21 days) (P < 0.001). Initial results suggest that laparoscopic procedures may be associated with more rapid rehabilitation compared with that of open tension-free mesh surgery. Most patients with inguinal hernia undergoing tension-free mesh repair by either technique would be suitable for day-case surgery.