Laparoscopic Versus Open Inguinal Hernia Repair: Recurrence and Chronic Pain

Abstract

ntroduction: Inguinal hernia repair is the most common general surgical procedure. Laparoscopic (TEP/TAPP) and open Lichtenstein techniques are both standard, but optimal choice for chronic pain and recurrence remains debated. Methods: Meta-analysis of 15 RCTs (n=5,804) with ≥2 years follow-up. Outcomes: recurrence (clinical/ultrasound), chronic pain (≥3 months, VAS≥3), operative time, return to work. Results: Recurrence was similar (laparoscopic 3.1% vs open 3.4%, OR 0.91, p=0.52). Chronic pain was lower with laparoscopy (8.2% vs 15.6%, OR 0.48, p<0.001). Return to work was faster (mean difference -4.2 days). Laparoscopy had longer operative time (+18 minutes) and higher visceral injury risk (0.3% vs 0.05%). Discussion: Reduced chronic pain with laparoscopy likely due to less mesh fixation trauma. Visceral injury risk remains a concern for inexperienced surgeons. Conclusion: Laparoscopic repair is preferred for bilateral, recurrent, or young active patients to reduce chronic pain. Open repair remains safe for unilateral primary hernias.