Prospective Randomized Study Comparing Laparoscopic and Open Tension-free Inguinal Hernia Repair with Shouldice’s Operation

Background: Although tension-free techniques of hernia repair using synthetic meshes revealed encouraging results, the best method of inguinal hernia repair is still unclear. Methods: In a prospective randomized phase-II-B study, early postoperative results of laparoscopic transabdominal preperitoneal repair (n = 80), open plug and patch repair (n = 80), and Shouldice’s operation (n = 80) were compared. Postoperative pain and patient’s comfort were defined as main endpoints. Results: The laparoscopic approach had significantly longer operation time and was more expensive (61 ± 12 minutes; $1,211) than plug and patch repair (36 ± 14 minutes; $124) and Shouldice’s operation (47 ± 17 minutes; $69). Main postoperative complications were wound hematomas, seromas, and superficial wound infection, without significant difference between the groups. Postoperative pain, analgesia requirements, limitation of daily activities, and return to work did not differ between laparoscopic and open tension-free repair but were significantly lower in both groups compared with Shouldice’s operation. So far, no recurrence was observed after a mean follow-up of 25 months. Conclusion: Open plug and patch repair is a promising technique of hernia repair in adults, because it offers the same excellent patient comfort as the laparoscopic repair but is less expensive and can be performed under local anesthesia.