Clinical Comparison of Laparoscopic and Open Mesh Repair for Bilateral Primary Inguinal Hernias: Insights from a Three-Armed Randomized Controlled Trial

Abstract

Background: The most effective strategy for simultaneously addressing bilateral inguinal hernias is a topic of ongoing debate. This study aims to assess and compare the results of laparoscopic and open mesh repair for bilateral primary inguinal hernias [1]–[3].Methods: In this prospective study, a total of 150 patients with bilateral primary inguinal hernias were enrolled. They were randomly assigned to one of three groups, each consisting of 50 patients. Group I underwent laparoscopic trans-abdominal pre-peritoneal (TAPP) repair with the use of two separate meshes. Group II underwent open pre-peritoneal (PP) repair with a single mesh, while Group III received bilateral Lichtenstein repair. This randomization was performed through sealed envelopes. RESULTS: When compared to open PP and bilateral Lichtenstein repair, Laparoscopic TAPP repair exhibited distinct advantages in this study. It was associated with a notably longer operative time but superior early postoperative results, including significantly reduced postoperative pain, shorter hospital stays, quicker return to normal activities and work [4]. Patients in the Laparoscopic TAPP group also reported lower rates of chronic groin pain and mesh sensation, along with significantly higher satisfaction rates compared to those in the open repair groups. However, there was no significant difference observed in the three-year recurrence rate among the study groups. Conclusion: Performing simultaneous laparoscopic TAPP repair for uncomplicated primary bilateral inguinal hernias offers distinct advantages in terms of early postoperative outcomes, reduced chronic pain, and greater patient satisfaction compared to open surgical approaches. Furthermore, it achieves these benefits while maintaining a similarly low recurrence rate.