[Open versus laparoscopic treatment in inguinal hernia. Our experience]

The knowledge acquired in recent years in the field of etiopathogenesis of materials for prosthesis and of surgical technics regarding inguinal hernias together with a renewed interest for local-regional anesthesia has created a real revolution in a field that for almost 100 years had been dominated by the same uncontrasted ideas. The fundamental stages in the evolution of surgical technics are reviewed as well as the most recent discoveries in the field of biochemical textiles and prosthesis available today that have contributed to the development of new surgical methods. These, distinguishing between "open" and laparoscopic technics, are compared on the basis of the data found in the literature concerning recurrence, morbidity, period of convalescence and costs. Personal experience concerns the last four years with 632 patients treated, some in emergency conditions and others in programmed operations, using the foremost methods of "open" surgery but preferring, among these, those that are tension free. The follow-up involved 84% of the patients for a period of no less than 18 months. A reduction of complications and of relapses was obtained: 5-9% in traditional operations against 0.5% for those that were tension free. With this type of operation the postoperative hospitalization was considerably reduced so that 35% of them could fit into the "one day surgery" category. On the basis of these results it is stressed that both the laparoscopic technics and the tension free technics offer advantages as compared to so called traditional methods; however, even though the first type seems to assure a shorter postoperative period, there is the inconvenience of higher costs and the necessity of general anesthesia.