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Laparoscopic vs. open inguinal hernia repair in Central Asia: a systematic review of technological readiness and
Yerlan Akkaliyev1, Maksut Kamaliev2, Merkhat Akkaliyev3
1Department of Surgery, Medical Center Hospital of the Presidential Affairs Administration of the Republic of Kazakhstan, Almaty, Kazakhstan.
Background:
Inguinal hernia repair is the most frequently performed general surgical procedure worldwide. While the transition from open to laparoscopic techniques (TAPP/TEP) is a success story in high-income nations, developing healthcare systems in Central Asia face a complex reality where the adoption of technology often outpaces surgical training.
Objectives:
We aimed to systematically review the evidence on hernia repair outcomes, specifically interrogating the trade-off between short-term recurrence and long-term quality of life (chronic pain). Additionally, we sought to evaluate the critical role of surgeon "technological readiness" in settings with limited resources.
Methods:
We conducted a systematic review in strict adherence to PRISMA 2020 guidelines. Searching PubMed, Scopus, and the Cochrane Library (2004-2026), we identified studies comparing laparoscopic vs. open repair and assessing surgical education in Low- and Middle-Income Countries (LMICs). Eligibility was defined via the PICOS framework, focusing on adult patients, recurrence/pain outcomes, and safety profiles in RCTs and observational studies.
Results:
A total of 34 studies were synthesized. The evidence confirms that while laparoscopic repair significantly reduces the risk of chronic pain compared to the Lichtenstein technique, this benefit is strictly contingent upon high surgical volume (>60 procedures per surgeon). Crucially, long-term registry data indicate that 42.5% of recurrences appear more than 10 years post-surgery a timeframe often ignored in short-term safety assessments. In the LMIC context, open repair remains a robust, cost-effective standard where simulation-based training is absent.
Conclusion:
While laparoscopic repair can be safely implemented in LMICs with dedicated training, the direct transposition of international guidelines without local adaptation poses safety risks. We propose a "Safety-First" Value-Based Decision Framework, emphasizing that context-sensitive implementation and institutional readiness must take precedence over technical novelty to ensure patient value.