[Laparoscopic or conventional repair of inguinal hernia with synthetic mesh?]

Laparoscopic inguinal hernia repair by means of the transabdominal preperitoneal technique (TAPP) was compared with open plug-and-patch-repair (PP) in a prospective study. From September 1992 until July 1994, 86 patients were operated using the TAPP technique; after introduction of PP in August 1994, 105 patients were operated using this technique. From August 1994 until April 1995, 24 more patients wanted the laparoscopic procedure. The two groups were comparable with regard to age, sex and the distribution of hernia types. Eighty-eight (84%) of the PP patients were operated under local anesthesia, while the others chose general anesthesia. The only intraoperative complication was a bleeding from the epigastric vessel in the laparoscopic group. Postoperative complications were three wound hematomas after TAPP (2.2%) and two wound hematomas and one superficial wound infection after PP (2.4%). All complications healed spontaneously. No detectable statistical difference was noted between the two groups with respect to postoperative pain, the consumption of analgetics, duration of hospitalization and reconvalescence. After a median follow-up of 34 months, two recurrences after TAPP (1.4%) and no recurrences after PP has been detected. Based on our experience we prefer PP for inguinal hernia repair in adults because it affords the same patient comfort as TAPP but is less expensive and can be performed under local anesthesia.