A randomized prospective controlled trial of laparoscopic extraperitoneal hernia repair and mesh-plug hernioplasty: a study of 315 cases

Inguinal hernias can be repaired by traditional methods, tension-free, mesh-plug hernioplasty, and the less conventional laparoscopic techniques that have the added advantage of quicker recovery. Between September 1994 and September 1997, a prospective randomized controlled trial was performed on 292 patients with a total of 315 hernias. Of these, 150 patients with 169 hernias underwent the extraperitoneal laparoscopic repair (TEP) and 142 patients with 146 hernias were treated with mesh-plug hernioplasty. Patients were examined at 1 week after surgery and every 4 months thereafter for 3 years. Operative results, postoperative recovery, complications, and recurrences were recorded. Follow-up was complete for 89% of the patients. The average operative time was 31.5 minutes for the TEP and 30.5 minutes for the mesh-plug hernioplasty. The average operative time for the last 75 laparoscopic cases was 20 minutes, 10 minutes shorter than the open-surgery group. The overall recurrence rate was (2.5%) for the TEP and (3%) for the mesh-plug hernioplasty. Patients undergoing the laparoscopic repair consumed less narcotic analgesic and returned to their normal activity 1 week sooner than the open-surgery group. A median of 8 days vs. 15 days was required for patients to return to work, respectively, in the TEP and open-surgery group (p<0.01). Intraoperative complications occurred in two patients (1.3%) in the TEP repair. Both had peritoneal tear that mandated conversion to the TAPP repair. There were no major postoperative complications. A total of 20 (13%) minor postoperative complications occurred in the TEP. Thirty-three (23%) minor complications occurred in the open-surgery group (p<0.01). Ninety-eight percent of the patients were discharged the same day in the open-surgery group compared to 100% in the laparoscopy group. Patients with inguinal hernias who undergo extraperitoneal laparoscopic repair have the same recurrences and hospital stay but recover more rapidly, consume less analgesic, and have fewer minor complications than those who undergo the mesh-plug hernioplasty.