ORIGINAL ARTICLE
Open Access

Laparoscopic Versus Open Mesh Repair for Inguinal Hernia: A Randomized Controlled Trial

Nigar Aliyeva1, Rauf A. Hasanov ORCID 2

1Department of General and Laparoscopic Surgery, Azerbaijan Medical University Teaching Hospital, Baku, Republic of Azerbaijan.

DOI: https://doi.org/10.18081/ajbm/2025.3/197Crossmark logo

 Received 28 April 2025, Revised 22 May 2025, Accepted 19 June 2025, Available online 25 July 2025
© 2025 El-Mansouri, et al. This is an open-access article under a Creative Commons license (CC BY 4.0).
CC BY 4.0

ABSTRACT

Background

Inguinal hernia repair remains one of the most common surgical procedures worldwide. While open mesh repair (Lichtenstein technique) is well established, laparoscopic approaches—Transabdominal Preperitoneal (TAPP) and Totally Extraperitoneal (TEP)—are gaining popularity for their minimally invasive advantages. This study aimed to compare postoperative outcomes, complications, and recurrence between laparoscopic and open mesh repair in adult Azerbaijani patients.

Methods

A prospective, randomized controlled trial was conducted at the Azerbaijan Medical University Teaching Hospital between January 2022 and December 2024. A total of 100 patients with primary unilateral inguinal hernia were randomized equally into two groups:
Group A: Laparoscopic mesh repair (TAPP or TEP)
Group B: Open mesh repair (Lichtenstein)
Primary outcomes included postoperative pain (VAS 0–10), hospital stay, and return to work. Secondary outcomes were complication rates, operative time, and recurrence at 12 months. Statistical analysis employed Student’s t-test, Chi-square test, and Kaplan–Meier survival analysis, with P < 0.05 considered significant.

Results

Baseline demographic variables were comparable between groups.
• Operative time: Laparoscopic 65.4 ± 14.2 min vs. Open 52.1 ± 11.8 min (P < 0.001)
• Mean postoperative pain (VAS 24h): 3.1 ± 1.0 vs. 5.5 ± 1.2 (P < 0.001)
• Hospital stays: 1.8 ± 0.7 days vs. 3.9 ± 1.2 days (P < 0.001)
• Return to work: 7.2 ± 2.5 days vs. 13.6 ± 3.4 days (P < 0.001)
The overall complication rate was 8% in laparoscopic vs. 22% in open repair (P = 0.041), with wound infection significantly lower in the laparoscopic group (2% vs. 10%). Recurrence at 12 months was 2% vs. 4% (P = 0.55). Recurrence-free survival: Laparoscopic 98%, Open 96% (Log-rank P = 0.47).

Conclusion

Laparoscopic inguinal hernia repair provides superior short-term outcomes—notably less pain, shorter hospital stays, and earlier return to work—without compromising long-term recurrence or safety. With appropriate training and institutional support, laparoscopic hernioplasty should be adopted as the preferred technique for primary and bilateral inguinal hernias in Azerbaijan and comparable healthcare systems.

Keywords: Inguinal hernia; Laparoscopic repair; TAPP; TEP; Lichtenstein repair; Randomized controlled trial

Cite this article

Aliyeva N, Hasanov R. Laparoscopic Versus Open Mesh Repair for Inguinal Hernia: A Randomized Controlled Trial. Advanced Journal of Biomedicine & Medicine. 2025;13(3):197-213. doi:10.18081/ajbm/2025.3/197

References

  1. Lichtenstein IL, Shulman AG, Amid PK, Montllor MM. The tension-free hernioplasty. Am J Surg. 1989;157(2):188-193. doi:10.1016/0002-9610(89)90526-6
  2. Arregui ME, Davis CJ, Yucel O, Nagan RF. Laparoscopic mesh repair of inguinal hernia using a preperitoneal approach: a preliminary report. Surg Laparosc Endosc. 1992;2(1):53-58. PMID: 1341468
  3. EU Hernia Trialists Collaboration. Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials. Ann Surg. 2002;235(3):322-332. doi:10.1097/00000658-200203000-00003
  4. Schmedt CG, Sauerland S, Bittner R. Comparison of endoscopic procedures vs Lichtenstein and other open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Ann Surg. 2005;242(6):879-888. doi:10.1097/01.sla.0000189542.09388.23
  5. McCormack K, Scott NW, Go PM, Ross SJ, Grant AM; EU Hernia Trialists Collaboration. Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev. 2003;(1):CD001785. doi:10.1002/14651858.CD001785
  6. Bittner R, Schwarz J. Inguinal hernia repair: current surgical techniques. Langenbecks Arch Surg. 2012;397(2):271-282. doi:10.1007/s00423-011-0875-7
  7. Neumayer L, Giobbie-Hurder A, Jonasson O, et al; Veterans Affairs Cooperative Hernia Study Group. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med. 2004;350(18):1819-1827. doi:10.1056/NEJMoa040093
  8. Bittner R, Montgomery MA, Arregui E, et al. Update of guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia. Surg Endosc. 2015;29(2):289-321. doi:10.1007/s00464-014-3917-8
  9. Eklund A, Montgomery A, Bergkvist L, Rudberg C. Chronic pain 5 years after randomized comparison of laparoscopic and Lichtenstein inguinal hernia repair. Br J Surg. 2010;97(4):600-608. doi:10.1002/bjs.6938
  10. McCormack K, Wake BL, Fraser C, Vale L, Perez J, Grant A. Transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) laparoscopic hernia repair: systematic review and meta-analysis. Surg Endosc. 2005;19(5):656-665. doi:10.1007/s00464-004-2222-3
  11. Aiolfi A, Cavalli M, Micheletto G, et al. TEP versus TAPP for inguinal hernia repair: a systematic review and meta-analysis. Surg Endosc. 2021;35(10):5092-5103. doi:10.1007/s00464-020-08028-3
  12. Sajid MS, Chan D, Cheek E, Baig MK. Comparison of open and laparoscopic repair of primary unilateral inguinal hernia: a meta-analysis of randomized controlled trials. 2009;13(2):137-149. doi:10.1007/s10029-008-0430-0
  13. Bansal VK, Misra MC, Babu D, et al. A prospective, randomized comparison of laparoscopic transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) inguinal hernia repair. Surg Endosc. 2012;26(3):639-649. doi:10.1007/s00464-011-1913-1
  14. Chowbey PK, Khullar R, Sharma A, et al. Laparoscopic inguinal hernia repair: transabdominal preperitoneal (TAPP) approach—a series of 1,000 patients. J Laparoendosc Adv Surg Tech A. 2003;13(5):323-327. doi:10.1089/109264203769681661
  15. Eklund A, Rudberg C, Smedberg S, et al. Short-term results of a randomized clinical trial comparing laparoscopic and open tension-free inguinal hernia repair. Br J Surg. 2006;93(9):1060-1068. doi:10.1002/bjs.5431
  16. Bittner R, Schmedt CG, Schwarz J, et al. Laparoscopic transabdominal preperitoneal repair of inguinal hernia in clinical practice: results of 12,678 operations. Surg Endosc. 2003;17(7):1067-1073. doi:10.1007/s00464-002-9175-7
  17. Wake BL, McCormack K, Fraser C, Vale L, Perez J, Grant A. Laparoscopic surgery for inguinal hernia repair: systematic review of effectiveness and economic evaluation. Health Technol Assess. 2005;9(14):1-203. doi:10.3310/hta9140
  18. Simons MP, Aufenacker T, Bay-Nielsen M, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. 2009;13(4):343-403. doi:10.1007/s10029-009-0529-7
  19. Zogala D, Malec A, Kowalski A, et al. Comparison of laparoscopic and open inguinal hernia repair in Poland: a multicenter analysis. Pol Przegl Chir. 2021;93(1):12-18. doi:10.5604/01.3001.0014.7349
  20. Yuksel O, Aydin C, Kayaalp C. Comparison of laparoscopic and open inguinal hernia repair: experience from Turkey. Turk J Surg. 2020;36(3):281-288. doi:10.5578/turkjsurg.4670
  21. Dvalishvili T, Berikashvili S, Kapanadze T. Laparoscopic inguinal hernia repair: Georgian experience in a tertiary hospital. Georgian Med News. 2021;(321):32-38. PMID: 34372918
  22. Popa F, Dragomir C, Beuran M. Comparative outcomes of laparoscopic versus open inguinal hernia repair in Romania. Chirurgia (Bucur). 2019;114(5):621-628. doi:10.21614/chirurgia.114.5.621
  23. Bansal VK, Misra MC, Kumar S, et al. Long-term outcomes of laparoscopic versus open repair of recurrent inguinal hernia: a randomized controlled trial. Surg Endosc. 2013;27(3):787-792. doi:10.1007/s00464-012-2510-1
  24. Hallén M, Sandblom G, Nordin P, Gunnarsson U. Patient-reported outcome 1 year after open or laparoscopic inguinal hernia repair: randomized multicentre trial. Br J Surg. 2008;95(10):1225-1231. doi:10.1002/bjs.6284
  25. Sharma A, Khullar R, Soni V, et al. Laparoscopic inguinal hernia repair: TAPP versus TEP—a randomized controlled trial. Surg Endosc. 2011;25(8):2285-2292. doi:10.1007/s00464-010-1545-5
  26. Rosen MJ. Laparoscopic versus open hernia repair: a systematic review. J Am Coll Surg. 2013;216(5):813-822. doi:10.1016/j.jamcollsurg.2012.12.046
  27. Bansal VK, Krishna A, Rajan K, et al. Laparoscopic versus open inguinal hernia repair: cost analysis from a developing country perspective. Surg Endosc. 2018;32(9):3876-3883. doi:10.1007/s00464-018-6112-2
  28. Köckerling F, Simons MP. Current concepts of inguinal hernia repair in adult patients. 2014;30(5):342-348. doi:10.1159/000366558
  29. Bay-Nielsen M, Kehlet H, Strand L, et al. Quality assessment of 26,304 herniorrhaphies in Denmark: a prospective nationwide study. 2001;358(9288):1124-1128. doi:10.1016/S0140-6736(01)06251-1
  30. HerniaSurge Group. International guidelines for groin hernia management. 2018;22(1):1-165. doi:10.1007/s10029-017-1668-x
  31. Hasanov RA, Aliyeva N, Ismayilov R, Huseynov K, Rzayeva L. Laparoscopic versus open mesh repair for inguinal hernia: a randomized controlled trial from Azerbaijan. Asian J Surg. 2025;48(2):215-225. doi:10.1016/j.asjsur.2025.01.007

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Nigar Aliyeva, Rauf A. Hasanov (2025). Laparoscopic Versus Open Mesh Repair for Inguinal Hernia: A Randomized Controlled Trial. American Journal of Biomedicine, 13(3), 197-213. https://doi.org/ 10. 10.18081/ajbm/2025.3/197
Nigar Aliyeva, Rauf A. Hasanov. "Laparoscopic Versus Open Mesh Repair for Inguinal Hernia: A Randomized Controlled Trial." American Journal of Biomedicine, vol. 13, no. 3, 2025, pp. 197-213. DOI: 10. 10.18081/ajbm/2025.3/197.
Nigar Aliyeva, Rauf A. Hasanov. Laparoscopic Versus Open Mesh Repair for Inguinal Hernia: A Randomized Controlled Trial. Am J Biomed. 2025;13(3):197-213. DOI: 10. 10.18081/ajbm/2025.3/197. PMID: .
Nigar Aliyeva, Rauf A. Hasanov 2025, "Laparoscopic Versus Open Mesh Repair for Inguinal Hernia: A Randomized Controlled Trial", American Journal of Biomedicine, vol. 13, no. 3, pp. 197-213.
@article{nigar2025, title={Laparoscopic Versus Open Mesh Repair for Inguinal Hernia: A Randomized Controlled Trial}, author={Nigar Aliyeva, Rauf A. Hasanov}, journal={American Journal of Biomedicine}, volume={13}, number={3}, pages={197-213}, year={2025}, doi={ 10. 10.18081/ajbm/2025.3/197} }
TY - JOUR AU - Nigar Aliyeva, Rauf A. Hasanov TI - Laparoscopic Versus Open Mesh Repair for Inguinal Hernia: A Randomized Controlled Trial JO - American Journal of Biomedicine VL - 13 IS - 3 SP - 197-213 PY - 2025 DO - 10. 10.18081/ajbm/2025.3/197 ER -
%0 Journal Article %A Nigar Aliyeva, Rauf A. Hasanov %T Laparoscopic Versus Open Mesh Repair for Inguinal Hernia: A Randomized Controlled Trial %J American Journal of Biomedicine %V 13 %N 3 %P 197-213 %D 2025 %R 10. 10.18081/ajbm/2025.3/197 %M
Nigar Aliyeva, Rauf A. Hasanov (2025). Laparoscopic Versus Open Mesh Repair for Inguinal Hernia: A Randomized Controlled Trial. American Journal of Biomedicine, 13(3), 197-213. https://doi.org/ 10. 10.18081/ajbm/2025.3/197

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