A Comparative Study of Clinical Outcomes between Open Inguinal Hernia Repair and Laparoscopic Totally Extraperitoneal (TEP) Repair

Abstract

BACKGROUND: Open Lichtenstein tension-free mesh repair and laparoscopic totally extraperitoneal repair (TEP) are commonly used for inguinal hernia repair.

OBJECTIVES: To compare postoperative pain, recovery, complications, recurrence, and follow-up outcomes between open Lichtenstein repair and laparoscopic TEP repair.

METHODS: A randomized controlled trial was conducted among 140 adults at Phrae Hospital undergoing elective inguinal hernia repair. Participants were assigned to one of two groups, comprising open Lichtenstein repair (Open group, n=70) and laparoscopic TEP repair (TEP group, n=70). Pain was assessed using a visual analog scale at 2, 6, and 24 hours and on postoperative day 2. Pain trajectories were analyzed using two-way repeated-measures analysis of variance with Greenhouse–Geisser correction. Other outcomes were compared using chi-square, Fisher’s exact, or Mann–Whitney U tests.

RESULTS: Baseline characteristics were comparable between groups. Pain changed significantly over time (F=247.91, p<0.001, partial η²=0.64), with significant time-by-group interaction (F=477.56, p<0.001, partial η²=0.78). The TEP group had higher pain at 2 hours but lower pain from 6 hours through postoperative day 2. Compared with the Open group, the TEP group had a lower cumulative rescue morphine dose within 24 hours (p=0.005), earlier ambulation (p<0.001), and shorter recovery time (p<0.001). Length of hospital stay did not differ between groups (p=0.99). Postoperative complications were less frequent in the TEP group than in the Open group (1.4% vs 20.0%, p<0.001), particularly wound dehiscence (0% vs 11.4%, p=0.006). Chronic pain, recurrence, and follow-up duration were comparable.

CONCLUSION: Laparoscopic TEP repair was associated with faster postoperative recovery, lower rescue morphine use, and fewer postoperative complications than open Lichtenstein repair.