Prospective non-randomized comparison of open versus laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair under different anesthetic methods.

Symeonidis, Dimitrios; Baloyiannis, Ioannis; Koukoulis, George; Pratsas, Konstantinos; Georgopoulou, Stavroula; Efthymiou, Mattheos; Tzovaras, George

PURPOSE To compare prospectively open vs. laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair performed under different anesthetic methods. METHODS A total of 175 patients scheduled for unilateral inguinal hernia repair were assigned to one of the following groups: (i) open repair under local anesthesia, (ii) open repair under regional anesthesia, (iii) open repair under general anesthesia, and (iv) TAPP under regional anesthesia. Immediate postoperative pain was the main outcome measured. Short- and long-term complications and the degree of patient satisfaction were also assessed. RESULTS Transabdominal preperitoneal repair under regional anesthesia yielded the lowest pain scores, whereas open repair under general anesthesia yielded the highest pain scores (P < 0.05). Open repair under local or general anesthesia had a lower urinary retention incidence than the spinal groups (P < 0.05). Chronic pain incidence was lower for the TAPP group (P 0.003). There were no differences in other short- and long-term complications. CONCLUSION Transabdominal preperitoneal repair under spinal anesthesia proved superior to open repair performed under different types of anesthesia in terms of immediate (24-h) postoperative pain. The method of anesthesia might have contributed more to this favorable outcome than the surgical technique itself, but at the cost of a high urinary retention incidence. The incidence of chronic pain was lower after TAPP repair.