Assessment of Surgical and Quality-of-Life Outcomes Between Laparoscopic Versus Open Inguinal Hernia Repair in Geriatric Patients

Abstract

Introduction:

Inguinal hernia repair is a common surgery, especially in the elderly population. However, the decision to perform surgery in elderly patients can be challenging due to higher complication rates. Laparoscopic inguinal hernia surgery is less commonly used in the elderly population despite its advantages. In this study, we aimed to investigate the safety and advantages of laparoscopic inguinal hernia surgery in elderly patients.

Methods:

We retrospectively compared the preoperative and postoperative (PO) data and Short Form-36 (SF-36) forms of elderly patients who underwent laparoscopic transabdominal preperitoneal and open inguinal hernia surgery. The primary outcomes were PO pain scores and complication rates.

Results:

A total of 79 patients with an age range between 65 and 86 years, who presented with inguinal hernias to Cekirge State Hospital's General Surgery Department between January 2017 and November 2019, were included. Seventy-nine patients underwent laparoscopic transabdominal preperitoneal technique and Lichtenstein hernia repair. The laparoscopic group had a lower rate of PO complications and less analgesic medication consumption and usage time compared with the open group. Furthermore, compared with the open group, the laparoscopic group had lower PO pain scores and higher SF-36 scores for physical function, physical role, pain, and general health at the 30th and 90th days after surgery.

Conclusion:

Our study suggests that laparoscopic inguinal hernia surgery can be safely performed in elderly patients with lower complication rates and faster recovery times compared with open surgery. The advantages of laparoscopic surgery, such as lower PO pain scores and faster recovery times, were also observed in elderly patients.

Introduction

Inguinal hernia repair is one of the most frequently performed elective general surgeries in the World. As the world population ages, the number of elderly patients who need inguinal hernia surgery is also increasing. The prevalence of inguinal hernia in the elderly is higher than that in the young because connective tissue disorders and the progressive weakening of collagen tissue of the abdominal wall with age appear to play a major role.¹

It is still difficult for surgeons to decide on surgery in elderly patients as the complication rates are higher. The presence of symptoms such as inguinal pain, complaints such as obstruction, incarceration, strangulation, and patient desire are the most important indications for inguinal hernia surgery. However, there is no definitive guideline for the operation in elderly patients. Despite the risk of strangulation and incarceration, surgery is frequently delayed in elderly patients due to higher intraoperative risks compared with normal population.² Elderly patients who present with minimal symptoms that do not affect their daily activities are advised to postpone surgical intervention to avoid possible complications.³

Currently, the most commonly used techniques for inguinal hernia repair are open approach and laparoscopic approach. Even if surgery is decided, laparoscopic hernia surgery is less practiced in the elderly population due to the long learning curve, long operation time, and complications that may occur due to laparoscopic surgery. Despite this, it has been shown in the general population that there is less postoperative (PO) pain and faster recovery time in laparoscopic surgery.⁴

Although laparoscopic surgery has shown advantages in the normal population, studies on inguinal hernia surgery in elderly patients are limited. The aim of this study is to investigate the safe applicability of laparoscopic inguinal hernia surgery by comparing the preoperative and PO data and Short Form-36 (SF-36) forms of elderly patients who underwent laparoscopic and open inguinal hernia surgery.

In this study, our primary aim was to investigate whether inguinal hernia surgery can be performed safely in elderly patients compared with the normal population and especially if laparoscopic hernia surgery can be performed safely.

Materials and Methods

The study and the related procedures were conducted in compliance with guidelines approved by the Ethics Committee at the Harran University Hospital. The local Ethics Committee approved this study with the registration number of (HRU/20.12.14).

In this retrospective cohort study, 79 patients with an age range between 65 and 86 years, who presented with inguinal hernias to Cekirge State Hospital's General Surgery Department between January 2017 and November 2019, were included. Seventy-nine patients who underwent transabdominal preperitoneal technique (TAPP) and Lichtenstein hernia (LH) repair. In Group 1, TAPP was performed, and in Group 2, LH was performed. Patients were identified by the demographic features such as, age, gender, body mass index (BMI), and preoperative findings such as hernia type, localization of hernia, depending on whether it is primary or recurrent, defect size, operating time, hospital stay, previous abdominal surgery history, classification of the American Society of Anesthesiologists (ASA), smoking history, alcohol usage, comorbidities, onset of hernia, and Nyhus hernia classification. PO outcomes, such as seroma, hematoma, wound infection, chronic groin pain, pain visual analog scale (VAS), recurrences captured in the follow-up clinic and self-reported by the patients were collected in the database.

All patients were assessed using the preoperative VAS for pain, and PO pain was evaluated using the VAS at the 6th, 12th, and 24th hour and 10th day after surgery. For PO pain management, all patients received intramuscular diclofenac sodium at 8-hour intervals for 24 hours after surgery. Patients were advised to take 500 mg of oral paracetamol as needed and to keep a record of the analgesics consumed.

Moreover, patients were asked to complete validated health-related quality-of-life questionnaires, which included the SF-36. The SF-36 form consisted of 11 sections and 36 questions, and the validated form used was in the native language of the patients.

The SF-36 forms completed by the patients before surgery, as well as at the 30th, 90th, and 180th month and 1st year PO follow-up visits, were analyzed.

Furthermore, patients were asked to rate their satisfaction after surgery using a question with three response options. This question was administered 1 week after the operation, and patients were asked to choose from the following response options: “I am very satisfied,” “satisfied,” or “dissatisfied.”

Inclusion criteria

Patients 65 years of age and above who underwent elective surgery for inguinal hernia and, had follow-up evaluations on the 10th day, 30th day, 90th day, 180th day and 1st year, and who did not have missing data on the VAS and SF-36 questionnaires, and had an ASA score of 1, 2, or 3, were included in the study.

Exclusion criteria

Patients who were under the age of 65, had an ASA grade of 4 or higher, did not complete their follow-up, had missing VAS scores or SF-36 forms, and underwent emergency surgery for inguinal hernia were excluded from the study.

Surgical techniques

All operations and PO follow-ups were performed by the same surgeon who had performed >100 TAPP and LH repairs before. All TAPP procedures were performed with general anesthesia, and no urinary catheter drainage was used. The first 10–12 mm trocar was placed in the peritoneal space through an umbilical incision. Pneumoperitoneum was created with CO₂ to a pressure of 10–12 mmHg. A polypropylene mesh with size 15 × 10 cm was placed in the preperitoneal plane and tacking device was used the fix the mesh. Mesh was fixed with a total of 2 tackers, 1 to the Cooper's ligament and 1 to the lateral edge of the mesh. The peritoneum was then closed with 3/0 Vicryl sutures.

All of the LH were performed under spinal anesthesia. An oblique incision was performed to access and polypropylene mesh with size 10 × 8 cm. The cord was inserted between tails of the mesh and then the mesh was fixed with 3/0 polypropylene to the inguinal ligament, conjoined tendon, and pubic tubercle.

The decision to perform the procedure with a TAPP approach versus a LH approach was at the discretion of the surgeon and the anesthesiologists. A single dose of first-generation cephalosporin was given 30 minutes before induction of anesthesia to all the patients.

Results

A total of 79 operations consisting of 45 TAPP and 34 LH repairs were evaluated. There were no differences in the age, sex, BMI, hernia type, defect size, whether the defect is primary or recurrent, hospital stay, ASA class, previous abdominal surgery history (previous hernia, laparotomy, cholecystectomy, appendectomy), alcohol usage, diabetes, chronic obstructive pulmonary disease and onset of hernia (P > .05). The localization side of the hernia (right, left, and bilateral), the type of anesthesia method applied (general or epidural), and smoking showed statistical differences between the two groups (P < .05).

When PO complications were analyzed, seroma formation and urinary retention were statistically less frequent in Group 1 compared with Group 2 (P < .05). However, there was no significant difference in terms of hematoma, wound infection, chronic groin pain, and recurrence (P > .05) (Table 1). There was also no significant difference in the duration of the operation and the length of hospital stay (P > .05) (Table 2). None of the operations in the Group 1 had to be converted to open hernia repair.

Table 1.

Preoperative Patient Demographic Data of Both Groups

	Group 1 (n = 45), n (%)	Group 2 (n = 34), n (%)	P
Age (years)			.413
Mean ± SD	72.37 ± 5.83	71.29 ± 5.74
Range	(65–86)	(65–86)
Gender
Male	40 (88.9)	31 (91.2)	.523
Female	5 (11.1)	3 (8.8)
BMI (kg/m²)			.891
Mean ± SD	26.26 ± 2.82	26.35 ± 2.92
Range	(20.7–32.3)	(21.2–31.2)
Localization side of hernia
Right	21 (46.7)	23 (67.6)	.02
Left	16 (35.6)	11 (32.4)
Bilateral	8 (17.8)	0
Type of hernia
Direct	29 (64.4)	18 (52.9)	.588
Indirect	13 (28.9)	13 (38.2)
Both	3 (6.7)	3 (8.8)
Primary			.321
Recurrence	2 (4.4)	0
Defect size (mm)			.682
Mean ± SD	29.91 ± 10.45	30.94 ± 11.70
Range	(10–65)	(15–66)
Anesthesia type			.001
General spinal	45 (100)	34 (100)
Previous abdominal surgery, n (8%)
Previous hernia	10 (22.2)	4 (11.8)	.652
Laparotomy	3 (6.7)	2 (5.9)
Cholecystectomy	1 (2.2)	0 (0)
Appendectomy	3 (6.7)	3 (8.8)
No surgery	28 (62.2)	25 (73.5)
ASA class			.149
Mean ± SD	2.29 ± 0.62	2.06 ± 0.77
Range	(1–3)	(1–3)
Smoking	34 (75.6)	12 (35.3)	.001
Alcohol usage	2 (4.4)	5 (14.7)	.118
Cardiac comorbidities	34 (75.6)	24 (70.6)	.404
COPD	2 (4.4)	3 (8.8)	.368
Diabetes	20 (44.4)	16 (47.1)	.498
Onset of hernia (days)			.503
Mean ± SD	90.62 ± 94.59	106.18 ± 110.36
Range	(3–450)	(7–450)
Hernia type
Nyhus type 1	2 (4.4)	4 (11.8)
Nyhus type 2	10 (22.2)	9 (26.5)	.489
Nyhus type 3A	28 (62.2)	18 (52.9)
Nyhus type 3B	3 (6.7)	3 (8.8)
Nyhus type 4	2 (4.4)	0 (0)

ASA, American Society of Anesthesiologists; BMI, body mass index; COPD, chronic obstructive pulmonary disease; SD, standard deviation.

Table 2.

Postoperative Complications, Mean Operative Time, and Mean Hospital Stay in Both Groups

	Group 1 (n = 45), n (%)	Group 2 (n = 34), n (%)	P
Complications
Seroma	5 (11.1)	15 (44.1)	.001
Hematoma	1 (2.2)	1 (2.9)	.679
Wound infection	0	1 (2.9)	.430
Chronic groin pain	1 (2.2)	0	.570
Recurrence	0	1 (2.9)	.430
Urinary retention	2 (4.4)	10 (29.4)	.003
Operation room time (minutes)			.398
Mean ± SD	49.37 ± 10.52	47.11 ± 13.12
Range	(30–75)	(25–85)
Hospital stay (days)			.115
Mean ± SD	1.04 ± 0.20	1.14 ± 0.35
Range	(1–2)	(1–2)

SD, standard deviation.

Patient satisfaction

The proportion of patients who were very satisfied, satisfied, and dissatisfied in the TAPP and Lichtenstein group was similar (P > .05) (Table 3).

Table 3.

Comparison of Satisfaction, Pain Scores, Duration, and Analgesic Drug Consumption between Two Groups

	Group 1 (n = 45), n (%)	Group 2 (n = 34), n (%)	P
Satisfaction status			.094
Very satisfied	14 (31.1)	6 (17.6)
Satisfied	29 (64.4)	22 (64.7)
Dissatisfied	2 (4.4)	6 (17.6)
Pain scores, mean ± SD, range
Preoperative	2.64 ± 0.88 (1–4)	2.55 ± 1.15 (1–5)	.710
Postoperative 6th hour	4.02 ± 0.89 (3–6)	3.14 ± 1.01 (1–5)	<.001
Postoperative 12th hour	2.0.8 ± 0.84 (1–4)	3.76 ± 1.37 (2–7)	<.001
Postoperative 10th day	1.26 ± 0.65 (0–4)	1.97 ± 0.64 (0–4)	<.001
Duration of analgesic drug use after discharge (days)
Mean ± SD, range	2.91 ± 1.14 (1–6)	4.70 ± 1.56 (2–9)	<.001
Consumption of analgesics after discharge (no of tablets)
Mean ± SD, range	10.08 ± 3.72 (4–20)	15.35 ± 6.97 (4–32)	<.001

SD, standard deviation.

PO pain

Pain scores in the Group 1 were higher than the scores in Group 2 at 6th hour PO. However, pain scores in the Group 1 were lower than the scores in the Group 2 at 12th hour and 10 days PO. There was significantly more consumption of analgesics after discharge (10.08 ± 3.72 tablets of paracetamol in Group 1 versus 15.35 ± 6.97 tablets of paracetamol in Group 2) (P < .001) and longer duration of analgesic drug use after discharge (4.70 ± 1.56 days versus 2.91 ± 1.14 days) in the Group 2 compared with the Group 1 (P < .001) (Table 3).

Quality of life

The quality of life was assessed using SF-36 scores. For the Physical Function (PF) domain, there were no significant differences between preoperative, PO 180th day, and PO 1-year scores (P = .322, 0.994, 0.567, respectively). However, for the PO 30th and 90th day scores, Group 1 had statistically higher PF values (93.11 ± 9.72 and 96.33 ± 5.97) than Group 2 (85.58 ± 13.63 and 90.44 ± 17.42), with P values of 0.005 and 0.038, respectively (Table 4).

Table 4.

Summary of Results of Short Form-36 Scales in Both Groups

	Group 1 (n = 45), mean ± SD, range	Group 2 (n = 34), mean ± SD, range	P
Preoperative SF-36 scales
Physical function	62.66 ± 10.79 (40–100)	65.29 ± 12.60 (40–100)	.322
Physical role	51.11 ± 18.42 (25–75)	55.14 ± 16.02 (25–75)	.312
Emotional role	68.09 ± 22.44 (33–100)	65.63 ± 26.59 (0–100)	.657
Vitality	56.77 ± 13.36 (30–85)	61.91 ± 13.76 (30–85)	.099
Mental health	69.51 ± 8.54 (56–88)	71.58 ± 9.28 (56–92)	.306
Social function	56.94 ± 13.73 (25–75)	61.02 ± 16.50 (25–87.5)	.322
Pain	65.16 ± 12.30 (32.5–100)	66.10 ± 14.44 (32.5–100)	.757
General health	61.85 ± 13.40 (40–100)	59.23 ± 16.78 (20–100)	.442
Postoperative 30th day SF-36 scales
Physical function	93.11 ± 9.72 (50–100)	85.58 ± 13.63 (45–100)	.005
Physical role	96.11 ± 9.16 (75–100)	83.08 ± 21.07 (25–100)	<.001
Emotional role	96.28 ± 12.78 (33.3–100)	95.09 ± 14.53 (33.3–100)	.70
Vitality	79.22 ± 8.91 (55–100)	75 ± 17.92 (20–100)	.174
Mental health	76.53 ± 11 (48–100)	73.41 ± 11.93 (48–100)	.232
Social function	91.94 ± 11.35 (50–100)	91.54 ± 15.06 (37.5–100)	.895
Pain	93.71 ± 6 (77.5–100)	86.83 ± 11.82 (55–100)	.001
General health	84.77 ± 9.82 (70–100)	78.38 ± 13.74 (45–100)	.018
Postoperative 90th day SF-36 scales
Physical function	96.33 ± 5.97 (85–100)	90.44 ± 17.42 (40–100)	.038
Physical role	97.22 ± 7.94 (75–100)	86.76 ± 16.55 (50–100)	<.001
Emotional role	98.51 ± 6.98 (66.5–100)	98.03 ± 7.97 (66.6–100)	.779
Vitality	82 ± 7.78 (55–100)	78.08 ± 13.14 (40–100)	.103
Mental health	76.53 ± 11 (48–100)	74.47 ± 10.92 (48–100)	.411
Social function	93.61 ± 9.08 (75–100)	90.44 ± 14.12 (50–100)	.229
Pain	95.66 ± 5.15 (87.5–100)	89.63 ± 9.08 (67.5–100)	<.001
General health	88.88 ± 10.35 (64.8–100)	83.07 ± 11.03 (60–100)	.019
Postoperative 180th day SF-36 scales
Physical function	96.33 ± 5.78 (85–100)	96.32 ± 5.68 (85–100)	.994
Physical role	91.11 ± 13.22 (50–100)	94.11 ± 10.76 (75–100)	.283
Emotional role	100 (100)	99.01 ± 5.72 (66.6–100)	.253
Vitality	82.33 ± 7.87 (55–100)	81.91 ± 8.79 (65–100)	.823
Mental health	76.71 ± 11.06 (48–100)	76.70 ± 10.71 (48–100)	.998
Social function	94.16 ± 8.67 (75–100)	93.01 ± 8.80 (75–100)	.563
Pain	93.27 ± 5.10 (87.5–100)	94.19 ± 6.84 (77.5–100)	.499
General health	88.88 ± 10.35 (64.8–100)	86.31 ± 9 (64.8–100)	.253
Postoperative 1 year SF-36 scales
Physical function	96.33 ± 5.78 (85–100)	97.05 ± 5.23 (85–100)	.567
Physical role	91.11 ± 13.22 (50–100)	94.11 ± 10.76 (75–100)	.283
Emotional role	99.25 ± 4.97 (66.6–100)	100 (100)	.388
Vitality	82.77 ± 8.29 (55–100)	82.05 ± 8.88 (55–100)	.712
Mental health	76.71 ± 11.06 (48–100)	76.82 ± 10.82 (48–100)	.964
Social function	96.38 ± 6.31 (75–100)	93.75 ± 8.83 (75–100)	.126
Pain	93.27 ± 5.10 (87.5–100)	94.19 ± 6.84 (77.5–100)	.499
General health	88.88 ± 10.35 (64.8–100)	86.83 ± 11.82 (55–100)	.253

SD, standard deviation; SF-36, Short Form-36.

In terms of the Physical Role (PR) domain, there were no significant differences between preoperative, PO 180th day, and PO 1-year scores (P = .312, 0.283, 0.283, respectively). However, for the PO 30th and 90th day scores, Group 1 had statistically higher PR values (96.11 ± 9.16 and 97.22 ± 7.94) than Group 2 (83.08 ± 21.07 and 86.76 ± 16.55), with P values <.001 for both (Table 4).

For the Emotional Role domain, there were no significant differences between preoperative, PO 30th day, PO 90th day, PO 180th day, and PO 1-year scores (P = .657, 0.70, 0.779, 0.253, 0.388, respectively) (Table 4).

For the Vitality (VT) domain, there were no significant differences between preoperative, PO 30th day, PO 90th day, PO 180th day, and PO 1-year scores (P = .099, 0.174, 0.103, 0.823, 0.712, respectively) (Table 4).

In terms of the Mental Health (MH) domain, there were no significant differences between preoperative, PO 30th day, PO 90th day, PO 180th day, and PO 1-year scores (P = .306, 0.232, 0.411, 0.998, 0.964, respectively) (Table 4).

For the Social Function domain, there were no significant differences between preoperative, PO 30th day, PO 90th day, PO 180th day, and PO 1-year scores (P = .322, 0.895, 0.229, 0.563, 0.126, respectively) (Table 4).

For the Pain (P) domain, there were no significant differences between preoperative, PO 180th day, and PO 1-year scores (P = .757, 0.499, 0.499, respectively). However, for the PO 30th and 90th day scores, Group 1 had statistically higher P values (93.71 ± 6 and 95.66 ± 5.15) than Group 2 (86.33 ± 11.82 and 89.63 ± 9.08), with P values of 0.001 and <0.001, respectively (Table 4).

Finally, for the General Health (GH) domain, there were no significant differences between preoperative, PO 180th day, and PO 1-year scores (P = .442, .253, .253, respectively). However, for the PO 30th and 90th day scores, Group 1 had statistically higher values (Table 4).

Discussion

Our study is the only publication known in the literature that compares laparoscopic TAPP and open inguinal hernia surgery with SF-36 forms in elderly patients preoperatively, on the 30th day, 90th day, 180th day, and 1st year. The results of our study have shown that laparoscopic hernia repair has advantages over open hernia repair in terms of less PO pain, faster recovery, and cosmetic benefits in elderly patients, and can be safely performed. In our study, no mortality was observed and low morbidity rates were found after inguinal hernia surgery in elderly patients, indicating that inguinal hernia surgery is safe for this patient population. However, laparoscopic inguinal hernia surgery is not preferred by some surgeons for elderly patients due to lack of experience, long learning curve, surgery under general anesthesia, and comorbidities. In addition, open inguinal hernia surgery is included in surgical training programs and is more commonly performed by surgeons during their training than laparoscopic surgery.

Other studies have also reported that inguinal hernia surgery is safe for elderly patients and has similar morbidity and mortality rates to younger patients.^2,5,6 In a study conducted by Zhu et al.,⁶ both laparoscopic and open procedures were found to be safe and feasible for inguinal hernia in patients over 80 years of age, but it was emphasized that determining the appropriate surgical plan depends not only on the patient's specific conditions but also on the surgeon's experience. This is because laparoscopic procedures have their advantages and disadvantages, and open procedures have their advantages and disadvantages, and the decision of which one to use depends on many factors, such as the patient's condition and the surgeon's experience.⁷ Furthermore, early return to daily life, shorter hospital stay, less wound infection, and smaller cosmetic scars are well-known advantages of laparoscopic surgery.^8,9

Dallas et al.⁴ compared the outcomes of Totally Extraperitoneal (TEP) and open inguinal hernia surgery in patients 80 years of age and above and found that the laparoscopic surgery group had a shorter operative time and hospital stay compared with the open surgery group. Additionally, the laparoscopic surgery group reported less pain and better cosmetic outcomes. However, there was no significant difference observed in complication rates between the two groups.⁴ Similarly, two separate studies have also shown shorter hospital stays in elderly patients treated with laparoscopic methods compared with open methods. Furthermore, it was found that patients treated with laparoscopic methods had less PO pain, less analgesic use, fewer complications, and fewer recurrences.^10,11

In our study, no significant difference was found in hospital stay between the laparoscopic and open surgical groups, which may be due to all surgeries being performed by a single surgeon and the same timing of ward visits. Additionally, there was no significant difference in recurrence rates between the laparoscopic and open surgical groups. However, PO seroma formation was more frequently observed in the open surgical group. Consistent with our findings, in a systematic review comparing techniques to reduce seroma formation after inguinal hernia surgery, Li et al. concluded that only 1 out of 36 patients developed a seroma after closure of the defect with barb sutures, and that defect closure reduced seroma formation.¹² In our study, we also observed a lower incidence of PO seroma formation in the laparoscopic surgery group, possibly due to closure of defects larger than 3 cm with sutures and the less invasive nature of laparoscopic surgery compared with open surgery. This study demonstrates that laparoscopic hernia repair is associated with lower PO pain scores compared with open hernia repair.

In a study comparing the effectiveness of spinal anesthesia versus general anesthesia during inguinal hernia repair in adults, PO pain was in favor of spinal anesthesia at 4 and 12 hours for both open and laparoscopic repairs. However, the spinal anesthesia group was found to have an increased risk of PO urinary retention and headache.¹³ In our study, all patients who underwent open surgical operations were given spinal anesthesia, so their pain scores were lower in the first 6 hours. However, these patients had more urinary retention, and a Foley catheter had to be inserted. Therefore, pain scores may have been higher in the open surgery group than in the laparoscopic group at 12 hours. In the PO period and after discharge, less analgesic medication use was observed in the laparoscopic group. Consistent with previous studies, laparoscopic hernia repair was reported to be associated with less PO pain, lower analgesic requirements, and faster recovery compared with open hernia repair.^10,11

This study highlights that SF-36 is frequently used to assess the effects of hernia repair on pain and quality of life. However, the tools used to evaluate pain and quality of life after hernia repair still require standardization. Therefore, future studies using more standardized tools for more appropriate measurements will help to more accurately evaluate pain and quality of life.^14–16 According to Abbas et al.'s study evaluating PO quality of life in a normal population who underwent laparoscopic and open hernia surgery, the quality of life in the laparoscopic group was significantly higher, particularly in the PF, PR, body pain, GH, and total physical health scales. This may reflect the lesser impact of body pain after laparoscopic surgery. However, it should be noted that in this study, the SF-36 form was not filled out preoperatively and was only filled out at PO month 1, which may limit its thorough examination.¹⁷ De Jonge et al. acknowledges the need for more standardization in the assessment of quality of life but believe that laparoscopic transabdominal (TAPP) repair offers significant advantages in terms of quality of life compared with open Lichtenstein repair.¹⁸

McCormack et al. present evidence that both TAPP and TEP repairs resulted in much better quality-of-life outcomes compared with open Lichtenstein repair.¹⁹ In contrast, Pokorny et al. believed that TAPP had less short-term PO pain, but did not find significant differences in quality of life between TAPP and other open techniques.²⁰ Our study showed that both laparoscopic and open hernia repair had similar preoperative quality-of-life scores, but laparoscopic repair had better quality-of-life scores in terms of PF, body pain, limitation due to physical problems, and GH perception at 30th day and 90th day PO. In conclusion, our study found that both laparoscopic and open hernia repair had similar preoperative quality-of-life scores, but laparoscopic repair had better quality-of-life scores in terms of PF, body pain, limitation in physical activities, and overall health perception at PO 30th day and 90th day. However, there were no significant differences in VT, social function, emotional and MH scales, and total MH. Overall, the TAPP group had better outcomes, and the technique's widespread use suggests that it should be preferred.

However, this study is limited by its single-center design and lack of long-term follow-up. Further studies with larger sample sizes and longer follow-up periods are necessary to confirm these findings.

Footnotes

Authors' Contributions

S.C.E. and O.C. contributed to the design of the study, data collection and analysis, interpretation of the results, and writing of the article. All authors have read and approved the final version of the article.

Disclosure Statement

The authors declare that they have no conflicts of interest.

Funding Information

This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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