Abstract

Inguinal hernia repair is one of the most common general surgical procedures worldwide. While open mesh repair has traditionally been standard, laparoscopic approaches such as totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) repair are increasingly used. This review compares laparoscopic and open inguinal hernia repair in adults to summarize current evidence on clinical outcomes.
A systematic search of PubMed/MEDLINE, Web of Science, Cochrane CENTRAL, and Google Scholar was conducted. Randomized controlled trials and comparative observational studies evaluating laparoscopic (TEP/TAPP) versus open mesh repair in adults were included. Outcomes assessed included postoperative pain, operative time, complications, recurrence, and return to normal activity. Risk of bias was evaluated using the Cochrane RoB 2.0 and ROBINS-I tools.
Fourteen studies met the inclusion criteria (6 RCTs, 8 observational). Most studies reported lower postoperative pain with laparoscopic repair. For example, one RCT showed chronic pain rates of 3.4% after TEP versus 22.1% after Lichtenstein repair, and another reported early postoperative VAS scores of 2.9 vs. 3.7, respectively. Return to normal activities was consistently faster with laparoscopy, with several trials showing recovery 3–6 days earlier. Operative time was longer for laparoscopic repair in most studies, often by 20–30 minutes. Recurrence rates were comparable between approaches, generally ranging from 1–4% for both laparoscopic and open repairs. Complication rates varied across studies but showed no consistent advantage for either technique. Risk-of-bias assessment indicated frequent high risk in blinding domains among RCTs and serious confounding in all non-randomized studies.
Laparoscopic repair, particularly TEP, is associated with less postoperative and chronic pain and faster recovery, while recurrence and complication rates are similar to open repair. Given the methodological limitations of available studies, further high-quality comparative research with standardized outcome reporting is needed.

Key words: Inguinal hernia repair, laparoscopic TEP, open Lichtenstein technique, postoperative pain, surgical outcomes.