Laparoscopic Repair Shows Lower Pain and Surgical Complications Than Open Hernia Surgery: Indian Study Finds

While open Lichtenstein tension-free mesh repair historically remains the standard approach for groin hernias, minimal access methods like transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) repairs offer faster recovery, yet large-scale comparative evidence in Indian settings remains scarce due to economic barriers. Addressing this gap, Dr. Tarun Mittal and colleagues from the Department of Laparoscopic, Laser, and General Surgery at Sir Ganga Ram Hospital, New Delhi, India, conducted a multicentric study to compare clinical outcomes between open and laparoscopic inguinal hernia repairs.

Therefore, the multicentric prospective study by the Indian Association of Gastrointestinal Endoscopy Surgeons (IAGES) tracked 2,679 adult patients receiving open (1,592) or laparoscopic (1,087) hernia repair across India over 3 months. Investigators evaluated key 30- and 90-day clinical endpoints, including pain levels, major medical complications, surgical site infections, chronic groin pain, and hernia recurrence.

Key Clinical Findings of the Study Includes:

• Enhanced Early Analgesia: Researchers recorded significantly lower day-one median Visual Analogue Scale (VAS) pain scores in laparoscopic repair compared with open repair (2 vs. 3, P<0.0001), with lower non-steroidal anti-inflammatory drugs (NSAIDs) utilization (30.27% vs. 48.62%, P<0.0001).
• Reduced Medical Morbidity: Investigators documented fewer major medical complications following laparoscopic repair compared to open procedures (0.55% vs. 2.70%, P<0.0001), with open repair accounting for all three post-operative mortalities (0.19% vs. 0%, P=0.276).
• Wound Infection Control: Researchers noted significantly lower 30-day surgical site infection rates with laparoscopic surgery than open repair (0.65% vs. 3.15%, P<0.0001), preventing deep-space mesh explantations required in open cases (0% vs. 1.55%, P<0.0001).
• Attenuated Long-Term Pain: The study observed less 90-day chronic groin pain among laparoscopic patients compared to open repair patients (3.99% vs. 6.43%, P=0.008), with zero laparoscopic patients suffering severe chronic pain compared to 8.25% in open cases.
• Equivalent Recurrence: The study demonstrated comparable 90-day hernia recurrence rates between laparoscopic and open cohorts (0.20% vs. 0.13%, P=0.654), confirming equal short-term anatomical durability.

The results suggest that laparoscopic inguinal hernia repair offers distinct clinical advantages over open repair, achieving superior postoperative safety with lower major medical complications (0.55% vs. 2.70%) and reduced 90-day chronic groin pain (3.99% vs. 6.43%). Furthermore, minimally invasive repair maintains equivalent short-term anatomical efficacy with low 90-day recurrence rates (0.20% vs. 0.13%), affirming its clinical role in suitable patient populations.

Thus, the study concludes clinicians may consider prioritizing laparoscopic repair selectively for patients presenting with bilateral hernias, higher Body Mass Index (BMI), or underlying metabolic comorbidities, while establishing standardized perioperative protocols across surgical centers.

Although the study's non-randomized design and 90-day follow-up duration present potential selection biases and lack long-term recurrence data, future prospective randomized trials evaluating multi-year outcomes and cost-effectiveness will help further refine clinical decision-making.

Reference

Mittal T, Dey A, Ahuja A, Agarwalla R, Priya P; IAGES Inguinal Hernia Collaborative Group. Current practices and outcomes in inguinal hernia management: A multi-centric prospective analysis of 2679 cases comparing open and laparoscopic repair in the Indian patients. Journal of Minimal Access Surgery. 2026.