An Analytical Study of Comparison Between Laparoscopic Hernioplasty and Lichtenstein's Tension-Free Hernioplasty

Background: Inguinal hernia repair is one of the most commonly performed surgical procedures worldwide. The optimal surgical technique remains debated, with both open Lichtenstein and laparoscopic Transabdominal Preperitoneal (TAPP) approaches offering distinct advantages.

Objectives: To compare the outcomes of TAPP hernioplasty versus Lichtenstein's open hernioplasty in terms of operative time, postoperative pain, complications, hospital stay, return to daily activities, recurrence, and patient satisfaction.

Methods: This prospective interventional study was conducted over two years (May 2023 to May 2025) at Government General Hospital, Kakinada, Andhra Pradesh. A total of 50 patients with inguinal hernia requiring surgical intervention were randomly allocated into two groups: Group 1 (n=25) underwent TAPP hernioplasty, and Group 2 (n=25) underwent Lichtenstein open hernioplasty. Both groups were compared regarding demographic profile, comorbidities, intraoperative and postoperative complications, pain scores, hospital stay, return to daily activities, recurrence, and patient satisfaction. Statistical analysis was performed using SPSS version 20, with p<0.05 considered significant.

Results: The mean age was higher in the TAPP group (50.8±2.5 years) compared to the Lichtenstein group (42.9±2.20 years) (p<0.05). Male predominance was observed in both groups (80% overall). Mean operative time was significantly longer in the TAPP group (80.75±16.3 minutes) versus Lichtenstein group (50.9±16.0 minutes) (p=0.001). Intraoperative complications were comparable between groups (p>0.05). Postoperative complications were significantly higher in the Lichtenstein group (32% vs. 4%, p<0.05), with seroma being the most common complication. Postoperative pain was significantly lower in the TAPP group, with 92% reporting mild pain compared to 72% in the Lichtenstein group (p<0.05). Hospital stay was shorter in the TAPP group (4.73±1.17 days vs. 7.15±1.98 days, p<0.05), and return to daily activities was faster (7.80±1.89 days vs. 15.25±2.51 days, p<0.05). Recurrence was observed only in the Lichtenstein group (16%) (p<0.05). Patient satisfaction was higher in the TAPP group (96% good satisfaction) compared to Lichtenstein group (88%), though not statistically significant (p>0.05).

Conclusion: While Lichtenstein repair offers shorter operative time, laparoscopic TAPP hernioplasty provides superior outcomes in terms of reduced postoperative pain, fewer complications, shorter hospital stay, faster recovery, and lower recurrence rates. TAPP is particularly advantageous in older patients and complex hernia cases. The choice of technique should be individualized based on patient characteristics and surgical expertise