Comparison between open and laparoscopic techniques in inguinal hernia repair regarding chronic postoperative pain and recurrence

Abstract

Chronic postoperative pain and hernia recurrence remain among the main complications associated with inguinal hernia repair, even after the introduction of prosthetic meshes and laparoscopic techniques. This study aimed to compare open and laparoscopic techniques in inguinal hernia repair regarding the incidence of chronic postoperative pain and hernia recurrence, as well as the main technical and biological factors related to these outcomes. This is a narrative literature review conducted through searches in the PubMed, Virtual Health Library (VHL), and SciELO databases using the descriptors “Inguinal Hernia”, “Hernioplasty”, “Lichtenstein”, “TAPP”, “TEP”, “Chronic Postoperative Pain”, and “Recurrence”. Original studies, systematic reviews, meta-analyses, randomized clinical trials, and international guidelines published in Portuguese, English, and Spanish were included. Chronic postoperative pain was mainly associated with neural injury, nerve entrapment, peri-prosthetic fibrosis, and inflammatory response related to surgical mesh implantation. Laparoscopic TAPP and TEP techniques demonstrated lower incidence of chronic inguinal pain when compared with the open Lichtenstein repair, especially in bilateral and recurrent hernias. Regarding hernia recurrence, the main associated factors included inadequate coverage of the myopectineal orifice, mesh fixation failure, insufficient preperitoneal dissection, and limited surgical experience. Recurrence rates were similar among techniques when procedures were performed by experienced surgeons with adequate technical standardization. The choice of surgical technique should consider anatomical factors, patient clinical characteristics, surgical team experience, and institutional resource availability.