A comparative study between totally extraperitoneal and transabdominal preperitoneal laparoscopic inguinal hernia repair techniques

Background: Groin hernia surgery is one of the most common procedures performed by surgeons worldwide. With the advent of minimal access surgery, the procedure for repair is now done either by transabdominal preperitoneal approach Transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) approach. The advantage of one procedure over the other is still controversial. Objectives: This prospective study was conducted to find out the intraoperative and postoperative outcomes of TEP and TAPP for inguinal hernia repair in terms of operative time, intraoperative complications, conversion to open, visual analog scale (VAS) score, postoperative complications, length of hospital stay, and recurrence of hernia and chronic pain. Materials and Methods: A total of 88 patients of inguinal hernia enrolled prospectively between November 2017 and November 2019 and patients aged 18 years and above admitted in Jawaharlal Nehru Medical College and Hospital were included in this study. Forty-four patients were included in TEP group, while 44 patients were allocated to TAPP group. Results: The statistical analysis was done using Chi-square test and unpaired t-test, respectively. The mean operative time in TEP was 91.14 ± 11.14 min and in TAPP repair was 103.16 ± 6.79 min, which was found to be significantly significant. The mean pain score on VAS score on postoperative day 1 was 5.70 ± 0.95 in laparoscopic TEP group and 5.86 ± 0.97 in laparoscopic TAPP group. The mean pain score on VAS score on postoperative day 2 was 3 ± 1.27 in laparoscopic TEP group and 2.95 ± 1.29 in laparoscopic TAPP group. Similarly, the mean pain score on VAS scale on postoperative day 7 was 0.863 ± 1.26 in laparoscopic TEP group and 0.659 ± 1.21 in laparoscopic TAPP group. No significant difference was observed in VAS between TEP and TAPP groups during follow-up. Both TEP and TAPP mesh techniques were comparable in terms of the intraoperative complications and postoperative complications (seroma [during hospital stay, after 1 week of discharge, after 1 month of follow-up]; hematoma [during hospital stay, after 1 week of discharge]; wound infection) and in conversion to open and length of hospital stay. The difference in mean cost of surgery was found to be statistically significant. Conclusion: Although the mean operative time and cost of surgery were significantly more in TAPP than in TEP group, no significant difference could be found between the intraoperative and postoperative complication rates, conversion to open, and length of hospital stay. Recurrence was observed in one case of TEP groups during follow-up. Our study supports the view that both laparoscopic TEP and TAPP mesh repairs of inguinal hernia are safe and efficacious.

The technical evolution of hernia repair has brought to the introduction of laparoscopy in this field. The most common laparoscopic techniques are transabdominal preperitoneal (TAPP) repair and totally extraperitoneal (TEP) repair. Indirect comparisons between TAPP and TEP have raised questions as to which is the superior approach in improving patient outcomes; however, there is still a scarcity of data directly comparing these laparoscopic approaches. The aim of this report is to offer a retrospective comparison between the two techniques with a long-term follow-up. This study is a retrospective comparative study, comparing TEP and TAPP in the treatment of groin hernias. All patients undergoing laparoscopic hernia repair from 2015 and 2020 at a large UK Hospital Trust with tertiary referral center, were considered as eligible for inclusion. The primary endpoint was rate of successful surgery defined as absence of recurrence and chronic pain at the end of the follow-up. Secondary endpoints were conversion rate (the switch from TEP to TAPP was considered as a conversion for the index procedure), need for admission, readmission rate, serious adverse events (including visceral injuries and vascular injuries), rate of persisting pain at the end of follow-up, operative time and overall complications rate (hematoma, seroma, wound/superficial infection, mesh/deep infection, port site hernia). Of the patients included in the study who underwent laparoscopic repair of inguinal hernia between 2015 and 2020, 140 (55.1%) underwent TEP and 114 (44.9%) had TAPP repair. The mean operative time did not differ between the two groups (P=0.202). The conversion rate was nil. The two procedures did not differ for intraoperative and postoperative complications. The length of hospital stay was significantly longer in the TAPP group (P<0.0001). The overall recurrence rate was 2.4%. and did not differ between the two groups. Costs were acquired from the clinical coding department. Mean costs were measured in pounds sterling and a significant difference was noted between the two groups (P=0.083). In the short term, the most common complication was seroma formation and was significantly more frequent in the TAPP group (P<0.001). In the long term, chronic pain was the most frequent complication in both groups and significant correlated when the operation performed for recurrent hernia, whereas the hernia Type 3 was a factor that which influenced recurrence. In conclusion, TAPP and TEP have similar, overall complication risks, postoperative acute and chronic pain incidence and recurrence rates. Since TAPP and TEP have comparable outcomes it is recommended that the choice of the technique should be based on the surgeon's skills, education, and experience.

Laparoscopic inguinal hernia repair utilizes either a transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) approach. The literature remains mixed on outcomes comparing TAPP versus TEP. The objective of our study was to assess outcomes, healthcare utilization, and cost differences between TAPP and TEP inguinal hernia repair. Adult patients who underwent elective inguinal hernia repair between 2013 and 2021 were retrospectively identified from our institution's electronic health record. Baseline characteristics and postoperative complications were compared using chi-squared test. Multivariable logistic regression was used to model the odds of experiencing a postoperative emergency department visit, readmission, and/or reoperation within 6months were surgery. Generalized linear models were used to investigate differences in cost between TAPP and TEP groups. 1086 patients underwent TAPP repair, while 1277 patients underwent TEP repair. TAPP patients had more than double the rates of readmissions (3.1% vs. 1.3%, p = 0.002) and reoperations (1.5% vs. 0.2%, p = 0.001) within 6months of surgery. On multivariable analysis, undergoing TAPP inguinal hernia repair was associated with higher odds of reoperations and/or readmissions within 6months of surgery (OR 2.8, CI [1.5, 5.1], p = 0.001). TAPP repair had a higher index surgery cost and higher costs associated with reoperations and readmissions compared to TEP repair. Although both approaches are very safe, TAPP inguinal hernia repair had higher rates of postoperative complications, increased healthcare utilization, and higher associated costs. Future studies should be directed toward decreasing postoperative healthcare utilization in order to decrease costs in inguinal hernia repair.

Minimal access approaches to inguinal hernia repair have added to the ongoing debate over the "best groin hernia repair." The present prospective randomized controlled trial was done to compare the totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) techniques of laparoscopic inguinal hernia repair. The present prospective randomized study was conducted between May 2007 and March, 2009 and included 100 patients suffering from uncomplicated primary groin hernia. Patients were randomized into group I (TEP) and group II (TAPP). Intraoperative variables and postoperative pain scores were recorded in a prestructured form. One hundred patients were included in the study (TEP, 53; TAPP, 47). Both groups were comparable in terms of demographic profile and hernia characteristics. The average operative time was higher in the TAPP group (p = 0.209). The pain scores at 1 h and 24 h after surgery and at 3-month follow-up were significantly higher in the TAPP group (p < 0.05). The average follow-up was 30.5 months. In the TEP group, 37.8% of patients had seroma compared to 18.3% in the TAPP group (p = 0.021). However, there was a higher incidence of scrotal edema in the TAPP group (16 vs. 9, p = 0.009). The wound infection rates were equal (2% vs. 3%). There has been no recurrence in either group during the follow-up period of 44 months. Overall, the patients were more satisfied with TEP rather than TAPP (p < 0.05). In the present study, TEP had a significant advantage over TAPP for significantly reduced postoperative pain up to 3 months, which resulted in a better patient satisfaction score. The other intraoperative complications, postoperative complications, and cost were similar in both groups. In terms of results, both repair techniques seemed equally effective, but TEP had an edge over TAPP.

Introduction. Endoscopic procedures for inguinal hernia repair have become widespread. There are many methods of such treatment: transinguinal preperitoneal mesh-plasty (TIPP), TAPP, TEP, MINI (combination of TEP and TAPP). However, the most common among them are TAPP and TEP. Despite the fact that these procedures are now common in many hospitals, the choice of tactics and repair procedures for different types of inguinal hernias is still uncertain. First, it concerns the quality of life of patients.&#x0D; Aim. The aim of this study was to compare TAPP, TEP and Lichtenstein based on quality of life analysis using the EuraHS-QoL scale.&#x0D; Materials and methods. We performed surgical treatment of inguinal hernia in 211 patients. Lichtenstein's procedure was performed in 65 patients (Lichtenstein group), transabdominal preperitoneal (TAPP) inguinal hernia repair in 81 patients (TAPP group) and totally extraperitoneal (TEP) inguinal hernia repair in 65 patients (TEP group). We assessed quality of life using a special scale for hernias (EuraHS-QoL). The missing values were treated according to the instructions of the validation study.&#x0D; Results and discussion. As we expected, inguinal hernia repair improved EuraHS-QoL scores in all groups. In the Lichtenstein group, the total mean decreased from 51.2 to 11.8 (4.3 times) (r=-0.13), in the TAPP group – from 51.1 to 9.9 (5.2 times), in the TEP group – from 51.2 to 12.6 (4.1 times). Cosmetic discomfort was highest at the follow-up visit in patients in the Lichtenstein group (4.2). In the TAPP group, this indicator was probably (p&lt;0.05) the smallest (3.0). Low-traumatic methods of operations in modern surgery are priorities today. The Lichtenstein procedure, despite its simplicity, is a traumatic operation compared to TAPP and TEP.&#x0D; Conclusions. Different options for inguinal hernia repair, which are based on the tension-free principle of inguinal canal correction, can be useful. However, when we analyzed the quality of life according to the EuraHS-QoL scale, we decided that transabdominal preperitoneal (TAPP) inguinal hernia repair is the most optimal in terms of various indicators.

Background and aim: To find the superiority of extended total extraperitoneal (E-TEP) repair and trans-abdominal pre-peritoneal (TAPP) mesh repair in inguinal hernia repair.Material and methods: A total of 30 patients with a unilateral or bilateral inguinal hernia (IH), and recurrent IH, following open repair were studied. Out of 30 patients, laparoscopic TAPP or E-TEP mesh repair was performed in an equal number of inguinal hernia patients. The patient's demographic parameters, duration of surgery, postoperative hospital stay, and complications were compared.Results: In the E-TEP group, 33.33% of patients had left inguinal hernia (LIH), 60% of patients were diagnosed with right inguinal hernia (RIH) and 6.67% of patients had right inguinal and right direct hernia (RDH). In the TAPP group, 33.33% of patients had LIH and 53.33% of patients were suffering from RIH. Moreover, 6.67% of patients were diagnosed with a left inguinal direct hernia, and a similar proportion of patients had a right inguinal direct hernia. The mean duration of surgery was found to be significantly higher in the TAPP group (P<0.0000). The mean postoperative hospital stay was 2.07±0.59 and 2.80±1.32 days in E-TEP and TAPP groups, respectively (P=0.044).Conclusion: In the present study, E-TEP mesh repair is a superior technique in the management of inguinal hernia as compared with TAPP repair.

Background: Transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) mesh repair are two common procedures which are nowadays commonly performed during laparoscopic approaches for inguinal hernias. This randomized prospective study was aimed to compare these two, TAPP and TEP laparoscopic approaches for inguinal hernia repair in terms of various outcomes. Materials and Methods: Patients were randomly picked and 30 (50%) were operated by laparoscopic TAPP hernioplasty and the 30 (50%) by laparoscopic TEP hernioplasty. Results: Both TEP and TAPP mesh repair techniques were comparable in terms of operative time, intraoperative complications, conversion to open, post-operative pain, time to resume normal activity, and recurrence. Duration of hospital stay was significantly more in TAPP group than TEP group. Conclusion: Laparoscopic repair of inguinal hernias is associated comparable results in both techniques TAPP and TEPP and choice between TAPP and TEPP is a personal choice of the concerned surgeon.

Background and Aim: Totally extraperitoneal (TEP) repair and transabdominal preperitoneal (TAPP) repair are the two standardized laparoscopic techniques for inguinal hernia repair. Although several studies were conducted in the past, there are still no certain answers regarding the best laparoscopic approach for inguinal hernia repair. Therefore, our aim was to compare the outcomes of the TAPP versus TEP for inguinal hernia. Materials and Methods: This prospective study was conducted at Dayanand Medical College and Hospital, Ludhiana, from January 1, 2018 to March 31, 2019 and included 54 patients admitted with unilateral or bilateral uncomplicated inguinal hernia. Patients undergoing laparoscopic TEP or TAPP inguinal hernia repair were compared on various intraoperative and postoperative parameters. Results: Fifty-four patients were included in the study (TEP, 27; TAPP, 27). Both groups were comparable in terms of demographic profile and hernia characteristics. TEP had significantly less mean operative time compared to TAPP. Pain scores and injectable analgesics’ requirement were significantly higher in TAPP compared to TEP. Postoperative stay was significantly higher in TAPP than TEP. Surgical outcome in terms of intraoperative and postoperative complications, hernia recurrence, and chronic pain for the two laparoscopic techniques was comparable. Conclusion: The lesser intraoperative duration of surgery with lesser postoperative pain scores and lesser postoperative hospital stay favor the use of TEP over TAPP for repair of inguinal hernia.

We have performed laparoscopic totally extraperitoneal (TEP) repair for inguinal hernia repair for the last 20years. We use two balloon dilators (sphere and kidney type) to dissect the preperitoneal space for the TEP repair. It may be difficult to obtain exposure in patients who previously underwent lower abdominal surgery, because of adhesions to the abdominal wall. We reviewed our experience with inguinal hernia repairs to retrospectively analyze factors that limit the laparoscopic TEP approach. From 2006 to 2016, 313 patients (281 men and 32 women) underwent laparoscopic TEP inguinal hernia repair at Yuki Hospital. The medical records of these patients were reviewed, and data for patients who previously underwent lower abdominal surgery were analyzed. Eighty-four patients previously underwent lower abdominal surgery including appendectomy (N = 23), inguinal hernia repair [N = 45; including contralateral TEP repair (N = 26), ipsilateral anterior approach (N = 11)], and laparotomy with a lower abdominal midline incision (N = 22). TEP repair was successfully completed in 75 patients (75/84; 89%) and the procedure changed in nine patients to an anterior approach (N = 5), or transabdominal preperitoneal (TAPP) repair (N = 4). The reasons for changing the procedure included difficulty to develop the operative field (N = 5), violation of the integrity of the peritoneal envelope (N = 2), and intraoperative bleeding (N = 2). Seven patients had a contralateral inguinal hernia after TEP repair. The majority of patients with an inguinal hernia and previous lower abdominal surgery underwent successful laparoscopic TEP repair. There is no need to avoid the laparoscopic TEP approach, even in patients with a history of previous lower abdominal surgery. However, patients after TEP repair of a contralateral inguinal hernia may be at increased risk for peritoneal injury and the approach may need to be changed.

Objective To compare the clinical efficacy of laparoscopic repair of laparoscopic transabdominal preperitoneal(TAPP) and Lichtenstein tension-free repair herniorrhaphy in the treatment of recurrent inguinal hernia in adults, and to explore the clinical advantages of TAPP in the treatment of recurrent inguinal hernia. Methods A retrospective analysis was conducted in 54 adult patients with recurrent inguinal hernia from December 2010 to January 2015.The patients were randomly divided into TAPP group and Lichtenstein group.The operation time, intraoperative bleeding volume, postoperative hospitalization time, cost of hospitalization, postoperative complications, early postoperative pain and the recurrence of hernia were compared between the two groups. Results All patients were successfully completed surgery.The operation time of TAPP group (47.2±9.4)min was significantly shorter than (73.1±10.4)min of Lichtenstein group (t=-2.503, P=0.034). The median amount of bleeding during operation of TAPP group was 40(15-110)ml, which was significantly less than 73(11-130)ml in Lichtenstein group (t=-6.018, P=0.000). Postoperative hospital stay of TAPP group[(6.5±1.4)d]was shorter than (8.2±1.6)d of the Lichtenstein group (t=-2.613, P=0.028). Early postoperative pain score of TAPP group[(1.8±1.2)points]was better than (2.9±1.4)points in Lichtenstein group (t=-7.006, P=0.000), the difference was statistically significant.However, the hospitalization cost of TAPP group[(8 842.8±415.2)yuan]was higher than (6 676.9±327.6)yuan of the Lichtenstein group, the difference was statistically significant(t=6.782, P<0.05). In TAPP group, 2 cases had complications after operation, which were less than 5 cases of Lichtenstein group.Postoperative follow up ranged from 6 to 48 months, 1 case of recurrence in Lichtenstein group, the recurrence rate was 3.8%.There was no recurrence in the TAPP group. Conclusion TAPP has the advantages of short operation time, less bleeding, rapid postoperative recovery, less postoperative pain and so on.It can be used as a recommended procedure for the treatment of recurrent inguinal hernia in adults. Key words: Hernia, inguinal; Laparoscopy; Transabdominal preperitioneal laparoscopic herniorrhaphy; Path tension-free hernioplasty; Recurrence

Introduction: Inguinal hernia is one of the most encountered surgical conditions globally - with significant prevalence among adult males. Surgical repair remains the definitive treatment and the two predominant techniques - open Lichtenstein repair and laparoscopic Transabdominal Preperitoneal (TAPP) repair - provide differing profiles in terms of operative time, recovery, pain, complications and cost. In the Indian context - evidence comparing these techniques in a controlled environment remains limited. Objectives: To compare TAPP and Lichtenstein repair techniques in terms of intra-operative and post-operative complications, pain outcomes, operative duration, hospitalization time, cost-effectiveness and recurrence in adult patients undergoing elective inguinal hernia repair. Methodology: This was a prospective, randomized controlled study conducted over 18 months at Sharda Hospital, a tertiary care hospital in Delhi NCR. A total of 45 adult patients with uncomplicated inguinal hernias were randomized into TAPP (n=23) and Lichtenstein (n=22) groups. Data collected included demographic profiles, operative parameters, post-operative complications (up to 6 months), VAS pain scores (post-op days 1 and 7), cost and hospital stay. Statistical analysis was performed using SPSS v29.0 - with p ≤ 0.05 considered significant. Results: TAPP repair showed superior outcomes in pain control with significantly lower VAS scores on day 1 (p&lt;0.0001) and day 7 (p=0.00012). Mean operative time was longer in TAPP (2.08 ± 0.65 hours) vs. Lichtenstein (1.57 ± 0.62 hours) (p=0.0105). Hospital stay was significantly shorter for TAPP (2.04 ± 0.77 days) vs. Lichtenstein (4.95 ± 1.36 days) (p&lt;0.0001). Intra-operative complications were rare, with only one vascular injury in the Lichtenstein group. On day 28, TAPP had lower rates of complications: 8.7% cord thickening and 4.35% each for tenderness and seroma; Lichtenstein had 9.09% SSI and 4.55% recurrence. TAPP incurred higher mean cost (₹20,045.45 ± ₹2,516.18) than Lichtenstein (₹15,909.09 ± ₹1,973.86) (p=0.0001), largely due to use of laparoscopic equipment. Conclusion: TAPP repair provided significantly better postoperative pain control, earlier discharge and reduced complication rates at the cost of longer operative time and higher expenditure. In well-equipped tertiary centres - TAPP is a superior choice for eligible patients and provides clinical benefits that justify the added cost in suitable cases.

Background/Objectives: The study aims to provide a comprehensive understanding of personalized treatment for patients with inguinal hernias at our hospital, focusing on complications, recurrence rates, and hospitalization duration to optimize treatment outcomes. Methods: Our center performs inguinal hernia surgery using an algorithm tailored to individual clinical conditions, developed in collaboration with the anesthesiology department. We retrospectively reviewed outcomes of open, totally extraperitoneal (TEP), and transabdominal preperitoneal (TAPP) approaches, with all procedures performed by a single surgeon. Results: A total of 229 patients (213 males; age range, 24-92 years; median age, 69 years) underwent inguinal hernia repair at Busan National University Hospital between January 2018 and April 2024. Patients in the open group had higher age and comorbidity burden (age/ASA American Society of Anesthesiologists physical status classification: open 74/3.5 vs. TAPP 70/2.0 vs. TEP 68/2.0; p = 0.036/< 0.001). There were no statistically significant differences in intraoperative complications (p = 1.000); however, the conversion rate was slightly higher in the TEP group (TEP 2 vs. TAPP 1). Length of hospital stay was longest in the TAPP group (open 3.77 days vs. TAPP 3.98 days vs. TEP 3.27 days; p = 0.817), while postoperative complication rates did not differ significantly among groups (overall complications: open 15.4% vs. TAPP 6.2% vs. TEP 4.3%; p = 0.100). Conclusions: Laparoscopic surgery is recommended when general anesthesia is feasible, with TEP preferred for patients without previous surgeries and TAPP for those with preperitoneal space (PPS) access challenges due to previous surgeries or radiation therapy. Open surgery is suitable for patients unable to undergo general anesthesia. Anesthesia and surgical approaches should be based on patient preferences and individual clinical conditions.

Inguinal hernia is one of the most common cases of elective surgery. Several methods are used to repair inguinal hernia, however, none of these methods have been introduced as the preferred method. Based on this, the current study was designed with the aim of comparing the postoperative short-term complications and recurrence after one year between laparoscopic transabdominal pre-peritoneal (TAPP) and Lichtenstein tension free repair in the treatment of primary unilateral inguinal hernia. In this clinical trial study, 122 patients who were candidates for inguinal hernia surgery in Ahvaz Golestan Hospital, Ahvaz, Southern Iran in 2022 were randomly assigned to two laparoscopic (TAPP) and open (Lichtenstein) surgery groups. Patients were compared in terms of short-term complications (hematoma, infection, seroma), post-surgery pain and number of hospitalization days, surgery duration, scar length and one-year recurrence rate. Wound infection, seroma, and hematoma after surgery in the TAPP group were significantly less than the patients in the Lichtenstein group (P=0.002). Pain intensity, recurrence rate and mean length of surgical scar in laparoscopic group patients were lower than open method group (P=0.001). The mean duration of surgery in the laparoscopic group was higher than the Lichtenstein group, but there was no remarkable difference (P=0.396). The mean duration of surgery in the TAPP group was higher than the Lichtenstein group, but there was no notable difference (P=0.396). The TAPP method has an obvious advantage over the conventional open surgery of Lichtenstein, especially in terms of reducing the initial postoperative pain and the occurrence of complications and recurrence after surgery.

Objectives: The high incidence of inguinal hernia over the globe makes hernia repair the most common procedure in general surgery, and 10-15% of all surgeries are composed of hernia repair. In this study, we tried to elucidate the effect of risk factors of laparoscopic techniques on chronic neuropathic pain formation in the postoperative period in patients who underwent Lichtenstein hernia repair and laparoscopic hernia repair. Methods: A total of 404 patients have been enrolled in this study. Two different surgery techniques have been conducted on the participants, as Lichtenstein repair (n=214) and laparoscopic inguinal hernia repair (n=190). Demographic data of the patients were recorded. Transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) techniques were applied to patients who underwent laparoscopic repair. The 'Lanss Pain Score' was utilized in the evaluation of chronic pain in the postoperative period. Results: We detected a statistically significant difference between the groups in terms of age and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scores (P&amp;lt;0.05). It was determined that the mean age of the patients with Lichtenstein repair was 57, and the mean LANSS score was 3. It was determined that the mean age of the patients with laparoscopic inguinal hernia repair was 49, and the mean LANSS score was 1. The distribution of demographic and clinical findings of the patients who underwent laparoscopic inguinal hernia repair according to the operation methods revealed no statistically significant difference in patients who underwent TAPP and TEP methods. Conclusions: In conclusion, the TEP and TAPP methods have lower pain in the postoperative period.

The current prospective randomized controlled clinical study aimed to assess the short- and long-term results of recurrent inguinal hernia repair, and to compare the results for transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) procedures with those for open tension-free repair. For this study, 82 patients were randomly assigned to undergo TAPP (group A, n = 24), TEP (group B, n = 26), or open Lichtenstein hernioplasty (group C, n = 32). All the patients with recurrent inguinal hernias had undergone previous repair using conventional open procedures. Physical examination showed Nyhus type II hernia in the vast majority of the patients (59%). High-risk patients (American Society of Anesthesiology [ASA] III or IV); coagulation disorders; previous abdominal or pelvic surgery; and irreducible, congenital, and massive scrotal or sliding hernias were excluded from the study. There was a statistically significant difference (p = 0.001) in operating time favoring the open procedure. The intensity of postoperative pain was greater in the open hernia repair group 24 h, 48 h, and 7 days after surgery (p = 0.001), with a greater consumption of pain medication among these patients (p < 0.004). The median time until return to work was 14 days for group A, 13 days for Group g, and 20 days for group C. The comparison was in favor of laparoscopically treated patients. Nine recurrences (4 in the laparoscopic groups and 5 in the open group) were documented within 3 years of follow-up evaluation. Laparoscopic inguinal hernia repair (TAPP or TEP) is the method of choice for dealing with recurrent inguinal hernia.