, Volume 23, Issue 3, pp 461–472 | Cite as

Open versus laparoscopic mesh repair of primary unilateral uncomplicated inguinal hernia: a systematic review with meta-analysis and trial sequential analysis

  • N. L. BullenEmail author
  • L. H. Massey
  • S. A. Antoniou
  • N. J. Smart
  • R. H. Fortelny
Part of the following topical collections:
  1. Forum on primary monolateral uncomplicated inguinal hernia



One standard repair technique for groin hernias does not exist. The objective of this study is to perform an update meta-analysis and trial sequential analysis to investigate if there is a difference in terms of recurrence between laparoscopic and open primary unilateral uncomplicated inguinal hernia repair.


The reporting methodology conforms to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Randomised controlled trials only were included. The intervention was laparoscopic mesh repair (transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP)). The control group was Lichtenstein repair. The primary outcome was recurrence rate and secondary outcomes were acute and chronic post-operative pain, morbidity and quality of life.


This study included 12 randomised controlled trials with 3966 patients randomised to Lichtenstein repair (n = 1926) or laparoscopic repair (n = 2040). There were no significant differences in recurrence rates between the laparoscopic and open groups (odds ratio (OR) 1.14, 95% CI 0.51–2.55, p = 0.76). Laparoscopic repair was associated with reduced rate of acute pain compared to open repair (mean difference 1.19, CI − 1.86, − 0.51, p ≤ 0.0006) and reduced odds of chronic pain compared to open (OR 0.41, CI 0.30–0.56, p ≤ 0.00001). The included trials were, however, of variable methodological quality. Trial sequential analysis reported that further studies are unlikely to demonstrate a statistically significant difference between the two techniques.


This meta-analysis and trial sequential analysis report no difference in recurrence rates between laparoscopic and open primary unilateral inguinal hernia repairs. Rates of acute and chronic pain are significantly less in the laparoscopic group.


Inguinal hernia Lichtenstein TAPP TEP 



There were no sources of funding associated with this review.

Compliance with ethical standards

Conflict of interest

NLB, LHM, SAA, NJS and RHF declare no conflict of interest.

Ethical approval

Approval from the institutional review board was not required for this study.

Human and animal rights

This article is a systematic review and meta-analysis and it contains data collected through literature review. It does not include research directly involving human or animal participation.

Informed consent

For this literature review, formal consent is not required.

Supplementary material

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Supplementary material 1 (DOCX 12 kb)
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Supplementary material 2 (DOCX 18 kb)
10029_2019_1989_MOESM3_ESM.docx (263 kb)
Supplementary material 3 (DOCX 262 kb)
10029_2019_1989_MOESM4_ESM.doc (64 kb)
Supplementary material 4 (DOC 64 kb)


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Colorectal SurgeryRoyal Devon and Exeter NHS Foundation Trust, Royal Devon and Exeter HospitalExeterUK
  2. 2.Surgical DepartmentSt Loukas HospitalThessalonikiGreece
  3. 3.European University CyprusNicosiaCyprus
  4. 4.Department of General, Visceral and Oncological SurgeryWilhelminenspitalViennaAustria
  5. 5.Medical FacultySigmund Freud UniversityViennaAustria

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