Skip to main content
Log in

Laparoscopic versus open repair of inguinal hernia: a longitudinal cohort study

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript



Traditionally, repair of an inguinal hernia has been by an open method, but laparoscopic techniques have recently been introduced and are increasing in popularity. This study aimed to compare early and late outcomes following laparoscopic and open repair of inguinal hernia.


We performed an analysis of inpatient Hospital Episode Statistics. Early-outcome criteria studied include in-hospital mortality, length of hospital stay, complications (infection, bleeding, injury to an organ, and urinary retention), and readmission. Late outcome was assessed by the need for a further inguinal hernia repair on the same side.


Between April 2002 and April 2004 there were 125,342 patients who underwent inguinal hernia repair and were included in the analysis. They were followed until April 2009. There were no differences in postoperative stay between the laparoscopic and open groups except for the laparoscopic bilateral hernia repair patients who had a shorter stay than the open group. Infection and bleeding were more common following open repair, whilst urinary retention and injury to an organ were more frequent after laparoscopic repair. Reoperation for another inguinal hernia was more common after laparoscopic (4.0 %) than after open repair of primary inguinal hernia (2.1 %), mostly in the first year after surgery. There was no difference in reoperation rate following repair of a recurrent inguinal hernia. Consultant caseload was strongly inversely correlated with reoperation following laparoscopic but not open repair of primary inguinal hernia.


Reoperation is more common after laparoscopic than after open repair of primary but not recurrent inguinal hernia. Surgeons with a low laparoscopic hernia repair caseload have an increased reoperation rate following laparoscopic repair of primary inguinal hernia. The increase in reoperation rate following laparoscopic repair is seen in the first year or two following the initial surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others


  1. Scott NW, McCormack K, Graham P et al (2002) Open mesh versus non-mesh for repair of femoral and inguinal hernia. Cochrane Database Syst Rev (4):CD002197

  2. Amato B, Moja L, Panico S et al (2009) Shouldice technique versus other open techniques for inguinal hernia repair. Cochrane Database Syst Rev (4):CD001543; update in: Cochrane Database Syst Rev 2012; (4):CD001543

  3. Rosenberg J, Bay-Nielsen M (2008) Current status of laparoscopic inguinal hernia repair in Denmark. Hernia 12:583–587

    Article  PubMed  CAS  Google Scholar 

  4. NICE (2010) Implementation uptake report: laparoscopic surgery for inguinal hernia repair. Accessed 7 Feb 2012

  5. NICE (2004) Laparoscopic surgery for inguinal hernia repair. NICE technology appraisal 83. Accessed 7 Feb 2012

  6. Neumayer L, Giobbie-Hurder A, Jonasson O et al (2004) Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 350:1819–1827

    Article  PubMed  CAS  Google Scholar 

  7. Millat B (2007) Inguinal hernia repair. A randomized multicentric study comparing laparoscopic and open surgical repair. J Chir (Paris) 144:119–124

    Article  CAS  Google Scholar 

  8. Eklund AS, Montgomery AK, Rasmussen IC et al (2009) Low recurrence rate after laparoscopic (TEP) and open (Lichtenstein) inguinal hernia repair: a randomized, multicenter trial with 5-year follow-up. Ann Surg 249:33–38

    Article  PubMed  Google Scholar 

  9. Karthikesalingam A, Markar SR, Holt PJ, Praseedom RK (2010) Meta-analysis of randomized controlled trials comparing laparoscopic with open mesh repair of recurrent inguinal hernia. Br J Surg 97:4–11

    Article  PubMed  CAS  Google Scholar 

  10. Arvidsson D, Berndsen FH, Larsson LG et al (2005) Randomized clinical trial comparing 5-year recurrence rate after laparoscopic versus Shouldice repair of primary inguinal hernia. Br J Surg 92:1085–1091

    Article  PubMed  CAS  Google Scholar 

  11. Pokorny H, Klingler A, Schmid T et al (2008) Recurrence and complications after laparoscopic versus open inguinal hernia repair: results of a prospective randomized multicenter trial. Hernia 12:385–389

    Article  PubMed  CAS  Google Scholar 

  12. Wullstein C, Strey C, Woeste G, Bechstein WO (2008) Inguinal hernia: laparoscopic or open surgery? Zentralbl Chir 133:433–439

    Article  PubMed  CAS  Google Scholar 

  13. Kald A, Nilsson E, Anderberg B et al (1998) Reoperation as surrogate endpoint in hernia surgery. A three year follow-up of 1565 herniorrhaphies. Eur J Surg 164:45–50

    Article  PubMed  CAS  Google Scholar 

  14. Nordin P, van der Linden W (2008) Volume of procedures and risk of recurrence after repair of groin hernia: national register study. BMJ 336:934–937

    Article  PubMed  Google Scholar 

  15. Campbell SE, Campbell MK, Grimshaw JM, Walker AE (2001) A systematic review of discharge coding accuracy. J Public Health Med 23:205–211

    Article  PubMed  CAS  Google Scholar 

  16. Audit Commission (2008) PbR Data Assurance Framework 2007/08. Findings from the first year of the national clinical coding audit programme, Health National Report. Accessed 7 Feb 2012

  17. Galland RB, Whatling PJ, Crook TJ, Magee TR (2000) Regional variation in varicose vein operations in England 1989–1996. Ann R Coll Surg Engl 82:275–279

    PubMed  CAS  Google Scholar 

  18. Hansell A, Bottle A, Shurlock L, Aylin P (2001) Accessing and using hospital activity data. J Public Health Med 23:51–56

    Article  PubMed  CAS  Google Scholar 

  19. Burns EM, Bottle A, Aylin P et al (2011) Variation in reoperation after colorectal surgery in England as an indicator of surgical performance: retrospective analysis of Hospital Episode Statistics. BMJ 343:d4836

    Article  PubMed  Google Scholar 

  20. Westaby S, Archer N, Manning N et al (2007) Comparison of hospital episode statistics and central cardiac audit database in public reporting of congenital heart surgery mortality. BMJ 335:759

    Article  PubMed  Google Scholar 

  21. McCormack K, Scott NW, Go PM et al (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev (1):CD001785

  22. de Lange DH, Aufenacker TJ, Roest M et al (2005) Inguinal hernia surgery in The Netherlands: a baseline study before the introduction of the Dutch Guidelines. Hernia 9:172–177

    Article  PubMed  Google Scholar 

  23. Schmedt CG, Sauerland S, Bittner R (2005) Comparison of endoscopic procedures vs Lichtenstein and other open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Surg Endosc 19:188–199

    Article  PubMed  CAS  Google Scholar 

  24. Myers E, Browne KM, Kavanagh DO, Hurley M (2010) Laparoscopic (TEP) versus Lichtenstein inguinal hernia repair: a comparison of quality-of-life outcomes. World J Surg 34:3059–3064

    Article  PubMed  Google Scholar 

  25. Kuhry E, van Veen RN, Langeveld HR et al (2007) Open or endoscopic total extraperitoneal inguinal hernia repair? A systematic review. Surg Endosc 21:161–166

    Article  PubMed  CAS  Google Scholar 

  26. Hamza Y, Gabr E, Hammadi H, Khalil R (2010) Four-arm randomized trial comparing laparoscopic and open hernia repairs. Int J Surg 8:25–28

    Article  PubMed  Google Scholar 

  27. Gokalp A, Inal M, Maralcan G, Baskonus I (2003) A prospective randomized study of Lichtenstein open tension-free versus laparoscopic totally extraperitoneal techniques for inguinal hernia repair. Acta Chir Belg 103:502–506

    PubMed  CAS  Google Scholar 

  28. Eklund A, Montgomery A, Bergkvist L, Rudberg C (2010) Chronic pain 5 years after randomized comparison of laparoscopic and Lichtenstein inguinal hernia repair. Br J Surg 97:600–608

    Article  PubMed  CAS  Google Scholar 

  29. Kouhia ST, Huttunen R, Silvasti SO et al (2009) Lichtenstein hernioplasty versus totally extraperitoneal laparoscopic hernioplasty in treatment of recurrent inguinal hernia—a prospective randomized trial. Ann Surg 249:384–387

    Article  PubMed  Google Scholar 

Download references


The Hospital Episode Statistics data extract used for this study was purchased by the Research and Development Department, Mid Cheshire Hospitals NHS Foundation Trust.


Yesar El-Dhuwaib, David Corless, Charis Emmett, Mark Deakin, and John Slavin have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations


Corresponding author

Correspondence to John Slavin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

El-Dhuwaib, Y., Corless, D., Emmett, C. et al. Laparoscopic versus open repair of inguinal hernia: a longitudinal cohort study. Surg Endosc 27, 936–945 (2013).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: