, Volume 21, Issue 5, pp 723–727 | Cite as

Laparoscopic extraperitoneal repair versus open inguinal hernia repair: 20-year follow-up of a randomized controlled trial

  • A. Barbaro
  • H. Kanhere
  • J. Bessell
  • G. J. MaddernEmail author
Original Article



This study compared the long-term recurrence rates of laparoscopic totally extraperitoneal (TEP) and open inguinal hernia repair in patients from a randomised trial completed in 1994. Laparoscopic inguinal hernia surgery, especially TEP repair, has gained widespread acceptance in recent years. There is still paucity of data on long-term follow-up comparing recurrence rates for open and laparoscopic techniques. This is the first study providing direct long-term comparative data about these techniques.


A randomised controlled trial was conducted between 1992 and 1994 on patients undergoing a laparoscopic TEP or an open inguinal hernia (Shouldice) repair at our institution. Of the original 104 participants, contemporary follow-up data could be obtained for 98 patients with regards to long-term recurrence. These data were collected with the help of questionnaires, telephone calls and retrieval of case records. Medical records were reviewed for all patients. Data were analysed using a Cox proportional hazards model.


There were 7/72 (9.7%) recurrences in the open group and 9/35 (25.7%) recurrences in the laparoscopic group. This difference in recurrence rates was statistically significant (HR = 2.94; 95% CI 1.05–8.25; p = 0.041.)


Laparoscopic TEP inguinal hernia repair performed in 1992–1994 had a higher recurrence rate than open Shouldice inguinal hernia repair during the same period. The original study was undertaken in the inceptive days of laparoscopic surgery and results need to be interpreted considering the technology and expertise available at that time.


Extraperitoneal Laparoscopy Inguinal hernia Long term outcomes 



We would like to acknowledge the assistance of Cara Baronian, Lynne Giles, Stuart Howell, Lisa Leopardi, and Sheona Page in the preparation of this manuscript.

Compliance with ethical standards

Conflict of interest

Author AB declares no conflict of interest. Author HK declares no conflict of interest. Author JB declares no conflict of interest. Author GM declares no conflict of interest.


None to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with ethical standards of the institution and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Human and animal rights

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag France SAS 2017

Authors and Affiliations

  • A. Barbaro
    • 1
  • H. Kanhere
    • 1
    • 3
  • J. Bessell
    • 2
  • G. J. Maddern
    • 1
    • 3
    Email author
  1. 1.University of Adelaide, Discipline of Surgery, The Queen Elizabeth HospitalWoodvilleAustralia
  2. 2.Department of SurgeryFlinders UniversityBedford ParkAustralia
  3. 3.Department of SurgeryThe Queen Elizabeth HospitalWoodville SouthAustralia

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