Open vs ‘Keyhole’

Open vs ‘Keyhole’

Meta-analysis of randomized controlled trials comparing Lichtenstein and totally extraperitoneal laparoscopic hernioplasty in treatment of inguinal hernias


Bobo Z1, Nan W1, Qin Q1, Tao W1, Jianguo L1, Xianli H2.
J Surg Res. 2014 Dec;192(2):409-20. doi: 10.1016/j.jss.2014.05.082. Epub 2014 Jun 4.
Finding the optimal approach to repair an inguinal hernia is controversial. Therefore, for the scientific evaluation of the total extraperitoneal (TEP) * and Lichtenstein** mesh techniques for the repair of inguinal hernia, meta-analyses of randomized controlled trials are necessary.



A complete literature search was conducted in the Cochrane Controlled Trials Register Databases, Pubmed, Embase, International Scientific Institute databases, and Chinese Biomedical Literature Database in various languages.


Randomized controlled trials (13), including 3279 patients, were retrieved from the electronic databases. The Lichtenstein group was associated with a shorter operating time; however, results show that TEP repair enabled patients a shorter time to return to work, less chronic pain compared with Lichtenstein operation. There was no significant difference in seromas, wound infections, or neuralgia. There are no statistically significant difference in terms of hernia recurrence when the follow-up time is ≤3 y. When follow-up time is >3 y, TEP repair shows a higher recurrence rate compared with Lichtenstein repairs.


There was insufficient evidence to determine the greater effectiveness between TEP* and Lichtenstein** mesh techniques.In future research, it is necessary for subgroup analyses of unilateral primary hernias, recurrent hernias, and simultaneous bilateral repair to be conducted to define the indications for the TEP approach.

* TEP = laparoscopic

** Lichtenstein = open