الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Background: Inguinal hernia repair is the most frequently performed operation in general surgery. However, the question about the most appropriate technique still confuses the community of surgeons. The standard method for inguinal hernia repair had changed little over a hundred years until the introduction of synthetic mesh. This mesh can be placed by either using an open approach or by using a minimal access laparoscopic technique.
Aim of Work: The purpose of this review was to compare laparoscopic techniques with open mesh technique for inguinal hernia repair.
Materials and Methods: All published randomized and non randomized controlled trial, meta-analysis, case –control trial &NICE guidelines comparing laparoscopic inguinal hernia repair with open inguinal hernia repair were eligible for inclusion. Trials were included only published in English. Participants were adults diagnosed with inguinal hernia either males or females. The following data items were sought for all trials: duration of operation (min), vascular injury, visceral injury, length of hospital stay (days), time to return to usual activities (days), time to return to work (days), post operative pain, chronic persisting inguinal pain (defined as inguinal pain of any severity as near 12 months after the operation as possible provided this was at least after 3 months), hernia recurrence, cost effectiveness, learning curve, quality of life.
Results: Overall, recurrence rates were higher among patients whose hernias were repaired by the laparoscopic technique (3.6%) compared to open group(1.9%)(p<0.001). In five studies concerning the treatment of recurrent hernias, the recurrence rate varies between 0.4% and 8.3% for laparoscopic techniques and between 1% and 15.6% for the Lichtenstein procedure. However, the recurrence rate differs greatly between hospitals and individual surgeons, especially for those that perform laparoscopic procedures. For those that have passed an educational program with specific regard to laparoscopy, the recurrence rate is low. Open mesh repair is economical, easy to teach and learn without any steep learning curve. Open hernia repair does not need any specialized training and results are same in both specialist and non-specialist center. Open hernia repair does not carry any risk of serious visceral or bowel injuries.
Conclusion: Laparoscopic hernia repair is more costly; difficult to learn with a steep learning curve, our results provide evidence that after a laparoscopic repair return to usual activity is faster and persisting pain is reduced. However, operation times are longer and there appears to be a higher rate of serious complication rate in respect of visceral and vascular injuries. The complication rate reduces as the surgeons become more experienced in this procedure comparable with that of open repair. Laparoscopic repair is associated with less post-operative morbidity and faster recovery and satisfaction as documented by less post-operative pain, earlier mobilization and discharge from the hospital, as well as early return to work.