A COMPARATIVE STUDY OF THE POSTOPERATIVE COURSE IN CONVENTIONAL AND ENDOSCOPIC INGUINAL HERNIOPLASTY
A COMPARATIVE STUDY OF THE POSTOPERATIVE COURSE IN CONVENTIONAL AND ENDOSCOPIC INGUINAL HERNIOPLASTY

Summary/Abstract: Inguinal hernia repair represents one of the most frequently performed surgical procedures worldwide, comprising a substantial component of general surgical practice. Despite the long-standing dominance of the open Lichtenstein technique, the development and refinement of endoscopic and laparoscopic approaches—primarily the transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) techniques—have transformed contemporary hernia management. These minimally invasive procedures aim to optimize postoperative recovery by minimizing surgical trauma, postoperative pain, and the risk of chronic discomfort, while maintaining comparable recurrence rates. This study aimed to comprehensively evaluate and compare the postoperative course following conventional and laparoscopic inguinal hernioplasty, with emphasis on intraoperative parameters, postoperative pain intensity, complication rates, duration of hospital stay, and long-term surgical outcomes. A prospective study was conducted on 200 patients (189 men and 11 women) diagnosed with inguinal hernia and treated using either the conventional Lichtenstein method (Group A) or laparoscopic techniques (TAPP/TEP) (Group B). Surgical procedures were performed at the Department of General Surgery, Clinical Hospital – Štip, Republic of Macedonia. Collected data included operative duration, intraoperative blood loss, incidence of postoperative seroma and other complications, postoperative pain and nausea, hospital stay, and recurrence rate over a mean follow-up period of 35 months. Pain and nausea were systematically assessed preoperatively, on postoperative day three, and during the first and fourth postoperative weeks using standardized scoring systems. Statistical analyses were performed using the t-test and chi-square test, with a significance threshold of p < 0.05. The laparoscopic group demonstrated a significantly longer operative duration (100 minutes) compared with the conventional group (76 minutes) (p = 0.001). However, laparoscopic procedures were associated with markedly lower intraoperative blood loss (10 mL vs. 50 mL), a substantially lower incidence of postoperative seroma (3% vs. 45%; p < 0.001), and fewer overall postoperative complications (2% vs. 9%). No statistically significant differences were observed in the incidence of postoperative pain or nausea at the evaluated time points. No life-threatening events or perioperative mortality occurred. Hospital stay was significantly shorter in the laparoscopic cohort, and no recurrences were observed in either group during follow-up. These findings underscore the importance of technical proficiency in both conventional and laparoscopic hernia repair. While laparoscopic techniques require advanced skills and longer operative time, they confer distinct advantages in terms of intraoperative safety, reduced postoperative morbidity, and accelerated recovery. Endoscopic inguinal hernioplasty thus constitutes a safe, efficient, and patient-centered alternative that aligns with the principles of modern minimally invasive surgery.

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