Comparative effectiveness of open versus endoscopic hernioplasty techniques in inguinal hernia repair: a retrospective study

Background: The optimal surgical approach for inguinal hernia repair remains debated. This study compared open (mesh and non-mesh) and endoscopic hernioplasty techniques, focusing on operative duration, postoperative pain, recovery and early complications. Methods: A retrospective cohort study was conducted on 334 patients who underwent inguinal hernioplasty at a single university clinic (2022-2024). Five techniques were evaluated: Bassini repair (n=32), Kimbarovsky repair (n=34), Lichtenstein tension-free repair (n=178), transabdominal preperitoneal repair (TAPP; n=71) and extended totally extraperitoneal repair (eTEP, n=19). Outcomes assessed included operative duration, postoperative pain intensity (Visual Analog Scale-VAS), pain duration and hospital stay, narcotic analgesic requirements and early complications. Results: Endoscopic techniques (TAPP and eTEP) demonstrated superior perioperative outcomes compared with open repairs. Patients undergoing TAPP/eTEP reported lower VAS scores (p<0.001) and a shorter duration of pain, with no narcotic analgesic use, versus 7.3% (Lichtenstein) and 34.8% (Bassini/Kimbarovsky). Median hospital stay was shorter after endoscopic repair (4 days) than following Lichtenstein repair (6–7 days). However, endoscopic procedures required longer operative times than open techniques. Early complication rates were low across all groups; seromas occurred more frequently after TAPP/eTEP repair (3.3%) than after Lichtenstein repair (0.5%), while hematomas were not observed in endoscopic cases. Conclusions: Endoscopic inguinal hernioplasty is associated with reduced postoperative pain, minimal narcotic requirement and shorter hospital stay, but longer operative duration. These techniques should be considered preferentially when adequate surgical expertise and resources are available and rapid recovery is prioritised. Lichtenstein repair remains a reliable open alternative, while non-mesh techniques demonstrated less favourable outcomes.