Clinical outcomes of open versus laparoscopic inguinal hernia mesh repair in Palestine: a multicenter retrospective cohort study

Abstract Background: Inguinal hernia repair is one of the most frequently performed surgical procedures worldwide, accounting for approximately 75% of abdominal wall hernias, and predominantly occurring in males. Although it is a common procedure with generally favourable outcomes, the postoperative outcomes, such as chronic pain, recurrence, and surgical complications, remain important concerns. Due to the large number of procedures performed worldwide and the associated healthcare costs, the assessment of surgical outcomes and the factors that affect patients’ recovery are essential to optimize management strategies and improve long-term results. The aim of this study was to evaluate postoperative outcomes after inguinal hernia repair in terms of the incidence of complications and postoperative course in an attempt to determine which approach is associated with fewer complications Method: A retrospective cohort study was conducted to compare the outcomes between open vs laparoscopic inguinal hernia mesh repair. All patients who underwent inguinal hernia mesh repair in 3 hospitals from 2017 to 2025 were collected. Patients were divided into groups based on surgical technique (open repair vs laparoscopic repair). Demographic data, operative time, length of hospital stay, postoperative complications including hematoma, seroma, wound infection, hydrocele, urinary retention, vomiting, and recurrence, were extracted and analysed. Statistical analysis was performed by using SPSS to compare outcomes between the two groups, with a P- value <0.05 considered statistically significant. Results: A total of 609 patients underwent inguinal hernia repair with mesh. Open repair was more prevalent (77.2%), while laparoscopic repair represented 22.8% of cases. Laparoscopic repair was more frequently performed for direct hernias, whereas indirect hernias were more commonly treated with open repair (p = 0.037). Reducible and uncomplicated hernias were significantly associated with laparoscopic repair (p < 0.001, p = 0.006), while irreducible and strangulated hernias were predominantly managed with open surgery. Patients undergoing laparoscopic repair were younger (median 51.5 vs. 55 years, p = 0.001) and had shorter operative duration (median 101.5 vs. 113 minutes, p = 0.001). Urinary retention occurred more frequently after open repair (5.5% vs. 0.7%, p = 0.015), whereas postoperative nausea and vomiting were more common following laparoscopy (2.2% vs. 0.2%, p = 0.039). Overall postoperative complications were low and comparable between the two approaches (12.6% vs. 14.4%, p = 0.572), and recurrence rates were minimal with no significant difference between groups (1.1% vs. 1.4%, p = 0.709). Conclusion: Both open and laparoscopic inguinal hernia repair demonstrated favourable safety profiles in this cohort; however, postoperative complications, such as chronic pain, remain a problem for some patients. Careful patient selection, proper surgical technique, and early recognition of risk factors may help improve postoperative outcomes. Further research is needed to improve surgical techniques and reduce postoperative morbidity.