Improved functional outcome and more rapid return to normal activity following laparoscopic hernia repair

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Abstract
Background: The laparoscopic repair of inguinal hernias remains a controversial subject. Advantages in terms of reduced postoperative pain and improved functional status have been demonstrated in some studies and refuted in others. We performed a prospective study of a group of young healthy patients to measure pain levels and time to return to normal activity following totally extraperitoneal laparoscopic (TEP) hernia repair and compared these outcomes to those seen following conventional anterior repair. Methods: A total of 151 patients were entered into a prospective nonrandomized study. Forty-eight patients underwent anterior repair; 103 underwent TEP repair. Patients were followed at 2 and 6 weeks to assess their level of function on a five-point scale. Their use of pain medication was also assessed, and total days away from work and days until return to full activity were documented. Results: The open group returned to work at 11.5 days and to full activity at 26.7 days. The TEP group returned to work at 6.4 days and to full activity at 14.2 days (p < 0.001 for both data). There was no statistically significant difference in the use of pain medication. The TEP group reported better functional status at 2 weeks than the open group. At 6 weeks, this difference was no longer statistically significant. Conclusion: As compared to conventional open repair, TEP hernia repair offers advantages in postoperative function and an earlier return to full activity.

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