الفهرس 
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Abstract
Introduction: Since its first description in late 1990s, laparoscopic inguinal hernioplasty has shown a great deal of promise; however, concurrently with its development, open anterior herniorrhaphy has evolved into a tension-free, mesh repair that is easily performed and associated with rapid recovery . Thus, the key question about laparoscopic inguinal hernia repair at present is whether it provides a significant advantage over the tension-free open repair now in use. It would appear to offer potential advantages, such as reduced postoperative pain, shortened recovery. In practice, however, the advantages are not invariably realized; a laparoscopic approach is not always minimally invasive, and various disadvantages arise from the current requirement for general anesthesia, the need to traverse the abdominal cavity and the increase in operating room time. Aim of work: To compare open tension-free inguinal hernia repair (Lichtenstein method) with transabdominal laparoscopic preperitoneal repair on recurrence rates at 1 year. To compare the two operative methods on the following secondary outcomes: (a) Postoperative complications, (b) Pain, (c) Time to return to normal activity, (d) Health-related quality of life, (e) Patient satisfaction Patients and Methods: This study was conducted on forty patients divided into two groups. All patients were subjected to the following: Full clinical assessment including assessment of the general condition of the patient according to American Society of Anesthesiologists (ASA), and complete laboratory investigations. Local examination of the inguinal region for assessment of characteristics of the hernia. Results: No significant difference was found between both groups regarding age, occupation, ASA class and co-morbid conditions as, DM, hypertension, smoking, urinary symptoms and chronic chest problems. But we found that more than half of our patients in the two groups working a heavy manual work and 15 patients were smokers. No significant difference was found between both groups as regards to the duration of the hernia, side and site of hernia defect and the Nyhus type of the hernia. We find that most of the hernias were indirect, more on the right side, mainly Nyhus type II, and of less than 6 months duration. Recurrence was found in 2 patients in the laparoscopic group only. Operative duration: was significantly longer in the laparoscopic group than the open group. Intraoperative: minor complications which occurred mainly in the laparoscopic group. Early postoperative: minor complications such as urine retension and groin pain which occurred in both groups without significant difference. Wound infection and scrotal hematoma occurred in open group. Failure of one patient in the laparoscopic group. Late postoperative: mild groin pain in one patient in each group and testicular pain in laparoscopic group. Pain score: VAS and pain grading was less in the laparoscopic group than the open group from the first postoperative day to the end of postoperative week. Pain medication: number of analgesic injections and tablet consumed by laparoscopic group patients was less than that of open group. Laparoscopic group patients returned to light activity and work earlier than open group patents. Laparoscopic group patients were more satisfied with surgery during the early 3 months after surgery, but at 6 months, no significant difference between both groups. Conclusions: Laparoscopic transabdominal preperitoneal hernioplasty has a higher incidence of intraoperative complications. Laparoscopic transabdominal preperitoneal hernioplasty causes less postoperative pain than Lichtenstein tension-free hernioplasty. Recurrence rate is high after Laparoscopic transabdominal preperitoneal hernioplasty than after Lichtenstein tension-free hernioplasty. Patients’ quality of life 1 and 3 months after the operation (assessed with the SF-36) and satisfaction with treatment is superior for laparoscopic patients who also have a shorter period of convalescence after surgery. Laparoscopic tension-free hernioplasty is associated with less inflammatory and stress response than open tension-free hernioplasty.