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Objectives: Laparoscopic inguinal herniorrhaphy was introduced into surgical practice in 1990. It has shown a great deal of promise and was shown to allow quicker and more thorough assessment and repair of bilateral groin hernias. However the evolution of tension-free open repair with mesh allows use of local or regional anesthesia and is associated with rapid recovery and a low recurrence rate. We sought to compare a large number of patients and compare national trends and outcomes between these approaches.
Methods: The NSQIP database was queried for laparoscopic or open bilateral inguinal hernia repair. Age, gender and comorbidities were quantified and outcomes data collected. Specifically, morbidity, mortality, length of stay and operative times were examined. Statistical analysis was then performed. A p-value of < 0.05 was considered significant.
Results: A total of 4985 patients were identified, of which 2025 patients underwent open repair of bilateral inguinal hernia and 2960 patients underwent laparoscopic repair.
Conclusions: Nationally, 59.4% of bilateral hernias were repaired laparoscopically. More patients with diabetes, HTN and history of CABG underwent open repair. Laparoscopic and open approaches have a similar complication profile. Operative time was shorter in the laparoscopic group (75.9 ± 35 vs. 85.2 ± 38.3 min, p<0.001) as was length of stay (0.18 ±1.1 vs. 0.409 ± 3.0 days, p<0.001).
Table 1. Patient comorbidites

	Open Repair N=2025	Laparoscopic Repair N=2960	P-Value
Male gender	1877 (92.7%)	2825 (95.4%)	<.001
Diabetes on oral	96 (4.7%)	101 (3.4%)	0.013
Diabetes on Insulin	23 (1.1%)	20 (0.7%)	0.013
HTN	742 (36.6)	834 (28.2%)	<0.001
CHF in 30 days	2 (0.1%)	2 (0.1%)	1
History of MI in 6 months	1 (0%)	2 (0.1%)	1
Prior PCI	117 (5.8%)	109 (3.7%)	.001
Prior CABG	123 (6.1%)	105 (3.5%)	<.001
PAD	13 (0.6%)	12 (0.4%)	0.308
ESRD	10 (0.5%)	9 (0.3%)	0.350
Smoker	409 (20.2%)	566 (19.1%)	0.363
Bleeding disorder	46 (2.3%)	34 (1.1%)	.003
ASA III or above	25 (1.2%)	14 (0.5%)	.005

Table 2. Patient outcome and complications

	Open Repair N=2025	Laparoscopic Repair N=2960	P-Value
Superficial SSI	8 (0.4%)	8 (0.4%)	1
Deep incisional SSI	1(0%)	0	0.406
Pneumonia	4 (0.2%)	3 (0.1%)	0.452
Unplanned Intubation	1 (0%)	2 (0.1%)	1
PE	1 (0%)	2 (0.1%)	1
Return to OR	19 (0.9%)	24 (0.8%)	0.643
ARF	0 (0%)	2 (0.1%)	0.517
UTI	6 (0.3%)	9 (0.3%)	1
MI	0	1	1
DVT	3 (0.1%)	3 (0.1%)	0.135
Operative time (min)	85.2 ± 38.3	75.9 ± 35	<0.001
Length of stay (days)	0.409 ± 3.0	0.18 ±1.1	<0.001
Mortality	2 (0.1%)	0 (0%)	0.165