**12. Literature review**

The results of laparoscopic and open inguinal hernia surgeries are now being compared very much. Postoperative pain complications, recurrence rates, patient satisfaction, cost analysis are frequently discussed. Papachariston and colleagues in their postoperative evaluation of pain study [8], even though it was reported to require more analgesic in the first 6 h in the TAPP group, pain was reported in 2–11% of the open surgery group and reported as 1–4.2% in the laparoscopic group. In the same study, persistent pain lasting from seventh day to 1 year in the open surgical group was associated with postoperative fibrosis, while point pain in the laparoscopic group was associated with scar tissue rupture. In a meta-analysis evaluating persistent pain [9], patch repair has been shown to reduce persistent pain as opposed to pain relief, and it has also been found that chronic pain is less in the laparoscopic method.

In a study in which approximately 10,000 patient outcomes were assessed in the United States and patients were followed for 3 years [10], the recurrence rate of the laparoscopic method was found to be 0.4%, and it was emphasized that the most important difference between open and laparoscopic operations was the achievement of sufficient experimentation, the number of operations performed. According to this recommendation, a randomized controlled trial conducted by the Veterans Affairs Cooperative Study and reporting of 2-year follow-ups [11], recurrence rates were reported as 10% for laparoscopic repair and 5% for open repair, but after 250 laparoscopic cases techniques, results were improved. In a more recent study, Lal et al. [12] has shown that surgeons have reduced recurrence rates from 9 to 2.9% after 100 operations. In different studies, it has been reported that the laparoscopic techniques are spreading and the time to assess the competence of the surgeons is between 50 and 100 cases. A meta-analysis by Köckerling et al. [13] evaluating the relationship between patch fixation and recurrence, cases that patch fixation was performed and in cases not performed, there was no difference in the duration of operation, patch-related complications, recurrence and duration of hospital stay.

urgent orchiectomy may be necessary. Treatment includes IV hydration and NSAIDs. If testicular artery is damaged, it can be caused testicular atrophy after long periods of operation. Vas deferens may not be manipulated during surgery and maximum effort to avoid disturb-

Postoperative pain, swelling and the presence of a mass in the inguinal region should be considered. Diagnosis can be made by radiological examinations. Technical factors that play a role in the development of recurrence include inappropriate patch size, inadequate patch, stress or inaccurate detection, lack of experience, tissue ischemia and infections. Factors related to the patient include malnutrition, obesity, wound healing disorders and uncontrolled diabetes

Other complications include urinary retention, which can be prevented by the patient's urination before surgery or by peroperative urinary catheterization. Paralytic ileus, visceral injuries, vascular injuries, intestinal obstruction, hypercapnia, pneumothorax and gas embolism

The results of laparoscopic and open inguinal hernia surgeries are now being compared very much. Postoperative pain complications, recurrence rates, patient satisfaction, cost analysis are frequently discussed. Papachariston and colleagues in their postoperative evaluation of pain study [8], even though it was reported to require more analgesic in the first 6 h in the TAPP group, pain was reported in 2–11% of the open surgery group and reported as 1–4.2% in the laparoscopic group. In the same study, persistent pain lasting from seventh day to 1 year in the open surgical group was associated with postoperative fibrosis, while point pain in the laparoscopic group was associated with scar tissue rupture. In a meta-analysis evaluating persistent pain [9], patch repair has been shown to reduce persistent pain as opposed to pain

relief, and it has also been found that chronic pain is less in the laparoscopic method.

In a study in which approximately 10,000 patient outcomes were assessed in the United States and patients were followed for 3 years [10], the recurrence rate of the laparoscopic method was found to be 0.4%, and it was emphasized that the most important difference between open and laparoscopic operations was the achievement of sufficient experimentation, the number of operations performed. According to this recommendation, a randomized controlled trial conducted by the Veterans Affairs Cooperative Study and reporting of 2-year follow-ups [11], recurrence rates were reported as 10% for laparoscopic repair and 5% for open repair, but after 250 laparoscopic cases techniques, results were improved. In a more recent study, Lal et al. [12] has shown that surgeons have reduced recurrence rates from 9 to 2.9% after 100 operations. In different studies, it has been reported that the laparoscopic techniques are spreading and the time to assess the competence of the surgeons is between 50 and

ing their nutrition may help to avoid these complications.

mellitus. Surgical intervention should be considered in the treatment.

**11.4. Recurrents**

88 Hernia Surgery and Recent Developments

are also uncommon complications.

**12. Literature review**

In a randomized controlled meta-analysis in which Wei and colleagues evaluated the outcomes of 1000 patients published in 2015, there was no difference between the two surgeries, pain score, operation time, return to daily activity, hospitalization time, complication and cost between the two surgeries. In conclusion, TEP was found to be more complicated than TAPP and advised to start laparoscopic surgery with TAPP to inexperienced surgeons [14]. In a study published by Köckerling et al. [15] there was no difference between two surgeries in terms of intraoperative complications and reoperation rates. However, after TAPP surgery, complication rates were found to be higher due to possible large complications, more scrotal hernia, elderly patient selection.

In a study conducted by Payne et al. [16] to measure postoperative quality of life, it has been shown that patients' compliance with straight leg exercises is better after laparoscopic surgery. Designed in the same way and studied by Lawrence et al. [17], this difference was more evident in bilateral hernia repair.

The problem of cost is still an important problem, with the fact that it has been removed from the big picture compared to the past. In the study conducted by Stylopoulos et al. [18] in 2003 and the results of 1.5 million patients evaluated, laparoscopic operations have been claimed to reduce costs compared to long-term open surgery when salary, health insurance costs, reduced job quality, delayed work shifts and the salary of the worker looking after the patient are taken into consideration. Farinas et al. [19] showed that 60% reduction in indirect costs could be achieved despite the 40% increase in the direct costs of using non-disposable devices and shortening of the operation time.

When TEP and TAPP were compared, there was no difference between the two techniques in terms of hospitalization time, recovery time and short term recurrence rates. The duration of the TEP technique is shorter than that of the TAPP technique [20]. However, according to the International Endohernia Association, it has been suggested that surgeons should apply the TEP technique after learning the TAPP technique and acquiring a certain experience in the learning curve [21].

In our study, we have found that there is only a minimal difference between TAPP and TEP techniques, in terms of operative time. There was no difference in both techniques when recurrence, return to work, pain score, duration of hospitalization and complications were evaluated. Particularly, we observed that bilateral and recurrent hernia had high patient satisfaction. Also we observed that TAPP surgery in the early stages of surgery, shortened the learning curve.

In conclusion, laparoscopic inguinal hernia surgery takes place in daily practice as an increasingly widespread up-to-date treatment method in which training and experience gained over time and patient satisfaction of clinical outcomes are very good.
