Page 28 - World Journal of Laparoscopic Surgery

RESEARCH ARTICLE
Open vs Laparoscopic Inguinal Hernia Repair: Influences of

Patient Age and BMI on Analgesic Requirements and Hospital

Stay Duration

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Derek K Mwagiru , Theresa A Larkin 2

AbstrAct
Aim: Comparisons between open vs laparoscopic surgical methods for inguinal hernia repair have yielded inconsistent results with respect
to patients’ pain levels and analgesic requirements post-surgery. This study compared open vs laparoscopic inguinal hernia repair in terms
of types and quantity of analgesics administered during the postoperative recovery period and the hospital stay, including the influences of
patient characteristics such as age, BMI, and previous inguinal hernia repair.
Materials and methods: This was a cross-sectional study of retrospective analysis of data pertaining to inguinal hernia repairs in a rural hospital
in Australia.
Results: Among 63 patients (60 males), 62% had undergone open and 38% laparoscopic surgery for inguinal hernia repair. Type and dose of
analgesic medications given during both the postoperative recovery period and the hospital ward stay and the duration of the hospital stay
were not significantly different between open and laparoscopic groups. However, there were significant influences of BMI, with significantly
more overweight and obese patients requiring a combination of opioids with nonsteroidal anti-inflammatory drug (NSAID) or paracetamol
during the hospital stay, and with obese patients having the longest hospital stay, followed by overweight patients. Patients who had open
surgery were significantly older and less likely to have had a previous inguinal hernia repair than those who had laparoscopic surgery, and there
was a significant correlation between age and duration of hospital stay.
Conclusion: Patient characteristics of age, BMI, and previous inguinal hernia repair are confounding factors when comparing analgesic
requirements and hospital stay duration after open vs laparoscopic inguinal hernia repair.
Keywords: Analgesic, BMI, Inguinal hernia, Laparoscopic.
World Journal of Laparoscopic Surgery (2020): 10.5005/jp-journals-10033-1393

IntroductIon 1,2 Department of Medical Sciences, Graduate School of Medicine,
Inguinal hernias are one of the most common abdominal University of Wollongong, Wollongong, New South Wales, Australia
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pathologies requiring surgery, with the lifetime risks of developing Corresponding Author: Theresa A Larkin, Department of Medical
2
an inguinal hernia estimated to be 27% for men and 3% for women. Sciences, Graduate School of Medicine, University of Wollongong,
An indirect inguinal hernia passes through the inguinal canal, while Wollongong, New South Wales, Australia, Phone: +61(2) 4221 5132,
e-mail: tlarkin@uow.edu.au
a direct inguinal hernia protrudes through the abdominal wall in
3,4
the area of Hesselbach’s triangle. Both types of hernias can arise How to cite this article: Mwagiru DK, Larkin TA. Open vs Laparoscopic
due to either congenital or acquired weakness of the abdominal Inguinal Hernia Repair: Influences of Patient Age and BMI on
Analgesic Requirements and Hospital Stay Duration. World J Lap Surg
wall and/or inguinal canal structures. 2020;13(1):26–30.
Current methods of inguinal hernia repair include either an Source of support: Nil

open or a laparoscopic surgical approach, with the overall success
based primarily on the fewest complications and the earliest Conflict of interest: None
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return to normal activities. Open hernia repairs involve an incision
through the skin, fascia, and muscle of the abdominal wall to expose is inconclusive; 5,12,18 however, as a subjective measure of pain this
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and reduce the hernia. In contrast, the laparoscopic method is is limited. Other studies have compared analgesic consumption
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minimally invasive and does not require the division of muscle. following inguinal hernia repair and reported this was lower after
Despite laparoscopic surgery being technically more complex, laparoscopic than open surgery, during the first day 5,10,11,14,19 and
7,8
which necessitates a longer duration of general anesthesia, it the first 7 days after surgery; 12,20,21 or not different between the two
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is usually associated with a shorter recovery time compared with surgical modes. However, most of these studies only assessed
open surgery. 9–12 patients’ intake of diclofenac and paracetamol, and did not consider
Recently, there has been increased focus on postoperative any of the opioid-based analgesic medications administered during
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and chronic pain as measures of surgical success. Several studies the immediate postoperative period or the hospital ward stay.
have reported chronic pain rates of up to 20% after inguinal hernia Patient characteristics can also influence analgesic medication
repair. 13–17 Of significance is that in addition to postoperative pain intake. There are several predictors of chronic pain including
itself being a measure of surgery recovery, untreated postoperative younger age, higher BMI, and being discharged on the day of
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pain is a risk factor for chronic pain. Assessment of postoperative surgery rather than staying overnight; 15,23 however, the associations
pain after inguinal hernia repair using visual analog scores (VAS) between these variables and postoperative pain have not been
© The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
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