Surgical Endoscopy

, Volume 34, Issue 2, pp 821–828 | Cite as

Outcomes and impact of laparoscopic inguinal hernia repair versus open inguinal hernia repair on healthcare spending and employee absenteeism

  • Gurteshwar Rana
  • Priscila Rodrigues Armijo
  • Shariq Khan
  • Nathan Bills
  • Marsha Morien
  • Jianying Zhang
  • Dmitry OleynikovEmail author



This study compares the impact of open (OIHR) versus laparoscopic (LIHR) inguinal hernia repair on healthcare spending and postoperative outcomes.


The TRUVEN database was queried using ICD9 procedure codes for open, laparoscopic, and robotic-assisted IHR, from 2012 to 2013. Patients > 18 years of age and continuously enrolled for 12 months postoperatively were included. Demographics, patient comorbidities, postoperative complications, pain medication use, length of hospital stay, missed work hours, postoperative visits, and overall expenditure were collected, and assessed at time of surgery and at 30-, 60-, 90-, 180-, and 365-days postoperatively. Statistical analysis was conducted using SAS, with α = 0.05.


66,116 patients were included (LIHR: N = 23,010; OIHR: N = 43,106). Robotic-assisted procedures were excluded due to small sample size (N = 61). The largest demographic was males between 55 and 64 years. LIHR had fewer surgical wound complications than OIHR (LIHR: 0.3%; OIHR: 0.5%, p = 0.007), less utilization of pain medication (LIHR: 23.3%; OIHR: 28.5%; p < 0.001), and fewer outpatient visits. In the 90-day postoperative period, LIHR had significantly fewer missed work hours (LIHR: 12.1 ± 23.2 h; OIHR: 12.9 ± 26.7 h, p = 0.023). LIHR had higher postoperative urinary complications (LIHR: 0.2%; OIHR: 0.1%; p < 0.001), consistent with the current literature. LIHR expenditures ($15,030 ± $25,906) were higher than OIHR ($13,303 ± 32,014), p < 0.001.


The results highlight the benefits of laparoscopic repair with regard to surgical wound complications, postoperative pain, outpatient visits, and missed work hours. These improved outcomes with respect to overall healthcare spending and employee absenteeism support the paradigm shift toward laparoscopic inguinal hernia repairs, in spite of higher overall expenditures.


Laparoscopic inguinal hernia repair Open inguinal hernia repair Postoperative outcomes Cost analysis Healthcare costs 



Funding for this study was provided by Medtronic as a Research Support Agreement, and by the Center for Advanced Surgical Technology at the University of Nebraska Medical Center.

Compliance with ethical standards


Dr. Oleynikov declares conflict of interest directly related to the submitted work, having received a research grant support from Medtronic; not directly related to the submitted work, he is the stock holder of Virtual Incision Corporation. Dr. Rana, Dr. Armijo, Mr. Khan, Dr. Bills, Ms. Morien, and Dr. Zhang have no conflicts of interest or financial ties to disclose.


  1. 1.
    HerniaSurge Group, Simons M, Smietanski M, Bonjer H, Bittner R, Miserez M, Aufenacker TJ, Chowbey P, Tran H, Sani R (2017) International guidelines for groin hernia management. Hernia 22:1–165CrossRefGoogle Scholar
  2. 2.
    Neumayer L, Giobbie-Hurder A, Jonasson O, Fitzgibbons R Jr, Dunlop D, Gibbs J, Reda D, Henderson W (2004) Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 350:1819–1827CrossRefGoogle Scholar
  3. 3.
    Ger R, Mishrick A, Hurwitz J, Romero C, Oddsen R (1993) Management of groin hernias by laparoscopy. World J Surg 17:46–50CrossRefGoogle Scholar
  4. 4.
    McCormack K, Scott N, Go PM, Ross SJ, Grant A (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. The Cochrane LibraryGoogle Scholar
  5. 5.
    Wellwood J, Sculpher MJ, Stoker D, Nicholls GJ, Geddes C, Whitehead A, Singh R, Spiegelhalter D (1998) Randomised controlled trial of laparoscopic versus open mesh repair for inguinal hernia: outcome and cost. BMJ 317:103–110CrossRefGoogle Scholar
  6. 6.
    Abbas AE, Ellatif MEA, Noaman N, Negm A, El-Morsy G, Amin M, Moatamed A (2012) Patient-perspective quality of life after laparoscopic and open hernia repair: a controlled randomized trial. Surg Endosc 26:2465–2470CrossRefGoogle Scholar
  7. 7.
    Liem MS, Halsema JA, van der Graaf Y, Schrijvers AJ, van Vroonhoven TJ (1997) Cost-effectiveness of extraperitoneal laparoscopic inguinal hernia repair: a randomized comparison with conventional herniorrhaphy. Coala trial group Ann Surg 226:668–675, discussion 675–6 PubMedGoogle Scholar
  8. 8.
    Butters M, Redecke J, Köninger J (2007) Long-term results of a randomized clinical trial of Shouldice, Lichtenstein and transabdominal preperitoneal hernia repairs. Br J Surg 94:562–565CrossRefGoogle Scholar
  9. 9.
    Elhendawy AO, Abd-Raboh OH, Ismail TA, Nagy AA (2018) Randomized comparative study between laparoscopic transabdominal pre-peritoneal versus totally extraperitoneal approach in inguinal hernia repair. Age (in years) 1:0–110Google Scholar
  10. 10.
    Tadaki C, Lomelin D, Simorov A, Jones R, Humphreys M, DaSilva M, Choudhury S, Shostrom V, Boilesen E, Kothari V, Oleynikov D, Goede M (2016) Perioperative outcomes and costs of laparoscopic versus open inguinal hernia repair. Hernia 20:1–6CrossRefGoogle Scholar
  11. 11.
    Poobalan AS, Bruce J, Smith WCS, King PM, Krukowski ZH, Chambers WA (2003) A review of chronic pain after inguinal herniorrhaphy. Clin J Pain 19:48–54CrossRefGoogle Scholar
  12. 12.
    Employer Cost for Employee Compensation, National Compensation Survey. United States Bureau of Labor Statistics. March 2004–June 2017.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Surgery, General SurgeryUniversity of Nebraska Medical CenterOmahaUSA
  2. 2.Center for Advanced Surgical TechnologyUniversity of Nebraska Medical CenterOmahaUSA
  3. 3.Minimally Invasive Therapies GroupMedtronicMansfieldUSA

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