Open, Laparoscopic or Robotic Approach: Which is the Best Surgical Technique for Inguinal Hernia Repair? An integrative review (Atena Editora)

Abstract

Introduction: the inguinal hernia occurs due to weakness of the abdominal wall, allowing tissue to protrude through vulnerable areas, such as the inguinal canal. It can be congenital, being more common in children, or acquired, prevalent in adults exposed to factors such as physical exertion and aging. The high prevalence of this condition highlights the importance of studying different surgical techniques, such as open, laparoscopic and robotic approaches. Inguinal hernia surgery has evolved from traditional methods, such as those of Bassini and Shouldice, to modern techniques such as tension-free repair with Lichtenstein mesh and, more recently, laparoscopic and robotic approaches. These innovations have reduced invasiveness, providing less pain and faster recovery. However, the choice of the ideal technique still depends on the patient's profile and the surgeon's experience, making understanding these options crucial for clinical success. Methods: This integrative review analyzed articles published between 2019 and 2024 in the BVS, PUBMED, and MEDLINE databases, using keywords related to surgical techniques for inguinal hernia. Of the 980 studies identified, after exclusions by specific criteria, 150 were reviewed and 29 included in the final analysis, comparing the open, laparoscopic, and robotic approaches. Results: The open approach is indicated for primary, large, or recurrent hernias; open repair involves a direct incision in the inguinal region. Techniques include hernioplasty with tensioning (Bassini) and without tensioning (Lichtenstein). It is simple, requires less equipment, and can be performed under local anesthesia, but recovery is slower and more painful, with a higher risk of complications. The laparoscopic approach became popular in the late 20th century, offering minimally invasive repair with less pain and faster recovery than open hernioplasty. TAPP and TEP techniques are common, with TAPP being more accessible due to its broad anatomical view. Laparoscopy requires general anesthesia, is more expensive, and has a longer learning curve. The recent technology offered by the robotic approach is ideal for complex cases, combining the precision of robotics with the benefits of laparoscopy. It offers 3D vision and greater control, but its high cost and prolonged learning curve limit its use, and it is reserved for challenging situations. Discussion: The comparison of techniques for inguinal hernia repair (open, laparoscopic, and robotic) involves aspects such as time, complications, cost, and recovery. The open technique is the most widely used, accessible, and economical, ideal for large hernias and emergencies, but has a slower recovery and greater morbidity. Laparoscopy offers less pain and faster recovery, and is preferred in specialized centers, but requires more skill and equipment. Robotic surgery is precise and suitable for complex cases, but is expensive and has a longer operative time. The choice of technique must consider the patient's profile, the surgeon's experience, and the available resources. Conclusion: The choice of technique for inguinal hernia repair must balance safety, efficacy, and cost, considering clinical factors and available resources. The open technique is widely used and cost-effective, but has greater morbidity and recovery time. Laparoscopy offers rapid recovery and good aesthetic results, but requires greater surgical dexterity. Robotic surgery is precise and indicated for complex cases, but is expensive and restricted to specialized centers. Further studies are needed to evaluate robotic surgery.