Open, Laparoscopic, and Robotic Inguinal Hernia Repair: Comparative Outcomes, Mesh Selection, and Individualized Surgical Decision-Making

Abstract

Inguinal hernia repair is among the most frequently performed general surgical procedures worldwide. Current operative strategies include open anterior mesh repair, laparo-endoscopic posterior repair, robotic preperitoneal repair, and selected non-mesh tissue reconstruction. Comparative evidence suggests that laparoscopic transabdominal preperitoneal and totally extraperitoneal repair can reduce postoperative pain and accelerate return to normal activity relative to open Lichtenstein repair, whereas recurrence outcomes are generally similar when techniques are performed by experienced surgeons. Robotic approaches offer technical flexibility but have not consistently demonstrated superior patient-centered outcomes sufficient to offset higher costs. Mesh-based repair remains standard for most adults, while Shouldice repair is a reasonable alternative in selected patients and expert hands. This narrative review summarizes operative principles, comparative clinical outcomes, chronic postoperative inguinal pain, recurrence, mesh selection, and factors influencing choice of repair. The optimal strategy should be adapted to laterality, recurrence, prior operations, comorbidity, patient preference, surgical resources, and surgeon experience.