***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Background : Giant prosthetic reinforcement of the visceral sac ( GPRVS ) , an open preperitoneal mesh repair , is a very effective groin hernia repair . Laparoscopic transabdominal preperitoneal repair ( TAPP ) , based on the same principle , is expected to combine low recurrence rates with minimal postoperation morbidity . Methods : Seventy-nine patients with 93 recurrent and 15 concomitant primary inguinal hernias were r and omized between GPRVS ( 37 patients ) and TAPP ( 42 patients ) .  Operating time , complications , pain , analgesia use , disability period , and recurrences were recorded . Results : Mean operating time was 56 min with GPRVS versus 79 min with TAPP ( p < 0.001 ) . Most complications were minor , except for a pulmonary embolus and an ileus , both after GPRVS . Patients experienced less pain after a laparoscopic repair . Average disability period was 23 days with GPRVS versus 13 days with TAPP ( p= 0.03 ) for work , and 29 versus 21 days , respectively ( p= 0.07 ) for physical activities . Recurrence rates at a mean follow-up of 34 months were 1 in 52 ( 1.9 % ) for GPRVS versus 7 in 56 ( 12.5 % ) for TAPP ( p= 0.04 ) . Hospital costs in U.S. dollars were comparable , with GPRVS at $ 1,150 and TAPP at $ 1,179 . Conclusions : Laparoscopic repair of recurrent inguinal hernia has a lower morbidity than GPRVS . However , laparoscopic repair is a difficult operation , and the potential technical failure rate is higher . With regard to recurrence rates , the open preperitoneal prosthetic mesh repair remains the best repair OBJECTIVE To compare outcome and costs between  laparoscopic and open hernia repair .  DESIGN Prospect i ve r and omised study . SETTING One university and two district hospitals in Sweden . SUBJECTS 200 men aged 25 - 75 years . MAIN OUTCOME MEASURES Operating time , hospital stay , complications , and time to recovery . A cost-minimisation- analysis was used in which the total costs were calculated for a defined period of time for each option . RESULT The one year follow-up rate was 98 % . Mean ( SD ) operation times in the laparoscopic and open groups were 72 ( 30 ) and 62 ( 25 ) minutes , respectively ( p = 0.009 ) . Hospital stay and complication rates did not differ between the groups . Among employees the mean ( SD ) periods off work in the laparoscopic and open groups were 10 ( 8) and 23 ( 21 ) days , respectively ( p = 0.0001 ) . The mean direct costs of the laparoscopic operation were increased by SEK 4037 ( US$ 483 ) but the savings in indirect costs result ing from earlier return to work were SEK 11392 ( US$ 1364 ) . CONCLUSIONS Laparoscopic hernia repair gave the employed patients faster recovery and return to work , and was the most cost-effective strategy provided that both direct and indirect costs were included BACKGROUND Benefits of  laparoscopic herniorrhaphy ( LH )  over  open hernia repair ( OH )  remain unproved . METHODS Interim analysis of a prospect i ve r and omized controlled trial compared OH with LH where study outcomes were measured by third-party evaluators through patient interviews . RESULTS Both groups were well matched for all baseline parameters , although LH patients anticipated a quicker postoperative recovery than OH ( p = 0.014 ) . No significant difference was noted in operating time or surgeon operative satisfaction . The median duration of hospital stay was 1 day in both groups ; LH patients made use of significantly less postoperative narcotics than OH ( p = 0.02 ) . No difference was observed in the duration s of convalescence ( LH , 9.6 + /- 7.6 days ; OH , 10.9 + /- 7.4 days ) . Greater improvements in quality of life were exhibited in LH patients than OH patients 1 month after operation ( p = 0.035 ) , with one of the two measures used . A greater percentage of LH patients seemed " very satisfied with their operation " ( p = 0.07 ) . Complication rates were similar , and a single recurrence , in a patient in the OH group , has been observed after a median follow-up of 14 months . CONCLUSIONS Direct cost measurements showed LH to be 40 % more expensive than OH in the context of a Canadian-type health care system . To date , benefits in postoperative pain and possibly quality of life have been detected in the LH group Abstract Background : In February 1993 a prospect i ve r and omized multicenter trial was initiated to compare  laparoscopic transabdominal preperitoneal hernioplasty to Shouldice herniorrhaphy  as performed by surgeons of nonspecialized clinics . Methods : Until January 1994 , 87 patients with 108 hernias took part in the trial ( 43 Shouldice and 44 laparoscopic repairs ) . Results : The laparoscopic procedure took significantly longer than did the open operation but caused less pain as measured by pain analogue score and consumption of paracetamol and narcotics . The postoperative complication rate was 26 % in the open and 16 % in the laparoscopic group . The patients in the laparoscopic group were discharged earlier and their convalescence was shorter than after open hernia repair . There has been one early recurrence in the laparoscopic and two in the open group to date with a mean follow-up of 201 days . Conclusions : Laparoscopic hernia repair causes less pain than the conventional operation and enables the patient to return to full work and usual activities earlier . The recurrence rate will not be known for 5 years Abstract Background :  Laparoscopic herniorrhaphy  is controversial and deserves critical evaluation . Methods : In a r and omized prospect i ve study transabdominal preperitoneal laparoscopic herniorrhaphy ( n= 24 ) was compared in patients to the tension-free Lichtenstein repair ( n= 29 ) utilizing vali date d and reliable pain and activity assessment tools . The Sickness Impact Profile ( SIP ) was used to compare preoperative normal activity to postoperative activity . A Pain-O-Meter ( visual analogue scale plus affective and sensory pain descriptors ) assessed intensity of pain . The total pain assessment score and SIP were compared across time ( postoperative day 1–42 ) . Analgesic medication was used as a covariate . Results : The total pain score was less for laparoscopic herniorrhaphy but this did not reach statistical significance . Similarly , the SIP showed modest improvement for laparoscopic herniorrhaphy . No differences between groups were noted for morphine equivalents of administered analgesics or length of hospitalization . Conclusion : Further investigation of laparoscopic herniorrhaphy is warranted To evaluate the merits of  laparoscopic inguinal hernia repair ( LHR )  compared to conventional open hernia repair ( OHR ) a r and omized study has been conducted . All patients were day surgical cases , of which 44 were r and omized to a st and ardized OHR under local anesthetic ( LA ) and 42 to an LHR under general anesthesia ( GA ) . Fifteen LHR patients had bilateral repairs .  Operative time for OHR was 30.5 min , for unilateral LHR 35 min , and for bilateral LHR 60 min . OHR patients were discharged after a median of 134.5 min , which was significantly shorter than LHR patients , whose median discharge was 225 min ( P<0.01 ) . Pain scores , activity levels , analgesia requirements , and time taken to return to work were not significantly different following surgery in either group ( P<0.05 ) . There have been two recurrent hernias and one small bowel obstruction in the LHR group . We conclude that both repairs can be successfully performed as day surgical procedures . The added cost of LHR at this stage does not warrant its widespread use in unilateral hernia repairs . Which procedure is adopted should be individualized ; however , patients with bilateral hernias on presentation can be successfully managed as day cases , obviating the need for hospitalization or two operations Laparoscopic hernia operations have been criticized in regard to their high hospital costs . This study was design ed to compare the costs and some outcome features of totally extraperitoneal endoscopic hernia operation ( TEP ) and Lichtenstein mesh repair ( OPN ) among 45 r and omized employed patients . The medians of operative time in the TEP and OPN groups were 67.5 and 53 min , respectively . Return to normal life was 14 days in the TEP group and 20 days in the OPN group . The hospital costs per patient were $ 1,239 ( all costs are in US dollars ) in the TEP group and $ 782 in the OPN group . The median total costs were $ 3,912 and $ 4,661 in the TEP and OPN groups , respectively . The  Lichtenstein operation is cheaper for the hospital . The total costs for working patients are lower with the endoscopic technique because fewer working days are lost UNLABELLED Laparoscopic herniorraphies have been used to reduce the pain and convalescence associated with open approaches . However , there is still not any consensus of the best approach . We compared open preperitoneal and laparoscopic total extraperitoneal approaches in groin hernia repair . METHODS Thirty-two patients underwent open preperitoneal herniorraphy ( Group I ) and other 32 patients underwent total extraperitoneal repair ( Group II ) . Time of surgery was noted . Visual Analogue Scale ( VAS ) was applied to evaluate the postoperative pain intensity . RESULTS Operation time was 35 ( 20 - 65 ) minutes in Group I and 58 ( 40 - 85 ) minutes in Group II ( p < 0.05 ) . The difference of complication ratios between two groups was not significant . Laparoscopic approach was associated with less pain within postoperative 24 hours as compared to the open technique . However , after the first postoperative day , there was no longer statistically significant difference between both groups . No recurrence has yet been seen in follow-up period of 15 ( 4 - 24 ) months . CONCLUSION Laparoscopic herniorraphy is associated with better results in term of postoperative pain within the first 24 hours as compared to open technique Abstract Objective : To compare  tension-free open mesh hernioplasty under local anaesthetic with transabdominal preperitoneal laparoscopic hernia repair under general anaesthetic . Design : A r and omised controlled trial of 403 patients with inguinal hernias . Setting : Two acute general hospitals in London between May 1995 and December 1996 . Subjects : 400 patients with a diagnosis of groin hernia , 200 in each group . Main outcome measures : Time until discharge , postoperative pain , and complications ; patients ' perceived health ( SF-36 ) , duration of convalescence , and patients ' satisfaction with surgery ; and health service costs . Results : More patients in the open group ( 96 % ) than in the laparoscopic group ( 89 % ) were discharged on the same day as the operation ( χ2=6.7 ; 1 df ; P=0.01 ) . Although pain scores were lower in the open group while the effect of the local anaesthetic persisted ( proportional odds ratio at 2 hours 3.5 ( 2.3 to 5.1 ) ) , scores after open repair were significantly higher for each day of the first week ( 0.5 ( 0.3 to 0.7 ) on day 7 ) and during the second week ( 0.7 ( 0.5 to 0.9 ) ) . At 1 month there was a greater improvement ( or less deterioration ) in mean SF-36 scores over baseline in the laparoscopic group compared with the open group on seven of eight dimensions , reaching significance on five . For every activity considered the median time until return to normal was significantly shorter for the laparoscopic group . Patients r and omised to laparoscopic repair were more satisfied with surgery at 1 month and 3 months after surgery . The mean cost per patient of laparoscopic repair was £ 335 ( 95 % confidence interval £ 228 to £ 441 ) more than the cost of open repair . Conclusion : This study confirms that laparoscopic hernia repair has considerable short term clinical advantages after discharge compared with open mesh hernioplasty , although it was more expensive . Key messages In the 4 hours after surgery laparoscopic hernia repair with general anaesthesia causes more pain than open repair with local anaesthesia ( mainly because of the anaesthesia used ) and necessitates longer stay in hospital . Laparoscopic hernia repair , however , causes less pain than open hernia repair during the first 2 weeks after discharge Laparoscopic hernia repair results in fewer episodes of wound infection , persistent local pain , genital swelling , numbness , and constipation than open repair . Urinary disturbances are more common after laparoscopic than after open repair Patients ' perception of health 1 month after the operation ( assessed with the SF-36 ) and satisfaction with treatment is superior for laparoscopic patients who also have a shorter period of convalescence after surgery The health service cost of day case laparoscopic repair  is £ 335 more than the cost of open mesh hernioplasty performed on a day case Abstract Background : The aim of this prospect i ve , r and omized , controlled clin 
    Output:
    
Operation times for laparoscopic repair were longer and there was a higher risk of rare serious complications .
Return to usual activities was faster , and there was less persisting pain and numbness .
Hernia recurrence was less common than after open non-mesh repair but not different to open mesh methods .
The review showed that laparoscopic repair takes longer and has more serious complications , but recovery is quicker with less persisting pain .
Reduced hernia recurrence was related to the use of mesh rather than the method of mesh placement