***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 A prospect i ve study of 242 patients with inguinal hernia who underwent tension‐free mesh repair by the laparoscopic transperitoneal ( n = 121 ) or the open Lichtenstein ( n = 121 ) technique  was performed . There was no significant difference in operation time between the laparoscopic ( median ( range ) 35 ( 20–90 ) min ) and Lichtenstein ( 40 ( 20–90 ) min ) procedures . Discharge within 24 h of operation was more common after laparoscopic surgery ( 89·3 per cent versus 48·7 per cent ) . Consequently , hospital stay was reduced with this approach ( median ( range ) 1 ( 1–7 ) days versus 2 ( 1–10 ) days for patients who had a Lichtenstein repair ) . There was no significant difference in parenteral analgesia requirements or visual analogue pain scores between the two groups . Although use of oral analgesia in hospital was greater in patients who underwent Lichtenstein hernioplasty , this may reflect their longer stay . Rehabilitation to normal activity and return to work was shorter in patients receiving laparoscopic repair ( median 7 and 10 days , respectively ) than Lichtenstein repair ( 14 and 21 days ) ( P < 0·001 ) . Initial results suggest that laparoscopic procedures may be associated with more rapid rehabilitation compared with that of open tension‐free mesh surgery . Most patients with inguinal hernia undergoing tension‐free mesh repair by either technique would be suitable for day‐case surgery 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 In a prospect i ve r and omized study postoperative pain , analgesic consumption , return to physical activity and work , cosmetic result and experience with the type of operation were assessed in 86 patients undergoing inguinal hernia repair by means of either the Shouldice technique ( n = 34 ) , the laparoscopic transabdominal preperitoneal ( TAPP ) ( n = 28 ) or total preperitoneal ( TPP ) ( n = 24 ) repair . Patients having TAPP repair had decreased visual analogue scale scores for pain on the day of operation compared with those undergoing TPP and Shouldice repair ( 4.8 versus 6.5 and 6.2 respectively , P = 0.02 ) and on the first postoperative day compared with TPP ( 4.0 versus 6.0 , P = 0.01 ) . There was no difference between the three groups for days 2 , 3 , 4 , 5 and 30 after operation . Patient satisfaction with the operation , analgesic consumption , return to physical activity such as walking , driving , climbing stairs , running , bicycling and sexual intercourse , as well as return to work , was comparable in the three groups . There was a better cosmetic result after TAPP and TPP repair . This study failed to demonstrate significant benefits from laparoscopic hernia repair over the Shouldice technique 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 BACKGROUND Inguinal hernias can be repaired by laparoscopic techniques , which have had better results than open surgery in several small studies . METHODS We performed a r and omized , multicenter trial in which 487 patients with inguinal hernias were treated by extraperitoneal laparoscopic repair and 507 patients were treated by conventional anterior repair .  We recorded information about postoperative recovery and complications and examined the patients for recurrences one and six weeks , six months , and one and two years after surgery . RESULTS Six patients in the open-surgery group but none in the laparoscopic-surgery group had wound abscesses ( P=0.03 ) , and the patients in the laparoscopic-surgery group had a more rapid recovery ( median time to the resumption of normal daily activity , 6 vs. 10 days ; time to the return to work , 14 vs. 21 days ; and time to the resumption of athletic activities , 24 vs. 36 days ; P<0.001 for all comparisons ) . With a median follow-up of 607 days , 31 patients ( 6 percent ) in the open-surgery group had recurrences , as compared with 17 patients ( 3 percent ) in the laparoscopic-surgery group ( P=0.05 ) . All but three of the recurrences in the latter group were within one year after surgery and were caused by surgeon-related errors . In the open-surgery group , 15 patients had recurrences during the first year , and 16 during the second year . Follow-up was complete for 97 percent of the patients . 
    Output:
    
REVIEW ER 'S CONCLUSIONS The use of mesh during laparoscopic hernia repair is associated with a relative reduction in the risk of hernia recurrence of around 30 - 50 % .
However , there is no apparent difference in recurrence between laparoscopic and open mesh methods of hernia repair .
The data suggests less persisting pain and numbness following laparoscopic repair .
Return to usual activities is faster .
However , operation times are longer and there appears to be a higher risk of serious complication rate in respect of visceral ( especially bladder ) and vascular injuries