***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 A cost-effectiveness ( CE ) analysis was performed of Bassini versus laparoscopic repair for primary inguinal hernia .  Incremental costs per 1-year recurrence-free patient were calculated for the societal and hospital perspective . From the hospital perspective , the incremental CE ratio of laparoscopic repair is 5.348 guilders . From the societal perspective , laparoscopic repair is both less costly and more effective than Bassini repair . Results were sensitive to assumptions about recurrence rates , laparoscopic operating time , and return to work .  Laparoscopic repair should replace Bassini repair in order to benefit society . From the hospital perspective , the decision to accept laparoscopic repair depends on the willingness to pay 181 patients have been included in a controlled r and omized prospect i ve study to compare two hernia repair technics : Classic al Shouldice herniography vs totally pre-peritoneal video-surgery . There was no mortality and no difference concerning morbidity , operating time and hospital stay .  Videosurgery allows detection and treatment of some bilateral hernias not diagnosed by clinical exam , ensures better post-operative comfort and has a significant effect on the time to return to work ( 12.5 vs 24.3 days ) . There was no recurrence in either group with a 12-month follow-up . These patients must be followed for a long time to compare their late results with those of conventional technics 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 This study was a pragmatic economic evaluation carried out alongside a multicentre r and omized controlled trial comparing  laparoscopic with open groin hernia repair .  The primary economic evaluation framework employed was a cost – utility analysis BACKGROUND The rapid and widespread introduction of minimal access surgery has major implication s for the National Health Service . It can not be assumed that replacing an open procedure with a minimal access alternative will be cost-effective . Laparoscopic inguinal hernia repair is a procedure for which the potential economic benefits are particularly unclear . It is currently being adopted in many centres , although limited evidence on its clinical and cost-effectiveness exists . METHODS This economic comparison of laparoscopic versus open hernia repair was undertaken on data collected on 104 patients undergoing surgery on a day case basis , in the context of a r and omized controlled trial . RESULTS The mean total health service cost of laparoscopic repair  was 1074 pounds versus 489 pounds for open repair [ mean difference in total health service costs 583 pounds ; 95 percent confidence interval ( CI ) 265 pounds-904 pounds ] . This difference was largely accounted for by the difference in theatre costs .  Laparoscopic repair remained significantly more expensive for most but not all of the scenarios explored in the sensitivity analysis . The direction of the cost-effectiveness ratio was not sensitive to assumptions about long-term recurrence . Neither was it sensitive to halving the operating time in the laparoscopic arm of the trial . When both operating time and the costs of consumables were reduced , laparoscopic repair  remained more expensive , but results for this scenario did not achieve statistical significance on this sample size . CONCLUSIONS Laparoscopic hernia repair appears an expensive option in most plausible situations . Furthermore , many uncertainties still exist about long-term outcome after the procedure and about the conditions necessary to maximize cost-effectiveness . Large-scale r and omized studies to evaluate laparoscopic hernia repair are currently under way to address these issues . We suggest that further evidence is awaited before this technology is further diffused OBJECTIVE To determine whether  transabdominal preperitoneal laparoscopic hernia repair  can equal or surpass an established open method at an acceptable cost . DESIGN A r and omized , prospect i ve comparison with a follow-up of 7 to 18 months ( median , 10 months ; planned , 5 years ) . SETTING Health maintenance organization hospital . PATIENTS One hundred patients between 20 and 70 years of age were r and omized . No patient withdrew from the study after r and omization . INTERVENTIONS Transabdominal preperitoneal laparoscopic and open tension-free repairs using a polypropylene mesh . MAIN OUTCOME MEASURES Operative and discharge times , costs , recovery , and morbidity . " Return to work " was supplemented by a performance assessment using a panel of exercises . RESULTS Operative and hospitalization times were not significantly different between the two types of repair . Patients with laparoscopic unilateral repairs  returned to work faster ( 9 vs 17 days ) . At 1 week postoperatively , performance of straight-leg raises correlated well with time to return to work for patients with strenuous jobs . The laparoscopic repair was more expensive than the open approach ( $ 3093 vs $ 2494 ) . CONCLUSIONS Laparoscopic transabdominal preperitoneal hernia repair can be accomplished with operative and hospitalization times and a short-term recurrence rate similar to those of an established open technique . Perioperative exercise testing may be an important adjunct to return to work in the comparison of methods In a prospect i ve , r and omized study ,  laparoscopic ( n = 20 ) and Lichtenstein ( n = 18 ) inguinal hernia repairs  were compared in relation to operative time , operative costs , hospital stay , postoperative pain , return to work , patient satisfaction , complications , and total costs . All the operations were performed with the patient under general anesthesia . The median operative times in the laparoscopic and Lichtenstein groups were 71.5 ( range , 43 - 140 ) and 45 ( 16 - 83 ) min , respectively ( p < 0.001 ) . Postoperative pain and use of analgesics was less in the laparoscopic group . The median time to return to work was 14 ( 8 - 26 ) days in the laparoscopic group and 19 ( 5 - 40 ) days in the Lichtenstein group . More complications occurred in the Lichtenstein group . The median of the operative costs , in U.S. dollars , was $ 1,395 and $ 878 , respectively , and the median total costs ( including community expenses result ing from lost workdays ) were $ 4,796 in the laparoscopic and $ 5,320 in the Lichtenstein groups BACKGROUND The role of laparoscopic inguinal hernia repair  is controversial . The aim of this study was to find out whether it is justified to switch from the predominantly modified Bassini repair which the authors had been using to laparoscopic repair . METHODS R and omized controlled trial in 120 eligible patients admitted for elective hernia repair in a university hospital . RESULTS Sixty patients underwent laparoscopic transabdominal preperitoneal mesh repair ; the other 60 patients had an open repair , mostly with the modified Bassini technique .  Operative time for laparoscopic repair was significantly longer , mean ( s.d . ) 95 ( 28 ) min vs 67 ( 27 ) min ( p < 0.001 ) . The mean analogue pain score during the first 24 h after surgery was 36.2 ( 20.2 ) in the laparoscopic group and 49.3 ( 24.9 ) in the open group ( p = 0.006 ) . The requirement for narcotic injections and postoperative disability in walking 10 m and getting out of bed were also significantly less following laparoscopic repair . The postoperative hospital stay was not significantly different , mean 2.6 ( 1.2 ) days for laparoscopic repair and 3.0 ( 1.5 ) days for open repair ( p = 0.1 ) . Patients were able to perform light activities without 
    Output:
    
Laparoscopic repair was less efficient than open mesh repair in terms of avoiding recurrences , avoided but it had a modest cost per additional day back at usual activities .
Laparoscopic repair is more likely to be efficient when compared with open nonmesh repair .
CONCLUSION The type of open repair with which laparoscopic repair is compared influences its cost-effectiveness .
The earlier return to usual activities provided by laparoscopic repair may make it worthwhile in some circumstances