Inguinal hernia had remained one of the most common conditions requiring surgical intervention worldwide and had represented a significant proportion of general surgical procedures. It had occurred when abdominal contents protruded through a weakness in the inguinal region and had been classified primarily into direct and indirect types.

Although inguinal hernias had often presented with pain, discomfort, swelling, or limitations in daily activities, some patients had remained asymptomatic until complications such as incarceration or strangulation had developed [1]. Surgical repair had been considered the definitive treatment for symptomatic inguinal hernias, with both open and laparoscopic approaches being widely used in clinical practice.

CME Journal of Geriatric Medicine                                                                                                                                                  686

Open inguinal hernia repair had traditionally been the standard surgical approach and had been performed through an incision over the inguinal region. Various open techniques had been developed, with mesh-based tension-free repair, particularly the Lichtenstein technique, having become widely accepted because of its effectiveness and relatively low recurrence rate [2]. Despite its established role, open repair had been associated with postoperative pain, wound-related complications, longer recovery periods, and a greater degree of local tissue trauma. Surgical site infection (SSI) had remained one of the important postoperative complications associated with open procedures, particularly because of the larger incision and greater exposure of subcutaneous tissues.

Laparoscopic inguinal hernia repair had subsequently gained increasing acceptance because it had offered several potential advantages over conventional open surgery [3]. Common laparoscopic techniques had included transabdominal preperitoneal repair and totally extraperitoneal repair. These approaches had used smaller incisions and had generally resulted in reduced tissue trauma, less postoperative pain, earlier mobilization, and faster return to normal activities. The laparoscopic approach had also provided the opportunity to identify and repair bilateral or occult hernias during the same procedure. However, it had required specialized equipment, advanced surgical expertise, and general anesthesia, which had influenced its availability and use in different healthcare settings [4].

Surgical site infection had been recognized as a clinically important postoperative complication because it had been associated with prolonged hospital stays, additional antibiotic treatment, increased healthcare costs, delayed wound healing, and, in severe cases, reoperation. Although inguinal hernia repair had generally been considered a clean surgical procedure with a relatively low incidence of infection, SSIs had continued to occur following both open and laparoscopic approaches [5]. The risk of infection had been influenced by several factors, including patient age, obesity, diabetes, smoking, immunocompromised status, operative duration, surgical technique, mesh placement, perioperative antibiotic administration, and postoperative wound care.

The comparative assessment of SSI rates between laparoscopic and open inguinal hernia repair had therefore been clinically relevant. While laparoscopic repair had theoretically reduced wound-related complications because of smaller incisions, the use of prosthetic mesh and the technical complexity of the procedure had raised questions regarding whether the reduction in wound exposure consistently translated into lower infection rates [6]. Conversely, open repair had involved a larger surgical wound but had remained widely practiced because of its technical familiarity, cost-effectiveness, and suitability for many patients.

Previous research had demonstrated variations in postoperative infection rates between the two techniques,

and differences had also been reported according to patient characteristics, institutional practices, surgical expertise, and infection-prevention protocols. Therefore, evaluating SSI rates within a defined clinical setting had been important for determining the relative safety of these approaches. A direct comparison had also helped identify whether laparoscopic repair had provided a meaningful advantage in reducing postoperative wound infections compared with open repair [8].

The present study had therefore been conducted to evaluate and compare the rates of surgical site infection following elective laparoscopic and open inguinal hernia repair. The study had focused on postoperative infection as the principal outcome and had aimed to provide clinically relevant evidence regarding the comparative wound safety of both surgical techniques. The findings had been expected to contribute to surgical decision-making and to support appropriate perioperative infection-prevention strategies in patients undergoing elective inguinal hernia repair [9].

Study Design and Setting

This comparative study was conducted at Nishtar University Hospital, Multan, from December 2025 to May 2026. The study was designed to compare the rates of surgical site infection (SSI) following elective laparoscopic and open inguinal hernia repair. A total of

90 patients who underwent elective inguinal hernia repair during the study period were enrolled. The participants were divided into two equal groups according to the surgical technique used. Group A consisted of 45 patients who underwent laparoscopic inguinal hernia repair, whereas Group B consisted of 45 patients who underwent conventional open inguinal hernia repair.

Patient Selection

Patients of either sex who were scheduled for elective repair of clinically diagnosed inguinal hernia were considered eligible for inclusion. Patients were included if they underwent a planned elective procedure and were available for postoperative assessment. Patients with emergency or strangulated hernias, recurrent hernias requiring complex repair, pre-existing infection at or near the operative site, or severe systemic illness that could significantly influence wound healing were excluded. Patients with incomplete clinical records or those who were unavailable for postoperative follow-up were also excluded.

Preoperative Assessment

All enrolled patients underwent a detailed preoperative evaluation. Relevant demographic and clinical information, including age, sex, body weight, comorbid conditions, smoking history, and relevant medical history, was recorded. A physical examination was performed to assess the hernia and identify any factors that could increase the risk of postoperative infection. Routine preoperative investigations were performed

according to institutional protocols. Patients were prepared for surgery using standard hospital procedures, including appropriate preoperative skin preparation and administration of prophylactic antibiotics when indicated.

Surgical Procedures

Laparoscopic inguinal hernia repair was performed using the institutionally adopted laparoscopic technique under general anesthesia. Appropriate mesh placement was carried out after reduction of the hernia, and port-site wounds were closed according to standard surgical practice. Open inguinal hernia repair was performed through a conventional inguinal incision under the appropriate type of anesthesia. The hernia sac was managed according to the operative findings, and mesh repair was performed where indicated. In both groups, efforts were made to maintain aseptic surgical technique, minimize tissue trauma, and ensure adequate hemostasis.

Assessment of Surgical Site Infection

The primary outcome was the occurrence of surgical site infection following inguinal hernia repair. Patients were assessed during the postoperative hospital stay and during scheduled follow-up visits. SSI was identified on the basis of clinical findings such as wound redness, swelling, increased local temperature, tenderness, purulent discharge, wound separation, or other evidence of infection. When clinically indicated, wound cultures and  additional  investigations  were  performed.  The 

occurrence, timing, and clinical characteristics of SSI were documented for each patient.

Data Collection and Statistical Analysis

Data were collected using a structured data collection form and entered into a computerized database. Demographic characteristics, operative details, postoperative findings, and SSI outcomes were recorded and compared between the two groups. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 26.0. Continuous variables were summarized using means and standard deviations, whereas categorical variables were presented as frequencies and percentages. The incidence of SSI was calculated separately for the laparoscopic and open repair groups. Appropriate statistical tests were applied to compare categorical and continuous variables between the groups. A p-value of less than 0.05 was considered statistically significant.

Ethical Considerations

The study was conducted according to accepted ethical principles for research involving human participants. Institutional ethical approval was obtained before commencement of the study. The purpose and procedures of the study were explained to eligible participants, and informed consent was obtained before enrollment. Patient confidentiality was maintained throughout the study, and collected information was used solely for research purposes.

A total of 90 patients who underwent elective inguinal hernia repair at Nishtar University Hospital, Multan, between December 2025 and May 2026 were included in the study. The patients were equally divided into two groups, with 45 patients undergoing laparoscopic repair and 45 undergoing open repair. The overall mean age of the study population was 44.8 ± 11.6 years. Male patients constituted the majority of the participants (84, 93.3%), whereas females accounted for 6 (6.7%) patients. The demographic distribution was comparable between the two treatment groups, allowing postoperative outcomes to be evaluated between the laparoscopic and open approaches.

Table 1. Demographic Characteristics of the Study Participants:

Table 1 showed that the mean age was 44.5 ± 11.4 years in the laparoscopic group and 45.1 ± 11.8 years in the open repair group, with an overall mean age of 44.8 ± 11.6 years. The participants were predominantly male in both groups, with 42 (93.3%) males in each group. Females accounted for 3 (6.7%) participants in each treatment group. Thus, the demographic characteristics were closely distributed between the two groups.

The principal postoperative outcomes are presented in Table 2. Surgical site infection (SSI) occurred considerably less frequently following laparoscopic repair than after open repair. Only 2 (4.4%) patients in the laparoscopic group developed SSI compared with 8 (17.8%) patients in the open repair group. This represented an absolute difference of 13.4 percentage points between the groups and was statistically significant (p = 0.044). The lower frequency of SSI among laparoscopic patients indicated a favorable wound-related outcome associated with the minimally invasive approach.

Table 2. Comparison of Operative and Postoperative Outcomes:

The mean duration of hospital stay was also significantly shorter in the laparoscopic group. Patients undergoing laparoscopic repair had a mean hospital stay of 1.6 ± 0.7 days, whereas those undergoing open repair remained hospitalized for 2.8 ± 1.1 days. The difference of 1.2 days was statistically significant (p < 0.001), demonstrating that laparoscopic repair was associated with earlier postoperative discharge.

In contrast, operative time was significantly longer among patients who underwent laparoscopic repair. The mean operative time was 74.5 ± 12.4 minutes in the laparoscopic group compared with 61.8 ± 10.6 minutes in the open repair group. The mean difference was 12.7 minutes and was statistically significant (p < 0.001). Despite requiring more operative time, laparoscopic repair demonstrated better postoperative outcomes, particularly with respect to surgical site infection and duration of hospital stay.

Overall, the results indicated that laparoscopic inguinal hernia repair was associated with a significantly lower rate of surgical site infection and shorter hospitalization than open repair. Although the laparoscopic procedure required significantly more operative time, the postoperative advantages suggested faster recovery and fewer wound-related complications. These findings supported the use of laparoscopic repair as an effective approach for elective inguinal hernia surgery in the studied population.

The present comparative study evaluated surgical site infection (SSI) rates following elective laparoscopic and open inguinal hernia repair. The findings indicated that the laparoscopic approach had been associated with a lower frequency of postoperative surgical site infections than the open approach. This difference had suggested that the minimally invasive technique might have provided an advantage in reducing wound-related complications in patients undergoing elective inguinal hernia repair [10]. The observed findings had been clinically relevant because SSI had remained one of the important postoperative complications that could prolong hospital stay, increase healthcare costs, delay recovery, and adversely affect patient satisfaction.

The lower SSI rate observed after laparoscopic repair could have been explained by the smaller size of the surgical incisions and reduced exposure of the operative wound to the external environment. In open hernia repair, a relatively larger groin incision had been required, which had created a greater tissue surface for bacterial contamination and postoperative wound complications [11]. In contrast, laparoscopic repair had involved small port-site incisions and had generally resulted in less disruption of the skin and subcutaneous tissues. Reduced tissue trauma and limited wound exposure had therefore potentially contributed to the lower infection rate observed in the laparoscopic group. The findings had also been consistent with the broader clinical understanding that minimally invasive surgical procedures could reduce postoperative wound morbidity.

Laparoscopic repair had usually been associated with less postoperative pain, earlier mobilization, and faster return to routine activities. Although the primary outcome of the present study had been SSI, these associated benefits had strengthened the clinical value of laparoscopic repair in appropriately selected patients [12]. However, the laparoscopic technique had required specialized equipment, adequate surgical expertise, and general anesthesia, which could have limited its availability in some healthcare settings.

The relatively higher infection rate following open repair

procedure-related factors. Longer operative exposure,

greater tissue handling, hematoma or seroma formation, and larger incisions could have increased the susceptibility of the wound to bacterial infection. Patient-related factors such as advanced age, obesity, diabetes, smoking, poor nutritional status, and inadequate postoperative wound care could also have contributed to SSI development [13]. Therefore, the difference between the two surgical techniques had not necessarily been attributable to the operative approach alone, and other perioperative variables might have played an important role.

Despite the apparent advantage of laparoscopic repair, open hernia repair had remained an effective and widely used treatment option. It had offered several practical advantages, including technical simplicity, relatively lower equipment requirements, and the possibility of performing the procedure under regional or local anesthesia in selected patients [14]. Consequently, the choice of surgical technique had needed to consider patient characteristics, hernia type, surgeon expertise, available resources, and institutional protocols rather than SSI risk alone.

Appropriate perioperative infection-prevention measures had remained important regardless of the surgical technique used. Proper skin preparation, adherence to aseptic techniques, appropriate antibiotic prophylaxis when indicated, careful handling of tissues, adequate hemostasis, and standardized postoperative wound care could have reduced the risk of SSI in both groups. The findings had therefore emphasized that improvements in surgical technique and infection-control practices could collectively contribute to better postoperative outcomes [15].

Overall, the study had demonstrated a comparatively lower risk of surgical site infection following elective laparoscopic inguinal hernia repair than following open repair. The findings had supported the use of laparoscopic repair as an effective approach for reducing wound-related postoperative morbidity in suitable patients. Nevertheless, larger prospective studies with longer follow-up periods had been needed to further evaluate SSI risk while operative duration, surgeon experience, antibiotic prophylaxis, and other potential confounding factors.

 might have been influenced by several patient- and                controlling  for  patient  characteristics,  comorbidities,

The study concluded that elective laparoscopic inguinal hernia repair had been associated with a lower rate of surgical site infection (SSI) compared with open inguinal hernia repair. Patients who had undergone laparoscopic repair had demonstrated fewer postoperative wound-related complications, which had suggested better infection control and improved short-term surgical outcomes. The reduced incidence of SSI had been attributed to the smaller incisions, limited tissue handling, and reduced exposure of the operative wound associated with the laparoscopic approach. Although both techniques had been considered effective for elective inguinal hernia repair, the laparoscopic approach had provided an advantage in reducing postoperative infectious complications. The findings had supported the preferential use of laparoscopic repair in appropriately selected patients, particularly when infection prevention and rapid postoperative recovery had been important considerations. However, surgical expertise, patient characteristics, availability of equipment, and overall clinical circumstances had remained important factors in selecting the most appropriate surgical technique.

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