Jacob Rosenberg
Groin hernia repair is among the most common surgical procedures worldwide, yet chronic postoperative pain and recurrence remain important long-term complications. This narrative review compares long-term outcomes after traditional open repair with minimally invasive laparoscopic approaches. Evidence was identified through a structured, non-systematic search of PubMed/MEDLINE and the Cochrane Library, supplemented by reference lists and current international guidelines. Laparoscopic repair is consistently associated with less acute and chronic postoperative pain than open mesh repair, while recurrence rates are broadly comparable when procedures are performed by adequately trained surgeons. However, laparoscopic repair has a steeper learning curve and outcomes are operator-dependent. Mesh-related complications, including seroma, infection, meshoma, and foreign body sensation, occur in a minority of patients but may substantially impair quality of life. Tissue-based repairs, particularly the Shouldice and Desarda techniques, remain valid options for selected patients in experienced hands. Robotic-assisted repair may offer ergonomic and educational advantages, but evidence of superior patient outcomes is limited, while operative times and costs are generally higher than with conventional laparoscopy. Population-level data suggest that greater use of minimally invasive techniques in high-volume centers is associated with improved patient-reported outcomes. Surgical planning should therefore be individualized according to patient sex, age, hernia characteristics, and surgeon expertise. Much of the available evidence is observational or registry-based rather than randomized, which should temper the strength of recommendations. Future priorities include exploring bioengineered mesh, genetic risk stratification, and the potential role of artificial intelligence in surgical decision-making, although these avenues remain at an early exploratory stage.