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.

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].

A comparative observational study was conducted at Nishtar University Hospital, Multan, from October 2025 to April 2026 to evaluate and compare the rates of surgical site infections (SSIs) following elective laparoscopic and open inguinal hernia repair. A total of 90 patients with clinically diagnosed inguinal hernia who underwent elective surgical repair during the study period were included. The study population was divided into two groups according to the operative technique used: Group A, comprising patients who underwent laparoscopic inguinal hernia repair, and Group B, comprising patients who underwent open inguinal hernia repair. Each group consisted of 45 patients. Patients of either sex who were aged 18 years or older, had a clinically diagnosed inguinal hernia, and were scheduled for elective surgical repair were included. Patients with emergency hernia presentations, strangulated or obstructed hernias, recurrent hernias, pre-existing wound infection, immunocompromised conditions, or severe systemic illness were excluded. Patients who had undergone previous abdominal or groin surgery that could have significantly influenced postoperative wound outcomes were also excluded. Individuals who did not complete the required postoperative follow-up were excluded from the final analysis. Before surgery, demographic and clinical information was recorded using a structured data collection proforma. Variables included age, sex, body mass index, type of inguinal hernia, relevant comorbidities, smoking status, and other factors that could have influenced the risk of postoperative infection. All patients underwent routine preoperative assessment, including clinical examination and appropriate laboratory investigations. The operative technique was selected according to the surgeon's assessment, patient characteristics, and institutional practice. Standard principles of aseptic technique and perioperative infection prevention were followed in both groups. Patients in the laparoscopic group underwent elective laparoscopic inguinal hernia repair using an appropriate mesh-based technique, while patients in the open group underwent conventional open mesh repair. The duration of surgery, type of anesthesia, intraoperative complications, and postoperative hospital stay were recorded. Perioperative antibiotic prophylaxis was administered according to the hospital's established surgical protocol. Efforts were made to maintain comparable infection-prevention measures, including appropriate skin preparation, sterile draping, and postoperative wound care, in both groups. The primary outcome was the development of surgical site infection within 30 days after surgery. SSI was assessed according to the clinical criteria for superficial and deep incisional infection, including wound erythema, warmth, swelling, tenderness, purulent discharge, wound dehiscence associated with infection, or a clinical diagnosis requiring antimicrobial treatment. The occurrence, type, and timing of SSI were documented. Secondary outcomes included postoperative fever, wound-related complications, duration of hospital stay, and other postoperative complications. Patients were followed during their hospital stay and subsequently through outpatient visits or telephone contact, as appropriate, for up to 30 days after surgery. Wound examination findings and treatment requirements were documented during follow-up. Particular attention was given to identifying infections that developed after discharge. Data were entered and analyzed using SPSS software. Continuous variables such as age, operative duration, and hospital stay were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. The incidence of SSI was compared between the laparoscopic and open repair groups using the Chi-square test or Fisher's exact test, as appropriate. Continuous variables were compared using the independent-samples t-test or an appropriate non-parametric test. A p-value of <0.05 was considered statistically significant. Ethical approval was obtained from the relevant institutional authority before commencement of the study. Written informed consent was obtained from all participants after the study objectives, procedures, potential risks, and benefits had been explained. 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, from January 2026 to June 2026 were included in the study. The patients were equally divided into two groups: 45 patients underwent laparoscopic inguinal hernia repair (Group A), while 45 underwent open inguinal hernia repair (Group B). The demographic and baseline characteristics of both groups were comparable. The mean age of patients was 48.2 ± 11.6 years in the laparoscopic group and 49.5 ± 12.1 years in the open group. Males predominated in both groups, accounting for 40 (88.9%) patients in Group A and 39 (86.7%) patients in Group B. The mean body mass index was 25.8 ± 3.1 kg/m² and 26.1 ± 3.4 kg/m², respectively. No statistically significant differences were observed between the groups regarding age, sex, or body mass index (p>0.05).

The distribution of surgical characteristics and postoperative outcomes is presented in Table 1. Unilateral hernias were more common than bilateral hernias in both groups. The mean operative time was significantly longer in the laparoscopic group than in the open group (68.4 ± 12.7 minutes versus 54.6 ± 10.9 minutes, p<0.001). However, the laparoscopic group demonstrated a shorter mean hospital stay, with patients remaining hospitalized for 1.4 ± 0.7 days compared with 2.1 ± 0.9 days in the open group (p<0.001). Postoperative wound-related complications were less frequent following laparoscopic repair.

Table 1. Baseline and perioperative characteristics of patients:

The primary outcome, postoperative surgical site infection (SSI), was assessed during the postoperative follow-up period. As shown in Table 2, SSI developed in 2 (4.4%) patients in the laparoscopic group compared with 6 (13.3%) patients in the open repair group. Although the infection rate was approximately three times higher in the open group, the difference did not reach statistical significance (p=0.14). Superficial SSI accounted for all infections observed in both groups, and no deep or organ-space infections were recorded.

Postoperative wound discharge was reported in 2 (4.4%) patients following laparoscopic repair and 7 (15.6%) following open repair (p=0.08). Wound seroma occurred in 4 (8.9%) patients in the laparoscopic group and 3 (6.7%) in the open group (p=0.69). Wound hematoma was observed in 2 (4.4%) and 4 (8.9%) patients, respectively (p=0.40). The overall postoperative complication rate was 17.8% in the laparoscopic group compared with 35.6% in the open group.

Table 2. Postoperative complications and surgical site infection rates:

Overall, the results indicated that laparoscopic repair was associated with a lower observed rate of SSI and fewer postoperative wound-related complications than open repair. The absolute difference in SSI rates was 8.9 percentage points (4.4% versus 13.3%). However, the difference in SSI incidence was not statistically significant at the conventional 5% significance level. The findings nevertheless demonstrated a favorable postoperative infection profile for laparoscopic repair, while open repair was associated with a numerically higher frequency of SSI and wound discharge.

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 might have been influenced by several patient- and 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 controlling for patient characteristics, comorbidities, operative duration, surgeon experience, antibiotic prophylaxis, and other potential confounding factors.

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.