| N Engl J Med 1997 May 29;336(22):1541-7 |
Comparison of conventional anterior surgery and
laparoscopic surgery for inguinal-hernia repair.
Liem MS, van der Graaf Y, van Steensel CJ, Boelhouwer RU, Clevers GJ,
Meijer WS, Stassen LP, Vente JP, Weidema WF, Schrijvers AJ, van
Vroonhoven TJ
Department of Surgery, University Hospital Utrecht, the Netherlands.
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 randomized, 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.
CONCLUSIONS: Patients with inguinal hernias who undergo laparoscopic
repair recover more rapidly and have fewer recurrences than those who
undergo open surgical repair.Laparoscopic or open inguinal herniorrhaphy? A
randomized prospective trial.
Payne JH Jr, Grininger LM, Izawa MT, Podoll EF, Lindahl PJ, Balfour J
Kaiser Foundation Hospital, Honolulu.
OBJECTIVE: To determine whether transabdominal preperitoneal laparoscopic
hernia repair can equal or surpass an established open method at an
acceptable cost. DESIGN: A randomized, prospective 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 randomized. No patient
withdrew from the study after randomization. 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.
| Arch Surg 1994 Apr;129(4):361-6 |
|
A prospective comparison of laparoscopic and
tension-free open herniorrhaphy.
Brooks DC
Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
OBJECTIVE: To compare results and outcomes following laparoscopic and
tension-free open inguinal herniorrhaphy. DESIGN: A prospective,
nonrandomized trial of a single surgeon's experience. SETTING: A large
university hospital. PATIENTS: The study included 100 patients with
116 hernias. Patients were offered open hernia repair or, if medically
suitable for general anesthesia, a laparoscopic hernia repair.
Fifty-seven patients underwent open repair and 43 patients underwent
laparoscopic repair. INTERVENTION: Laparoscopic repair was performed
using a transabdominal preperitoneal mesh technique. Open hernia
repair was performed using a mesh-plug technique in which the hernia
sac was reduced and held in place by a cone of mesh. The floor was
covered with a second piece of mesh that encircled the cord and was
sutured at the internal ring; it was held in place under the external
oblique without sutures. RESULTS: Patients undergoing open repair were
older than those undergoing laparoscopic repair. The distribution of
hernia types was similar. The laparoscopic operation took longer than
the open operation (mean [+/- SD], 1.9 +/- 0.4 hours vs 1.6 +/- 0.4
hours; P < .05), was more expensive ($4165 +/- $1154 vs $2985 +/-
$1682; P < .05), and required more postoperative admissions (28% vs
3.5%). There were three recurrences in the laparoscopic group and none
in the open group. Patients undergoing laparoscopic repair consumed
the same amount of narcotic analgesics as did the group undergoing
open repair and had discomfort for the same amount of time. Patients
undergoing laparoscopic repair returned to work sooner than did
patients undergoing open repair (5.6 days vs 10.3 days; P < .05).
CONCLUSIONS: Laparoscopic hernia repair returns patients to the
workplace faster than open hernia repair despite a similar analgesic
requirement. The laparoscopic repair costs more and has a higher
recurrence rate than open repair. Laparoscopic repair is most suitable
for bilateral hernias. Further investigation of this technique is
required before its wide-scale application can be recommended.
| Ann Chir Gynaecol 1998;87(1):22-5 |
|
Laparoscopic versus open preperitoneal inguinal
hernia repair: a prospective randomised trial.
Aitola P, Airo I, Matikainen M
Department of Surgery, Tampere University Hospital and Medical School,
Finland.
BACKGROUND AND AIMS: Before choosing between open and laparoscopic
preperitoneal tension-free repair, a study comparing their safety and
short-term outcome was needed. No randomised studies comparing the two
hernia repair techniques have hitherto been published. MATERIAL AND
METHODS: A prospective randomised study was carried out comparing
laparoscopic transabdominal preperitoneal mesh herniorrhaphy (n = 24)
to open preperitoneal mesh herniorrhaphy (n = 25). RESULTS: When
comparing unilateral repairs, the mean operation time was
significantly (P < 0.01) shorter in the open group (55 min) than in
the laparoscopic group (66 min). Pain on movement (P < 0.05) and
pain on coughing (P < 0.01) receded more rapidly in the
laparoscopic group. The median time before return to work or normal
activity was 7 days (range 1-60) in laparoscopic and 5 days (1-30) in
open repair. There were five (21%) complications associated with the
laparoscopic procedure, while the open procedure resulted in two (8%)
complications. After a median follow-up of 18 months the recurrence
rate in the laparoscopic group was 13% and in the open group 8%.
CONCLUSIONS: In this study the open method was associated with fewer
complications and recurrences than the laparoscopic technique. Despite
the decreased postoperative discomfort after laparoscopic repair,
there was no significant difference in median time before return to
work or normal activity. These results together with the higher cost
of the laparoscopic procedure suggest that the open method is more
suitable at least for unilateral hernias.
| Surg Endosc 1996 May;10(5):495-500 |
|
A randomized controlled trial of laparoscopic
extraperitoneal hernia repair as a day surgical procedure.
Bessell JR, Baxter P, Riddell P, Watkin S, Maddern GJ
Department of Surgery, The Queen Elizabeth Hospital, Woodville Road,
Woodville, South Australia 5011, Australia.
BACKGROUND: A randomized controlled trial was conducted in a day
surgery setting comparing a standardized variant of the Shouldice
hernioplasty with extraperitoneal laparoscopic herniorrhaphy. METHODS:
The laparoscopic repair was technically challenging, evidenced by
conversion from extraperitoneal to transabdominal repairs in 6.25% of
patients. It was free from the inherent dangers of intraperitoneal
laparoscopy. Surgical morbidity was low and comparable to that for
patients randomized to the open repair. RESULTS: Outcome following
laparoscopic extraperitoneal herniorrhaphy varied depending on the
parameter measured. It was comparable to the open repair with respect
to postoperative activity levels and the number of days required for
return to work but inferior to the open repair in terms of operation
time and time to hospital discharge. The extraperitoneal approach was
superior to the open repair with respect to postoperative pain levels
and analgesic requirements. No attempt was made to compare recurrence
rates due to the short follow-up period. CONCLUSIONS: Laparoscopic
extraperitoneal herniorrhaphy should not supercede conventional hernia
repair until subjected to further trials with the aid of larger study
populations and greater technical expertise; the results of long-term
recurrence rates are awaited.
| Br J Surg 1999 Mar;86(3):316-9 |
|
Randomized clinical trial of laparoscopic versus
open inguinal hernia repair.
Juul P, Christensen K
Department of Surgery, Nyborg Hospital, Denmark.
BACKGROUND: Several studies have suggested that better results are
obtained after laparoscopic repair of inguinal hernia than after
conventional operation. This is most obvious for bilateral and
recurrent hernias but less accepted for primary unilateral hernias.
METHODS: This was a randomized clinical trial comparing transabdominal
preperitoneal laparoscopic repair with the Shouldice technique in
patients with primary unilateral hernia. Some 138 patients were
randomized to laparoscopic hernia repair and 130 to open surgical
repair. RESULTS: The complication rates in the two groups were
similar. In the laparoscopic group the patients returned to work more
rapidly with a median time of 13 versus 18 days (P < 0.005) and had
a shorter period of analgesia intake with a median time of 2.1 versus
2.7 days (P < 0.02). The follow-up was 97.8 per cent complete. At a
median of 12 months, four recurrences (2.9 per cent) were detected in
the laparoscopic group and three (2.3 per cent) in the open group.
CONCLUSION: This study shows that in patients with a primary
unilateral hernia laparoscopic repair results in less postoperative
pain and a quicker recovery than open repair.
| Surg Endosc 1998 Jun;12(6):846-51 |
|
Laparoscopic vs open inguinal hernia repair. A
randomized, controlled trial.
Tanphiphat C, Tanprayoon T, Sangsubhan C, Chatamra K
Department of Surgery, Faculty of Medicine, Chulalongkorn Hospital,
Chulalongkorn University, Rama IV Road, Bangkok 10330, Thailand.
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:
Randomized 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 pain
or discomfort sooner after laparoscopic repair, median interquartile
range 8 (5-14) days vs 14 (8-19) days (p = 0.013). Patients also
resumed heavy activities sooner, but not significantly, after
laparoscopic repair, median 28 (17-60) days vs 35 (20-56) days (p =
0.25). The return to work was not significantly different, median 14
(8-25) days after laparoscopic repair and 15 (11-21) days after open
repair (p = 0.14). After a mean follow-up of 32 months one patient
developed a recurrent hernia 3 months after a laparoscopic repair.
Laparoscopic repair was more costly than open repair by approximately
$400. CONCLUSIONS: Laparoscopic inguinal hernia repair was associated
with less early postoperative pain and disability and earlier return
to full activities than open repair, but there were no benefits
regarding postoperative hospital stay and return to work; laparoscopic
repair was also more costly.
| J Laparoendosc Surg 1995 Dec;5(6):349-55 |
|
A comparative study of laparoscopic extraperitoneal
and transabdominal preperitoneal herniorrhaphy.
Khoury N
Department of Surgery, Jean-Talon Hospital, Montreal, Quebec, Canada.
Laparoscopic minimally invasive surgical procedures are gaining
popularity. Laparoscopic hernia repair is now less controversial and
more readily acceptable, with at present numerous technical
modifications described in an attempt to define the best procedure.
Between November 1992 and February 1995, a nonrandomized trial of
laparoscopic inguinal herniorrhaphy was performed on 115 patients with
a total of 120 hernias. Of these 58 patients with 60 hernias underwent
the transabdominal preperitoneal patch repair (TAPP) without plug and
57 patients with a total of 60 hernias were offered the
extraperitoneal (EXTRA) approach using a distension balloon. The
average operative time was 55 min for the TAPP and 50 min for the
EXTRA procedure. The overall recurrence rate was 1.7% with a follow up
of 1-27 months. The recurrence rate was 3.4% for the TAPP and none for
the EXTRA approach. All patients returned to their normal activity
within 1 week of discharge. Patients undergoing the EXTRA repair
consumed less amount of narcotic analgesic than did the group
undergoing the TAPP repair. Of the EXTRA group 58% did not require any
analgesic, compared to 22% of the TAPP group (p < 05). There were
no intraoperative complications. A total of 8 (6.9%) postoperative
complications occurred in 115 patients. Four complications (6.9%)
occurred in the TAPP procedure: 2 transient urinary retentions, 1
pulmonary edema, and 1 Richter's type hernia. Four (6.9%)
complications occurred in the EXTRA procedure: 1 urinary retention, 2
abdominal wall ecchymoses, and 1 thoracic pain. Hospital stay was
shorter for the EXTRA group: 57% were discharged the same day and 98%
were discharged within 24 h of their operations for the EXTRA group
compared to 10 and 84%, respectively, for the TAPP (p < 0.05).
Laparoscopic extraperitoneal hernia repair can be accomplished with
shorter hospitalization and less analgesic requirement than the TAPP
repair. The overall incidence of complications, the recurrence rate,
and the return to normal activity were not different between the two
types of repair.
| Surg Endosc 1998 Jul;12(7):979-86 |
t |
A randomized, controlled, clinical study of
laparoscopic vs open tension-free inguinal hernia repair.
Paganini AM, Lezoche E, Carle F, Carlei F, Favretti F, Feliciotti
F, Gesuita R, Guerrieri M, Lomanto D, Nardovino M, Panti M, Ribichini
P, Sarli L, Sottili M, Tamburini A, Taschieri A
Istituto di Scienze Chirurgiche, Universita di Ancona, Ospedale
Umberto I degrees, Piazza Cappelli 1, 60121 Ancona, Italy.
BACKGROUND: The aim of this prospective, randomized, controlled
clinical study was to compare laparoscopic transabdominal
preperitoneal (TAPP) hernia repair with a standard tension-free open
mesh repair (open). METHODS: A total of 108 low-risk patients with
unilateral (primary or recurrent) or bilateral hernias were randomized
to TAPP (group 1 = 52 cases) or open (group 2 = 56 cases). The outcome
measures included operating time, complications, postoperative pain,
return to normal activity, operating theater costs, and recurrences.
RESULTS: The mean operative time was longer for the TAPP than for the
open group only in unilateral primary hernias. At rest, the median
Visual Analog Scale (VAS) score was higher for group 1 than group 2 at
48 h postoperatively. Mild to discomforting pain in the inguinal
region after 7 days, night pain after 30 days, and inguinal hardening
after 3 months were more frequent in group 2 than group 1. No
significant differences were observed in return to normal activities
between the groups. One hernia recurrence was observed after 1 month
in group 1. TAPP was significantly more expensive than open.
CONCLUSIONS: TAPP was associated with less postoperative pain than
open. The increase in operating theater costs, however, was dramatic
and was not compensated by shorter time away from work. TAPP should
not be adopted routinely unless its costs can be drastically reduced.
| Br J Surg 1997 Jan;84(1):64-7 |
|
A randomized comparison of physical performance
following laparoscopic and open inguinal hernia repair. The Coala
Trial Group.
Liem MS, van der Graaf Y, Zwart RC, Geurts I, van Vroonhoven TJ
Department of General Surgery, University Hospital Utrecht, The
Netherlands.
BACKGROUND: Return to normal activity after laparoscopic inguinal
hernia repair has been reported to occur sooner than after
conventional repair. METHODS: As part of a randomized study, the
ability of patients to return to normal activity was assessed by
measuring abdominal muscular performance with an exercise test. In
addition, patients completed a questionnaire concerning activities of
daily life (ADL) and were asked when they returned to normal
activities. All patients were given similar instructions for
resumption of activities. RESULTS: Patients who had a laparoscopic
repair returned to normal activities sooner (6 versus 10 days; P =
0.0003). One week after operation, these patients were able to perform
more repetitions of both exercise (14 versus two straight leg raises;
16 versus seven curled sit ups; both P < 0.0001) and their ADL
scores were significantly better (89 versus 72; P = 0.0001).
CONCLUSION: Laparoscopic hernia repair results in a quicker recovery.
| Ann Surg 1999 Aug;230(2):225-31 |
|
Laparoscopic mesh versus open preperitoneal mesh
versus conventional technique for inguinal hernia repair: a randomized
multicenter trial (SCUR Hernia Repair Study).
Johansson B, Hallerback B, Glise H, Anesten B, Smedberg S, Roman J
Department of Surgery, Norra Alvsborgs Lanssjukhus, Trollhattan,
Sweden.
OBJECTIVE: To evaluate the influence of the laparoscopic technique in
hernia repair regarding time to full recovery and return to work,
complications, recurrence rate, and economic aspects. SUMMARY
BACKGROUND DATA: Several studies have shown advantages in terms of
less pain and faster recovery after laparoscopic hernia repair,
whereas others have not, and the cost-effectiveness has been
questioned. The laparoscopic technique must be thoroughly compared
with the open procedures before its true place in hernia surgery can
be defined. METHODS: Six hundred thirteen male patients aged 40 to 75
years were randomized to the conventional procedure, preperitoneal
mesh placed by the open technique, or laparoscopic preperitoneal mesh
(TAPP). Follow-up was after 7 days, 8 weeks, and 1 year. RESULTS: Of
613 patients undergoing surgery, 604 (98.5%) were followed for 1 year.
Patients who underwent TAPP gained full recovery after 18.4 days,
compared with 24.2 days for open mesh (p < 0.001) and 26.4 days for
the conventional procedure (p < 0.001). Patients who underwent TAPP
returned to work after 14.7 days, compared with 17.7 days for open
mesh (p = 0.05) and 17.9 days for the conventional procedure (p =
0.04). They also had significantly less restriction in physical
activities after 7 days. The TAPP procedure was more expensive, mainly
as a result of longer surgical time and equipment costs, even after
compensation for earlier return to work. Complications were more
common in the TAPP group, with a varying pattern between the groups.
Four recurrences in the conventional, 11 in the open mesh, and 4 in
the TAPP group were recorded after 1 year (p = n.s.). CONCLUSION: The
laparoscopic technique results in both shorter time to full recovery
and shorter time to return to work, at the price of substantially
increased costs.
| Surg Clin North Am 1996 Jun;76(3):483-91 |
|
Laparoscopic herniorrhaphy.
Swanstrom LL
Department of Minimally Invasive Surgery, Legacy Portland Hospital,
Oregon, USA.
There is little doubt that laparoscopic herniorrhaphy has assumed a
place in the pantheon of hernia repair. There is also little doubt
that further work needs to be done to determine the exact role that
laparoscopic hernia repair should play in the surgical armamentarium.
Hernias have been surgically treated since the early Greeks. In
contrast, laparoscopic hernia repair has a history of only 6 years.
Even within that short time, laparoscopic hernia repair techniques
have not remained unchanged. This is obviously a technique in
evolution, as indicated by the abandonment of early repairs
("plug and mesh" and IPOM) and the gradual gain in
pre-eminence of the TEP repair. During the same time frame, surgery
itself has evolved into a discipline more concerned with
cost-effectiveness, outcomes, and "consumer acceptance."
Confluence of these two developments has led to a situation in which
traditional concerns regarding surgical procedures (i.e., recurrence
rates or complication rates) assume less of a role than
cost-effectiveness, learnability, marketability, and medical-legal
considerations. No surgeon, whether practicing in a academic setting
or a private practice, is exempt from these pressures. Laparoscopic
hernia repair therefore seems to fit into a very specialized niche. In
our community, the majority of general surgeons are only too happy to
not do laparoscopic hernia repairs. On the other hand, in our
experience, certain indications do seem to cry out for a laparoscopic
approach. At our own center we have found that laparoscopic repairs
can indeed be effective, and even cost-effective, under specific
circumstances. These include completing a minimal learning curve,
utilizing the properitoneal approach, minimizing the use of reusable
instruments, using dissecting balloons as a time-saving device, and
very specific patient selection criteria. At present these include
patients with bilateral inguinal hernias on clinical examination,
patients with recurrent unilateral or bilateral hernias, and patients
who, because of economic pressures, must return to work within 10 days
of surgery. Within these limitations we feel that the laparoscopic
approach definitely has a place in repair of inguinal hernias. In the
future new techniques, decreased equipment costs, and the ability to
use local anesthesia may increase the applicability of laparoscopic
herniorrhaphy.
Prospective randomized study comparing laparoscopic
and open tension-free inguinal hernia repair with Shouldice's
operation.
Zieren J, Zieren HU, Jacobi CA, Wenger FA, Muller JM
Department of Surgery, Charite, Humboldt University of Berlin,
Germany.
BACKGROUND: Although tension-free techniques of hernia repair using
synthetic meshes revealed encouraging results, the best method of
inguinal hernia repair is still unclear. METHODS: In a prospective
randomized phase-II-B study, early postoperative results of
laparoscopic transabdominal preperitoneal repair (n = 80), open plug
and patch repair (n = 80), and Shouldice's operation (n = 80) were
compared. Postoperative pain and patient's comfort were defined as
main endpoints. RESULTS: The laparoscopic approach had significantly
longer operation time and was more expensive (61 +/- 12 minutes;
$1,211) than plug and patch repair (36 +/- 14 minutes; $124) and
Shouldice's operation (47 +/- 17 minutes; $69). Main postoperative
complications were wound hematomas, seromas, and superficial wound
infection, without significant difference between the groups.
Postoperative pain, analgesia requirements, limitation of daily
activities, and return to work did not differ between laparoscopic and
open tension-free repair but were significantly lower in both groups
compared with Shouldice's operation. So far, no recurrence was
observed after a mean follow-up of 25 months. CONCLUSION: Open plug
and patch repair is a promising technique of hernia repair in adults,
because it offers the same excellent patient comfort as the
laparoscopic repair but is less expensive and can be performed under
local anesthesia.
| Surgery 1993 Oct;114(4):765-72; discussion 772-4 |
|
Laparoscopic herniorrhaphy: results and technical
aspects in 450 consecutive procedures.
Geis WP, Crafton WB, Novak MJ, Malago M
Lutheran General Hospital, University of Chicago, Ill. 60068.
BACKGROUND. The effectiveness of laparoscopic herniorrhaphy, the
patient outcome, and technical aspects have been controversial. We
have performed 450 consecutive laparoscopic inguinal herniorrhaphies
and have reviewed the rationale, technical aspects, and the outcomes.
METHODS. Four hundred and fifty consecutive laparoscopic
herniorrhaphies were performed using synthetic mesh for tensionless
repair and adhering to surgical principles of preperitoneal
herniorrhaphy. Patients were 16 to 83 years of age, 74% men, 26%
women. Mesh was transfixed to anatomic landmarks with suture or
staples. The peritoneum was closed, separating mesh from abdominal
contents. RESULTS. Ninety percent of patients were discharged from
perioperative care; 10% were in the hospital 23 hours as a result of
urinary retention, cardiac disease, etc. No adhesive or mesh
complications occurred. Three hernias recurred at 2 to 4 months after
operation. Two were repaired laparoscopically. CONCLUSIONS.
Laparoscopic inguinal herniorrhaphy is a safe and effective procedure.
It compares favorably with other classic methods of hernia repair
(especially use of a tensionless repair with mesh). Patients exhibit
minimum morbidity and ambulate soon with minimal discomfort. This
repair should be considered preferential in many subsets of patients.
| World J Surg 1999 Oct;23(10):1004-7; discussion
1008-9 |
Tension-free laparoscopic and open hernia repair:
randomized controlled trial of early results.
Picchio M, Lombardi A, Zolovkins A, Mihelsons M, La Torre G
1st Department of Surgery, University of Rome "La Sapienza,"
Via Lancisi 3, 00161 Rome, Italy.
The aim of the study was prospectively to compare the early results
and outcome in 105 patients randomly allocated to undergo tension-free
laparoscopic hernia repair (LHR) with transabdominal preperitoneal
technique (53 patients) or open hernia repair (OHR) with mesh
apposition (52 patients). The mean (SD) operation time was longer in
the LHR group than in the OHR group: 49.6 (5.4) versus 33. 9 (6.2)
minutes; p < 0.001. One laparoscopic case was converted to open
repair to deal with a hemorrhage from an aberrant obturatory artery at
the level of Cooper's ligament. Groin discomfort or pain was the most
common complication after both procedures. The patients requiring
none, one, two, or more than two doses of intramuscular diclofenac
were, respectively, 40.4%, 40.4%, 15.4%, and 3.8% after LHR and 50.0%,
30.8%, 17.3%, and 1.9% after OHR (p = 0.69; NS). The mean +/- SEM
(range) postoperative visual analog scale score, ranging from 0 (no
pain) to 10 (worst pain imaginable), was 3.1 +/- 0.2 (1-7) in the LHR
subset and 2.7 +/- 0.2 (1-5) in the OHR group (p = 0.14; NS); on the
second postoperative day the score was 2.3 +/- 0.2 (1-6) and 1.8 +/-
0.1 (1-4), respectively (p < 0.03). The time +/- SEM (range) of
resumption of pain-free normal activities and work was faster in OHR
group: 6.1 +/- 0.2 (4-8) weeks versus 6.5 +/- 0.1 (4-8) weeks; p <
0.03. Our results showed that tension-free open hernia repair is
superior to LHR in terms of postoperative pain with no important
differences in recovery. </HEA
|
