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Laparoscopic or open inguinal herniorrhaphy? A randomized prospective trial
J H Payne1, L M Grininger, M T Izawa
1Kaiser 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.