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Laparoscopic vs open inguinal hernia repair. A randomized, controlled trial
C Tanphiphat1, T Tanprayoon, C Sangsubhan
1Department of Surgery, Faculty of Medicine, Chulalongkorn Hospital, Chulalongkorn University, Rama IV Road, Bangkok 10330, Thailand.
Insights
Laparoscopic inguinal hernia repair offers less pain and faster recovery than open surgery. However, it is more expensive and does not significantly improve hospital stay or return to work times.
Area of Science:
- Surgical Innovation
- Minimally Invasive Surgery
- Hernia Repair Techniques
Background:
- The efficacy of laparoscopic inguinal hernia repair compared to traditional open methods remains a subject of debate.
- This study evaluates the transition from modified Bassini repair to laparoscopic techniques.
Purpose of the Study:
- To determine if laparoscopic inguinal hernia repair is a justified alternative to open repair.
- To compare outcomes between laparoscopic transabdominal preperitoneal mesh repair and modified Bassini open repair.
Main Methods:
- A randomized controlled trial involving 120 patients undergoing elective hernia repair.
- Patients were divided into two groups: laparoscopic repair (n=60) and open repair (n=60).
Main Results:
- Laparoscopic repair had a longer operative time (95 vs 67 min) but significantly less early postoperative pain (36.2 vs 49.3) and disability.
- Patients undergoing laparoscopic repair returned to light activities sooner (8 vs 14 days) but hospital stay and return to work were not significantly different.
- Laparoscopic repair was associated with higher costs (approx. $400 more) and one recurrence after 32 months follow-up.
Conclusions:
- Laparoscopic inguinal hernia repair provides benefits in terms of reduced early postoperative pain and disability.
- Despite faster return to light activities, laparoscopic repair does not offer advantages in hospital stay or return to work and is more costly.
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.