A prospective comparison of laparoscopic and tension-free open herniorrhaphy
D. C. Brooks
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.
