Open vs. Laparoscopic repair of inguinal hernias: Lap. repair may be better.

A recent study published in the March issue of Archives of Surgery 2012 suggests that patients who undergo a laparoscopic inguinal hernia repair (Total extraperitoneal inguinal hernia repair (TEP)), report higher patient satisfaction, less chronic pain and less impairment of inguinal (groin) sensation compared to those who undergo a tension-free open Lichtenstein repair.
Hernia Surgery. Two surgeons performing an operation

Hasan H. Eker, M.D., of Erasmus Medical Center, Rotterdam, the Netherlands, and colleagues conducted a prospective multicenter randomized clinical trial and randomly assigned 660 patients to receive one of the two techniques (336 to TEP and 324 to Lichtenstein repair). The mean (average) age of patients was 55 years at the time they were included in the study and long-term follow-up visits occurred at one year and five years after surgery. They reported both short-term and long-term chronic pain at five years after surgery wwas more likely after open tension free repair Lichtenstein repair compared to a TEP laparoscopic procedure (32% vs 23 percent for short-term pain and 28% vs 15% for long-term pain). It was also noted that there was a reduced likelihood that patient might show impaired sensation in the area after a laparoscopic (keyhole) repair compared to open surgery (1% vs. 22%). The authors of the research paper commented that “Patients are more satisfied after TEP with the surgical procedure and with their operative scars. Therefore, TEP should be recommended in experienced hands.”

The authors note that the experience level of the surgeon was associated with hernia recurrence after inguinal hernia repair. The overall incidences of hernia recurrence after laparoscopic and open surgery were similar after five years after surgery, but among experienced surgeons (those who had performed more than 25 procedures) the recurrence rates were “significantly lower” after a keyhole approach. However, the positives outcomes associated with a keyhole approach should be counterbalanced by the higher risk of complications.

Randomized Clinical Trial of Total Extraperitoneal Inguinal Hernioplasty vs Lichtenstein RepairA Long-term Follow-up Study

Eker HE, MDLangeveld HR, Klitsie PJ et al. Archives Surgery. March 2012;147(3):256-260. 

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