Laparoscopic versus open repair of groin hernia: a randomised comparison

• Published in: The Lancet (British edition) Vol. 354; no. 9174; pp. 185 - 190
• Main Authors: Ross, S, Scott, N, Grant, A S, O'Dwyer, P
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 17-07-1999; Lancet; Elsevier Limited
• Subjects: Abdomen; Biological and medical sciences; Hernias; Medical sciences; Pain; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Human; Relapse; Prognosis; Multicenter study; Laparoscopic surgery; Anatomical reconstruction; Inguinal; Hernia; Randomization; Treatment; Abdominal disease; Surgery; Adult; Complication; Endoscopy; Technique; Comparative study
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(98)10010-7

Repair of a groin hernia is one of the most common elective operations performed in general surgery. Our aim was to compare laparoscopic repair with open repair of groin hernia.
At 26 hospitals in the UK and lreland, 928 patients with groin hernia were randomly assigned to laparoscopic repair (n=468) or open hernia repair (n=460, of which 433 were tension-free mesh repairs). Patients were clinically assessed at 1 week and 1 year after surgery, and were sent questionnaires at 3 months and 1 year. The primary endpoints were: complications: return to usual activities of social life (as the most generally applicable example of return to usual activities); hernia recurrence; groin pain that persisted at 1 year; and costs to the health services. All analyses were by intention to treat.
At 1 week, at least one complication was found in 108 (29·9%) patients allocated to laparoscopic repair and in 155 (43·5%) patients allocated to open repair (95% CI for difference −20·6% to −6·6%, p<0·001). There were three serious surgical complications all of which occurred in the laparoscopic group. Patients in the laparoscopic group returned to the usual activities of social life sooner than the patients in the open repair group (10 [IQR 7–21] vs 14 [7–28] days, p=0·004). At 1 year after the operation, the laparoscopic group had a lower rate of persistent groin pain than those who had open repair (28·7% vs 36·7% [95% CI for difference −14·7% to −1·4%], p=0·0018). Hwever, all seven hernia recurrences occurred in the laparoscopic group not in the open repair group 1·9% vs 0·0% [95% Clfor difference 0·5% to 3·4%], p=0·0017).
Although laparoscopic hernia repair has advantages for patients, concerns about safety indicate that open repair is the more appropriate option for the general surgeon. Our findings lend support to the move towards laparoscopic hernia surgery becoming part of the domain of specialist surgeons.