Laparoscopic versus open inguinal hernia repair

Inguinal hernias are common, with a lifetime risk of 27% in men and 3% in women. Inguinal hernia repair is one of the most common operations in general surgery. Despite more than 200 years of experience, the optimal surgical approach to inguinal hernia remains controversial. Surgeons and patients face many decisions when it comes to inguinal hernias: repair or no repair, mesh or no mesh, what kind of mesh, open or laparoscopic, extraperitoneal or transabdominal, and so forth. Inguinal hernia repairs have morbidity and recurrence rates that are not inconsequential. The search for the gold standard of repair continues.     

Laparoscopic versus open inguinal hernia repair in octogenarians

Purpose  

This retrospective chart review was designed to compare outcomes for open and laparoscopic repair of inguinal hernias in the population over the age of 80.     

腹腔镜经腹腹膜前疝修补术与开放无张力疝修补术治疗腹股沟疝的疗效比较

目的比较腹腔镜经腹腹膜前疝修补术（TAPP）与开放无张力疝修补术治疗腹股沟疝的临床疗效。 方法选取2016年11月至2019年11月,包头医学院第一附属医院普外科一病区腹股沟疝住院患者209例,按照术式不同分为2组。试验组患者102例,行腹腔镜经腹腹膜前疝修补术;对照组患者107例,行开放式无张力疝修补术。观察记录2组患者的手术时间、术中出血量、术后住院时间及术后使用镇痛药物情况等指标,并进行对比分析。 结果2组手术均获成功,试验组无中转开放手术。试验组与对照组比较,手术时间延长（46.87±4.94）min vs（38.40±4.29）min,术中出血量降低（5.40±1.64）ml vs（11.12±2.09）ml,术后住院时间减少（4.18±1.09）d vs（5.08± 1.58）d,术后使用镇痛药和疼痛评分均减少,差异均有统计学意义（均P<0.05）。术后随访均恢复良好,随访时间为6～42个月,2组患者均未复发,无明显术后并发症发生。 结论TAPP治疗腹股沟疝与开放式无张力疝修补术相比,具有微创、安全有效、无明显瘢痕等特点,是临床上可靠的治疗腹股沟疝选择之一。     

Laparoscopic vs open inguinal hernia repair

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. Received: 23 May 1997/Accepted: 1 August 1997     

Laparoscopic extraperitoneal inguinal hernia repair versus open mesh repair: a prospective randomized controlled trial

BACKGROUND: This study was designed to compare an open tension-free technique (Lichtenstein repair) with a laparoscopic totally extraperitoneal hernia repair (TEP). METHODS: One hundred sixty-eight men aged 30 to 65 years with primary or recurrent inguinal hernia were randomized to TEP or open mesh technique in the manner of Lichtenstein. Follow-up was after 1 and 6 weeks, and 1 year. RESULTS: Eighty-one patients were randomized to TEP, and 87 to open repair. For 1 patient in each group, the operation was converted to a different type of repair. No difference was seen in overall complications between the 2 groups. However, 1 patient in the TEP group underwent operation for small bowel obstruction after surgery. A higher frequency of postoperative hematomas was seen in the open group (P <.05). Patients in the TEP group consumed less analgesic after surgery (P <.001), returned to work earlier (P <.01), and had a shorter time to full recovery (P <.01). Two recurrences occurred in the TEP group 1 year after surgery. CONCLUSION: The TEP technique was associated with less postoperative pain, a shorter time to full recovery, and an earlier return to work compared with the open tension-free repair. No difference was seen in overall complications. However, 2 recurrences did occur after 1 year in the TEP group.     

Chronic pain after open inguinal hernia repair: a longitudinal self-assessment study

Introduction  

The aim of the present study was to assess the variation of self-reported pain over a period of 2 years in three groups of patients with no, moderate and severe pain at 3 months after primary open inguinal hernia repair.     

Laparoscopic versus open mesh repair for recurrent inguinal hernia: a meta-analysis of outcomes

Background

The objective of this study was to examine the outcomes of comparisons between laparoscopic and open mesh repairs in the setting of recurrent inguinal hernia.

Methods

The electronic databases MEDLINE, Embase, Pubmed, and the Cochrane Library were used to search for articles from 1990 to 2008. The present meta-analysis pooled the effects of outcomes of a total of 1,542 patients enrolled into 5 randomized controlled trials and 7 comparative studies, using classic and modern meta-analytic methods.

Results

Significantly fewer cases of hematoma/seroma formation were observed in the laparoscopic group in comparison with the Lichtenstein group (odds ratio, .38; .15-.96; P = .04). A matter of great importance is the higher relative risk of overall recurrence in the transabdominal preperitoneal group compared with the totally extraperitoneal group (relative risk, 3.25; 1.32-7.9; P = .01).

Conclusions

Laparoscopic versus open mesh repair for recurrent inguinal hernia was equivalent in most of the analyzed outcomes.     

Laparoscopic versus open ventral hernia mesh repair: a prospective study

Background An incisional hernia develops in 3% to 13% of laparotomy incisions, with primary suture repair of ventral hernias yielding unsatisfactory results. The introduction of a prosthetic mesh to ensure abdominal wall strength without tension has decreased the recurrence rate, but open repair requires significant soft tissue dissection in tissues that are already of poor quality as well as flap creation, increasing complication rates and affecting the recurrence rate. A minimally invasive approach was applied to the repair pf ventral hernias, with the expectation of earlier recovery, fewer postoperative complications, and decreased recurrence rates. This prospective study was performed to objectively analyze and compare the outcomes after open and laparoscopic ventral hernia repair. Methods The outcomes for 50 unselected patients who underwent laparoscopic ventral hernia repair were compared with those for 50 consecutive unselected patients who underwent open repair. The open surgical operations were performed by the Rives and Stoppa technique using prosthetic mesh, whereas the laparoscopic repairs were performed using the intraperitoneal onlay mesh (IPOM) repair technique in all cases. Results The study group consisted of 100 patients (82 women and 18 men) with a mean age of 55.25 years (range, 30–83 years). The patients in the two groups were comparable at baseline in terms of sex, presenting complaints, and comorbid conditions. The patients in laparoscopic group had larger defects (93.96 vs 55.88 cm²; p = 0.0023). The mean follow-up time was 20.8 months (95% confidence interval [CI], 18.5640–23.0227 months). The mean surgery durations were 90.6 min for the laparoscopic repair and 93.3 min for the open repair (p = 0.769, nonsignificant difference). The mean postoperative stay was shorter for the laparoscopic group than for the open hernia group (2.7 vs 4.7 days; p = 0.044). The pain scores were similar in the two groups at 24 and 48 h, but significantly less at 72 h in the laparoscopic group (mean visual analog scale score, 2.9412 vs 4.1702; p = 0.001). There were fewer complications (24%) and recurrences (2%) among the patients who underwent laparoscopic repair than among those who had open repair (30% and 10%, respectively). Conclusions The findings demonstrate that laparoscopic ventral hernia repair in our experience was safe and resulted in shorter operative time, fewer complications, shorter hospital stays, and less recurrence. Hence, it should be considered as the procedure of choice for ventral hernia repair.     

Laparoscopic repair of inguinal hernia in infants: Comparison with open hernia repair

Purpose

This study aimed to evaluate the usefulness of laparoscopic repair of inguinal hernia (LR) in infants in comparison with open hernia repair (OR).

Laparoscopic extraperitoneal repair versus open inguinal hernia repair: 20-year follow-up of a randomized controlled trial

Purpose

This study compared the long-term recurrence rates of laparoscopic totally extraperitoneal (TEP) and open inguinal hernia repair in patients from a randomised trial completed in 1994. Laparoscopic inguinal hernia surgery, especially TEP repair, has gained widespread acceptance in recent years. There is still paucity of data on long-term follow-up comparing recurrence rates for open and laparoscopic techniques. This is the first study providing direct long-term comparative data about these techniques.

Methods

A randomised controlled trial was conducted between 1992 and 1994 on patients undergoing a laparoscopic TEP or an open inguinal hernia (Shouldice) repair at our institution. Of the original 104 participants, contemporary follow-up data could be obtained for 98 patients with regards to long-term recurrence. These data were collected with the help of questionnaires, telephone calls and retrieval of case records. Medical records were reviewed for all patients. Data were analysed using a Cox proportional hazards model.

Results

There were 7/72 (9.7%) recurrences in the open group and 9/35 (25.7%) recurrences in the laparoscopic group. This difference in recurrence rates was statistically significant (HR = 2.94; 95% CI 1.05–8.25; p = 0.041.)

Conclusion

Laparoscopic TEP inguinal hernia repair performed in 1992–1994 had a higher recurrence rate than open Shouldice inguinal hernia repair during the same period. The original study was undertaken in the inceptive days of laparoscopic surgery and results need to be interpreted considering the technology and expertise available at that time.

     

Laparoscopic versus open ventral hernia repair

Ventral hernia repair remains one of the most common operations performed by general surgeons. Despite the frequency with which this procedure is performed, there is little agreement and extensive controversy as to the cause of most of the hernias, or the ideal approach to repair these complicated problems. This article attempts to identify and provide some clarification of these controversial issues in abdominal wall reconstruction after ventral herniation based on the available literature.     

Laparoscopic versus open incisional hernia repair

Background Incisional hernia is a common complication of abdominal surgery, and it is often a source of morbidity and high costs for health care. This is a case-control study to compare laparoscopic versus anterior-open incisional hernia repair. Methods 170 patients with incisional hernia were enrolled in this study between September 2001 and December 2004. Of these, 85 underwent anterior-open repair (open group: OG), and 85 underwent laparoscopic repair (laparoscopic group: LG). The clinical outcome was determined by a median follow-up of 24.0 months for LG and OG. Results No difference was noticed between the two groups in age, American Society of Anesthesiologists (ASA) score, body mass index (BMI), and incisional hernia diameter. Mean operative time was 61.0 min for LG patients and 150.9 min for OG patients (p < .05). Mean hospitalization was 2.7 days for LG patients and 9.9 days for OG patients (p < .05). Mean return to work was 13 days (range, 6–15 days) in LG patients and 25 days (range, 16–30 days) in OG patients. Complications occurred in 16.4 % of LG patients and 29.4 % of OG patients, with a relapse rate of 2.3% in LG and 1.1% in OG patients. Conclusions Short-term results indicate that laparoscopic incisional hernia repair is associated with a shorter operative time and hospitalization, a faster return to work, and a lower incidence of wound infections and major complications compared to the anterior-open procedure. Further studies and longer follow-up are required to confirm these findings.     

Laparoscopic versus open incisional hernia repair

BACKGROUND: To analyze hospital resource utilization for laparoscopic vs open incisional hernia repair including the postoperative period. METHODS: Prospectively collected administrative data for incisional hernia repairs were examined. A total of 884 incisional hernia repairs were examined for trends in type of approach over time. Starting October 2001, detailed records were available, and examined for operating room (OR) time, cost data, length of stay (LOS), and 30-day postoperative hospital encounters. RESULTS: Of the total, 469 incisional hernias were approached laparoscopically (53%) and 415 open (47%). Laparoscopic repair had shorter LOS (1 +/- 0.2 days vs 2 +/- 0.6 days), longer OR time (149 +/- 4 min vs 89 +/- 4 min), higher supply costs (2,237 dollars +/- 71 dollars vs 664 dollars +/- 113 dollars), slightly lower total hospital cost (6,396 dollars +/- 477 dollars vs 7,197 dollars +/- 1,819 dollars), and slightly more postoperative hospital encounters (15% vs 13%). Use of laparoscopy increased over time (37% in 2000 vs 68% in 2004). CONCLUSIONS: Laparoscopic incisional hernia repair is becoming increasingly popular, and not at increased cost to the health care system.     

Tension-free laparoscopic versus open inguinal hernia repair

AIM: During the last decade laparoscopic techniques have been applied to the treatment of inguinal hernia to combine tension-free technique, esthetic, and functional benefits of mini-invasive surgery. Anyway controversy persists regarding the most effective inguinal hernia repair. The aim of this study is to compare the open technique and the laparoscopic approach concerning: complications, recurrences, recovery time and return to usual activity. METHODS: A randomized prospective analysis of 121 consecutive inguinal hernia repairs was performed over a 12-month period. Male well-informed patients with primary monolateral inguinal hernia (ASA I-II) were divided into 2 groups and consecutively treated; group A was treated with laparoscopic transabdominal preperitoneal approach (TAPP) (median age 47+/-7 years, 57 patients), group B with open mesh herniorrhaphy (45+/-6 years, 64 patients). RESULTS: Complication rate was 5.26% for group A (none needed conversion) and 4.68% for group B. All complications were considered minor. No recurrences were observed over a 12-month follow-up in both groups. Post-operative hospital stay and return to activity show statistically significant differences. Median post-hospital stay was 1.7 days for group A while it was longer (2.9 days) for group B. Significant difference was observed in the duration of convalescence too (group A 9.3+/-7.2 days; group B 12.1+/-7. 1 days). CONCLUSION: On the basis of our experience, even if a longer follow-up is needed, the validity of laparoscopic approach to inguinal hernia is confirmed. General anesthesia and higher costs are reasonable compromises for a shorter period of discomfort in patients with a low ASA index and busy job/sport activity.     

Laparoscopic versus open incisional hernia repair: a retrospective cohort study with costs analysis on 269 patients

Purpose

To compare clinical outcomes and institutional costs of elective laparoscopic and open incisional hernia mesh repairs and to identify independent predictors of prolonged operative time and hospital length of stay (LOS).

Methods

Retrospective observational cohort study on 269 consecutive patients who underwent elective incisional hernia mesh repair, laparoscopic group (N = 94) and open group (N = 175), between May 2004 and July 2014.

Results

Operative time was shorter in the laparoscopic versus open group (p < 0.0001). Perioperative morbidity and mortality were similar in the two groups. Patients in the laparoscopic group were discharged a median of 2 days earlier (p < 0.0001). At a median follow-up over 50 months, no difference in hernia recurrence was detected between the groups. In laparoscopic group total institutional costs were lower (p = 0.02). At Cox regression analysis adjusted for potential confounders, large wall defect (W3) and higher operative risk (ASA score 3–4) were associated with prolonged operative time, while midline hernia site was associated with increased hospital LOS. Open surgical approach was associated with prolongation of both operative time and LOS.

Conclusions

Laparoscopic approach may be considered safely to all patients for incisional hernia repair, regardless of patients’ characteristics (age, gender, BMI, ASA score, comorbidities) and size of the wall defect (W2-3), with the advantage of shorter operating time and hospital LOS that yields reduced total institutional costs. Patients with higher ASA score and large hernia defects are at risk of prolonged operative time, while an open approach is associated with longer duration of surgical operation and hospital LOS.

     

Laparoscopic inguinal hernia repair

As a consequence of the development of laparoscopic cholecystectomy in the late 1980s, diagnostic and therapeutic laparoscopy has now become an integral part of the average general surgeon's practice. Many conventional operations have been successfully adapted for the laparoscopic approach. A laparoscopic operation is unquestionably the surgical procedure of choice for gastroesophageal reflux disease and removal of the gallbladder, spleen, or adrenal gland unless specific contraindications are present. However, the value of laparoscopic techniques for other operations remains controversial within the surgical community. Laparoscopic inguinal herniorrhaphy (LIH) is a case in point. Frequent reanalysis of the controversial procedures such as laparoscopic herniorrhaphy is especially important because videoscopic operations remain in their developmental stages and thus continue to evolve. With this in mind, the purpose of this review was to examine the current state of the art of laparoscopic inguinal herniorrhaphy in relationship to its conventional counterparts.     

Laparoscopic inguinal hernia repair

Background: Despite numerous attempts to improve the techniques used for hernia repair, current published series show that recurrence rates are as high as 5-20%. The complexity of inguinal anatomy, combined with multiple potential areas of weakness, has contributed to the difficulty in preventing recurrences. However, the laparoscopic approach to inguinal herniorrhaphy has allowed clear visualization of all preperitoneal fascial planes and anatomic landmarks, as well as the hernia defect(s) and the peritoneal reflection. In the course of our performance of a series of 1,224 laparoscopic inguinal hernia repairs, we have developed a total extraperitoneal approach that yields excellent results with a low initial recurrence rate. Herein we describe our experience. Methods: After our initial 300 transabdominal preperitoneal (TAPP) hernia repairs, which resulted in six recurrences, two bowel injuries, one bladder injury, and six cutaneous nerve injuries, the total extraperitoneal approach (TEP) was adopted. Results: The first 300 TEP repairs resulted in one recurrence, two bowel injuries, one bladder injury, and two cutaneous nerve injuries. All major complications occurred in patients who had had previous lower abdominal surgery. In the last 624 TEP herniorrhaphies we implemented some modifications to the technique, especially for patients with previous lower abdominal surgery. In this group we recorded one bladder injury, no cutaneous nerve injuries, and one recurrence. Conclusions: The total extraperitoneal approach for laparoscopic herniorrhaphy allows for a safe and effective repair with low rates of complication and recurrence. A thorough knowledge of the anatomy of the extraperitoneal space and especially the two- and three-dimensional inguinal anatomy of this space contributed greatly to the evolution of our technique.     

Laparoscopic versus open umbilical hernia repair.

BACKGROUND: The use of prosthetic material for open umbilical hernia repair has been reported to reduce recurrence rates. The aim of this study was to compare outcomes after laparoscopic versus open umbilical hernia repair. METHODS: We reviewed all umbilical hernia repairs performed from November 1995 to October 2000. Demographic data, hernia characteristics, and outcomes were compared. RESULTS: Of the 76 patients identified, 32 underwent laparoscopic repair (LR), 24 primary suture repairs (PSR), and 20 open repairs with mesh (ORWM). Preoperative characteristics were similar between groups. Hernia size was similar between LR and ORWM groups, and both were larger than that in the PSR group. ORWM compared with the other techniques resulted in longer operating time, more frequent use of drains, higher complication rates, and prolonged return to normal activities (RTNA). The length of stay (LOS) was longer in the ORWM than in the PSR group. When compared with ORWM, LR resulted in lower recurrence rates. LR resulted in fewer recurrences in patients with previous repairs and hernias larger than 3 cm than in both open techniques. CONCLUSIONS: LR results in faster RTNA, and lower complication and recurrence rates compared with those in ORWM. Patients with larger hernias and previous repairs benefit from LR.