Prospective evaluation of 6895 groin hernia repairs in women

BACKGROUND: Although 8 per cent of groin hernia repairs are performed in women, there is little published literature relating specifically to women. This study compared differences in outcome between women and men after groin hernia repair. METHODS: Data collected prospectively in the Swedish Hernia Register between 1992 and 2003 were analysed, including 6895 groin hernia repairs in women and 83 753 in men. RESULTS: A higher proportion of emergency operations was carried out in women (16.9 per cent) than men (5.0 per cent), leading to bowel resection in 16.6 and 5.6 per cent respectively. During reoperation femoral hernias were found in 41.6 per cent of the women who were diagnosed with a direct or indirect inguinal hernia at the primary operation. The corresponding proportion for men was 4.6 per cent. The hernia repair was not classified as a standard operation (e.g. Shouldice, Lichtenstein, Plug/Mesh, TAPP/TEP) in 38.2 per cent of women and 11.2 per cent of men. Women had a significantly higher risk of reoperation for recurrence than men, and techniques associated with the lowest risk for reoperation in men had the highest risk in women. CONCLUSION: A greater proportion of women than men require emergency groin hernia repair, with consequently higher rates of bowel resection, complications and death. Surgical techniques developed for use in men may put women at unnecessary risk.     

Reoperation After Recurrent Groin Hernia Repair

OBJECTIVE: To analyze reoperation rates for recurrent and primary groin hernia repair documented in the Swedish Hernia Register from 1996 to 1998, and to study variables associated with increased or decreased relative risks for reoperation after recurrent hernia. METHODS: Data were retrieved for all groin hernia repairs prospectively recorded in the Swedish Hernia register from 1996 to 1998. Actuarial analysis adjusted for patients' death was used for calculating the cumulative incidence of reoperation. Relative risk for reoperation was estimated using the Cox proportional hazards model. RESULTS: From 1996 to 1998, 17,985 groin hernia operations were recorded in the Swedish Hernia Register, 15% for recurrent hernia and 85% for primary hernia. At 24 months the risk for having had a reoperation was 4.6% after recurrent hernia repair and 1.7% after primary hernia repair. The relative risk for reoperation was significantly lower for laparoscopic methods and for anterior tension-free repair than for other techniques. Postoperative complications and direct hernia were associated with an increased relative risk for reoperation. Day-case surgery and local infiltration anesthesia were used less frequently for recurrent hernia than for primary hernia. CONCLUSIONS: Recurrent groin hernia still constitutes a significant quantitative problem for the surgical community. This study supports the use of mesh by laparoscopy or anterior tension-free repair for recurrent hernia operations.     

Risk of recurrence 5 years or more after primary Lichtenstein mesh and sutured inguinal hernia repair

BACKGROUND: The risk of recurrence of inguinal hernia within 5 years of repair is lower after mesh than sutured repair in men, but no large-scale studies have compared the risk of recurrence beyond 5 years. METHODS: The Danish Hernia Database prospectively collects data on almost all primary inguinal hernia repairs in men (older than 18 years). This study used data recorded over 8 years, analysing reoperations for recurrent hernia in the intervals 0-30 months, 30-60 months and 60-96 months after operation. RESULTS: The reoperation rate was significantly lower after Lichtenstein open mesh repairs than open sutured repairs (Cox hazard ratio (HR) 0.45 (95 per cent confidence interval (c.i.) 0.39 to 0.51) for 0-30 months after surgery; HR 0.38 (95 per cent c.i. 0.29 to 0.49) for 30-60 months). In 13 674 primary inguinal hernia repairs with an observation interval of 5 years or more, the risk of reoperation after Lichtenstein repair was a quarter of that after sutured repair (HR 0.25 (95 per cent c.i. 0.16 to 0.40) for 60-96 months after surgery). After 5 years, the reoperation rate increased continuously after sutured repair but not after mesh repair. CONCLUSION: Lichtenstein mesh repair for inguinal hernia prevented recurrence beyond 5 years after the primary operation, but sutured repair did not.     

Long-term results of a randomized clinical trial of Shouldice, Lichtenstein and transabdominal preperitoneal hernia repairs

INTRODUCTION: There is an ongoing debate about the preferred technique for inguinal hernia repair. In this randomized study the long-term results of Shouldice, Lichtenstein and transabdominal preperitoneal (TAPP) hernia repair were compared. METHODS: Some 280 men with a primary hernia were randomized prospectively to undergo Shouldice, tension-free Lichtenstein or laparoscopic TAPP repair. Patients were examined after 52 months to assess hernia recurrence, nerve damage, testicular atrophy and patient satisfaction. RESULTS: Hernia recurrence occurred in six patients after Shouldice repair, and in one patient each after Lichtenstein and TAPP repairs. All recurrences after tension-free repairs were diagnosed within the first year after surgery. Nerve injuries were significantly more frequent after open Shouldice and Lichtenstein repairs. Patient satisfaction was greatest after laparoscopic TAPP repair. CONCLUSION: Tension-free repair was superior to the non-mesh Shouldice technique. The open anterior approach to the groin was associated with demonstrable nerve injury, and laparoscopic TAPP repair was the most effective approach in the hands of an experienced surgeon.     

A prospective trial of primary inguinal hernia repair by surgical trainees

The main hypotheses were that the Lichtenstein inguinal hernia repair has a lower recurrence rate and similar incidence of chronic groin pain compared to sutured repairs when performed by surgical trainees. In a U.S. Veterans Administration Hospital, 150 primary hernia repairs were randomized to a Lichtenstein, McVay, or Shouldice repair. The Shouldice repair included a routine relaxing incision. First- and second-year residents, under the supervision of an experienced general surgeon, performed the procedure. Long-term follow-up was obtained in 81% of patients. Hernia recurrence rate was Lichtenstein 8%, McVay 10%, Shouldice 5% (P>0.1) at 6–9 years follow-up. More patients had chronic groin pain following Lichtenstein repair (38%) than after Shouldice repair (7%) (P<0.05). More information is needed on long-term groin pain following anterior mesh repair. The Shouldice inguinal hernia repair may have a role in open primary herniorrhaphy to decrease the risk of chronic groin pain.     

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??The time profile of groin hernia recurrences Magnusson N*, Nordin P, Hedberg M, et al. *Department of Surgery, Mora Hospital, Mora, Sweden
Corresponding author: Magnusson N??E-mail: niklas.magnusson@ltdalarna.se
Abstract Objective If the pathogeneses of the development of a recurrence varies following the different methods of hernia repair, the time required to develop a recurrence could be expected to vary. The aim of the study was to identify risk factors affecting the time interval between the primary repair and the reoperation. Methods Data from the Swedish Hernia Register were used. Each year of the 5-year follow-up period was treated as a separate subgroup and merged together into one large group. For each risk factor, we performed a Cox proportional hazard analysis, testing for interactions between the year and the risk factor, with reoperation as the endpoint. Results Altogether, 142,578 repairs were recorded, of which 7.7% were performed on women. The mean age of the cohort was 59 years. The overall recurrence rate in the 5-year period was 4.3%. Multivariate analysis showed that recurrence following surgery for recurrent hernia occurred relatively early (P < 0.05).Recurrence also appeared early if postoperative complications were registered (P< 0.05). Recurrence after suture repair or laparoscopic repair appeared relatively early compared to recurrence following open mesh repair (P < 0.05). In a separate analysis, a relatively higher risk for early recurrence was seen for all sutured repairs compared to all mesh repairs (P< 0.05). Conclusion The pathogenesis behind the development of recurrence probably differs depending on the technique applied during the hernia repair. The higher proportion of early recurrences following laparoscopic repair, suture repair and recurrent repair may be explained by the high proportion of technical failures.     

Outcome of repair of bilateral groin hernias: a prospective evaluation of 1,487 patients.

OBJECTIVE: To find out whether simultaneous repair of bilateral hernias increases the risk of recurrence compared with unilateral repair. DESIGN: Prospective study. SETTING: Swedish hospitals participating in the Swedish Hernia Register (SHR). Interventions: Prospective collection of data from the SHR, 1992-1999 inclusive. The Cox proportional hazard test was used for calculating odds ratio (OR). MAIN OUTCOME MEASURES: Hernia repairs were followed up in a life table fashion until re-operation for recurrence or death of the patient. RESULTS: 33416 unilateral and 1487 bilateral operations on 2974 groin hernias were found. Direct hernias were more common in the bilateral than in the unilateral group, 1,825, 61% compared with 13,336, 40%, (p < 0.0001). A laparoscopic method was used for 1774 (60%) of bilateral and 3285 (10%) unilateral repairs, and 455 bilateral operations (31%) were done as day cases compared with 18376 (55%) unilateral ones (p < 0.0001 for both comparisons). The cumulative incidence of reoperation at three years for groin hernias after bilateral and unilateral repair was 4.1% (95% confidence interval 3.1% to 5.1%) and 3.4% (95% Cl 3.1% to 3.7%, respectively. After adjustment for other risk factors, the OR for reoperation for recurrence after bilateral repair was 1.2 (95% CI 0.9 to 1.5) with unilateral repair as reference. The OR for reoperation after laparoscopic bilateral repair compared with open bilateral repair was 0.9 (95% CI 0.6 to 1.4). CONCLUSIONS: Simultaneous repair of bilateral hernias does not increase the risk of reoperation for recurrence and there is no significant difference in the risk of reoperation after bilateral repair using open or laparoscopic techniques.     

Lower Reoperation Rate for Recurrence after Mesh versus Sutured Elective Repair in Small Umbilical and Epigastric Hernias. A Nationwide Register Study

Background

Repair for a small (≤2 cm) umbilical and epigastric hernia is a minor surgical procedure. The most common surgical repair techniques are a sutured repair or a repair with mesh reinforcement. However, the optimal repair technique with regard to risk of reoperation for recurrence is not well documented. The aim of the present study was in a nationwide setup to investigate the reoperation rate for recurrence after small open umbilical and epigastric hernia repairs using either sutured or mesh repair.

Materials and methods

This was a prospective cohort study based on intraoperative registrations from the Danish Ventral Hernia Database (DVHD) of patients undergoing elective open mesh and sutured repair for small (≤2 cm) umbilical and epigastric hernias. Patients were included during a 4-year study period. A complete follow-up was obtained by combining intraoperative data from the DVHD with data from the Danish National Patient Register. The cumulative reoperation rates were obtained using cumulative incidence plot and compared with the log rank test.

Results and conclusions

In total, 4,786 small (≤2 cm) elective open umbilical and epigastric hernia repairs were included. Age was median 48 years (range 18–95 years). Follow-up was 21 months (range 0–47 months). The cumulated reoperation rates for recurrence were 2.2 % for mesh reinforcement and 5.6 % for sutured repair (P = 0.001). The overall cumulated reoperation rate for sutured and mesh repairs was 4.8 %. In conclusion, reoperation rate for recurrence for small umbilical and epigastric hernias was significantly lower after mesh repair compared with sutured repair. Mesh reinforcement should be routine in even small umbilical or epigastric hernias to lower the risk of reoperation for recurrence avoid recurrence.     

Chronic complaints after simple sutured repair for umbilical or epigastric hernias may be related to recurrence

Purpose

Umbilical and epigastric hernia repairs are minor, but are commonly conducted surgical procedures. Long-term results have only been sparsely investigated. Our objective was to investigate the risk of chronic complaints after a simple sutured repair for small umbilical and epigastric hernias.

Methods

A retrospective cohort study with a 5-year questionnaire and clinical follow-up was conducted. Patients undergoing primary elective, open non-mesh umbilical or epigastric sutured hernia repair were included. Patients completed a structured questionnaire regarding chronic complaints during work and leisure activities using a verbal rating scale. The primary outcome was chronic complaints.

Results

A total of 295 patients were included for analysis after a median of 5.0-year (range 2.8–8.0) follow-up period. Follow-up results were achieved from 262 of the included patients (90 % response rate). Up till 5.8 % of the patients reported moderate or severe pain and discomfort. Work and leisure activities were restricted in 8.5 and 10.0 % of patients, respectively. Patients with chronic complaints had a higher incidence of recurrence (clinical and reoperation), than patients with none or mild complaints (78.6 vs. 22.2 % (P?<?0.001)). The recurrence rate was significantly higher after a repair with absorbable suture (20.1 %) compared with non-absorbable suture repair (4.2 %) (P?<?0.001).

Conclusion

We found that chronic complaints after a simple sutured umbilical or epigastric repair was in the level of 5.5 % and could in part be explained by recurrence. Furthermore, absorbable suture should be omitted to reduce risk of recurrence.     

青年男性病人的腹股沟疝修补:用补片还是单纯缝合?

目的目前还没有治疗青年男性腹股沟疝病人的最佳修补方法的大宗病例报道。该文分析了丹麦全国青年男性病人接受Lichtenstein术或传统非补片修补术后复发再手术的风险。方法在丹麦国家疝数据库内前瞻性地记录了1998-01-01至2005-12-31所有接受手术治疗的腹股沟疝病例,以复发再次接受手术作为判定复发的标准。该研究的入组标准为数据库中年龄在18～30岁之间的原发性腹股沟斜疝并在研究阶段内接受了第一次修补手术的病例。结果在纳入该研究的3181例病人中,1120例(中位年龄23岁,范围18～30岁)接受了单纯的缝合修补术,2061例(中位年龄24岁,范围18～30岁)接受了Lichtenstein术。单纯缝合组的中位随访时间为62(0～96)个月,Lichtenstein组的中位随访时间为41(0～96)个月。两组的5年累积复发再手术率分别为1.6%(Lichtenstein组)和3.9%(单纯缝合组),单纯缝合组的术后总复发再手术率(39例,3.5%)为Lichtenstein组(24例,1.2%)的将近3倍(P=0.003)。结论与传统单纯缝合修补术相比,在18～30岁的青年腹股沟斜疝病人中应用Lich...     

Risk of femoral hernia after inguinal herniorrhaphy

BACKGROUND: Small case series have suggested an increased risk of femoral hernia after previous inguinal herniorrhaphy, but no large-scale data with complete follow-up are available. METHODS: Data were extracted from the Danish Hernia Database covering the interval from 1 January 1998 to 1 July 2001, and included 34 849 groin hernia repairs. RESULTS: Of 1297 femoral hernia repairs, 71 patients had previously had an operation for inguinal hernia within the observation period. These 71 femoral hernias represented 7.9 per cent of all reoperations for groin hernia recorded in the database. The median time to reoperation for a 'recurrent' femoral hernia after previous inguinal herniorrhaphy was 7 months, compared with 10 months for inguinal recurrences. The risk of developing a 'recurrent' femoral hernia after previous inguinal herniorrhaphy was 15 times higher than the rate of femoral hernia repair in the general population. CONCLUSION: This study of 34 849 groin hernia repairs demonstrated a 15-fold greater incidence of femoral hernia after inguinal herniorrhaphy compared with the spontaneous incidence. These femoral recurrences occurred earlier than inguinal recurrences, suggesting that they were possibly femoral hernias overlooked at the primary operation.     

Chronic pain after open mesh and sutured repair of indirect inguinal hernia in young males

BACKGROUND: Chronic pain is common after herniorrhaphy, but the effect of surgical technique (mesh versus non-mesh repair) and the social consequences of the pain have not been established. The aim of this study was to analyse chronic postherniorrhaphy pain and its social consequences in young males operated on for an indirect inguinal hernia with a Lichtenstein mesh repair, Shouldice or Marcy (annulorrhaphy) repair. METHODS: This was a postal questionnaire study carried out within the Danish and Swedish Hernia Database Collaboration. Some 2612 patients responded (response rate 80.9 per cent), of whom 1250 had undergone a Lichtenstein, 630 a Shouldice and 732 a Marcy repair. RESULTS: Chronic pain had been experienced within the previous month by 22.9 per cent of the patients who responded. There was an overall decrease in pain with time, from 29.7 per cent at 6-12 months to 18.1 per cent at 37-48 months after surgery, with no overall differences between the three types of repair. Pain was more common in patients younger than 40 years of age. Some 3.9 per cent of patients described the pain as moderate to severe and as frequent or constant. Of all patients with pain, 10.7 per cent experienced it as worse after than before surgery, and 56.6 per cent stated that it interfered with social activities. CONCLUSION: Chronic pain is common after primary inguinal hernia repair in young males, but there is no difference in the pain associated with open mesh and non-mesh repair.     

Femoral hernias: a register analysis of 588 repairs

Summary From 1 January 1992 to 31 December 1997 18,281 inguinal hernias and 588 femoral hernias were recorded in the Swedish Hernia Register. The aim of the present study was to characterise these femoral hernias and to evaluate the reoperation rate following their repair. 64% of all femoral hernias were located in the right groin and 36% in the left groin (p < 0.001). The male to female ratio for femoral hernia was 1:1.6; mean ages of patients with femoral and inguinal hernia were 63.4 ± 17.1 and 59.1 ± 16.4 years, respectively (p < 0.001). Emergency surgery and bowel resection at emergency surgery were more common with femoral than with inguinal hernia. The rate of ambulatory surgery was lower for femoral hernia than for inguinal hernia, mainly due to the higher emergency rate for femoral hernia. At three years the cumulative incidence of reoperation was 4.6% (95% confidence interval 2.4–6.8%) for femoral hernia and 4.0% (95% confidence interval 3.6–4.4%) for inguinal hernia (p > 0.05). Male sex and postoperative complications were associated with a significantly increased risk of reoperation following femoral hernia repair. The relative risk of reoperation was not affected by patient age, elective/emergency surgery, primary/recurrent hernia or hernia side. Repair techniques using mesh were associated with a lower reoperation rate than techniques without mesh, although the difference did not reach statistical significance.     

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??Groin hernia repair in young males: mesh or sutured repair? Bisgaard T*,Bay-Nielsen M,Kehlet H. *Department of Surgery, Køge Sygehus, Køge, Denmark
Corresponding author: Bisgaard T,e-mail:thuebisgaard@tdcadsl.dk
Abstract Objective Large-scale data for the optimal inguinal hernia repair in younger men with an indirect hernia is not available. We analysed nationwide data for risk of reoperation in younger men after a primary repair using a Lichtenstein operation or a conventional non-mesh hernia repair. Methods Prospective recording of all inguinal hernia repairs from 1 January 1998 to 31 December 2005 in the national Danish Hernia Database, using reoperation rate as a proxy for recurrence. We included only men between the age of 18 and 30 years with a primary repair of a primary indirect inguinal hernia. Results A primary sutured repair was performed in 1,120 men (median age 23 years, range 18-30) and a Lichtenstein mesh repair in 2,061 young men (24 years, range 18-30) (total 3,181 patients). The observation time after conventional hernia repair was median 62 months (range 0-96) and 41 months (range 0-96) after a Lichtenstein repair. The cumulative incidence of reoperation at 5 years was 1.6% (Lichtenstein) versus 3.9% (sutured repair), while overall reoperation rates were almost three-fold as high after a sutured repair (39 reoperations, overall reoperation rate = 3.5%) compared to a Lichtenstein repair (24 reoperations, overall reoperation rate=1.2%;P=0.0003). Conclusion Lichtenstein repair for an indirect inguinal hernia reduces the risk of recurrence in young men between the age of 18 and 30 years compared with a sutured repair. The use of a Lichtenstein mesh repair in young males must be balanced against the risk of chronic pain.     

Choice of anesthesia and risk of reoperation for recurrence in groin hernia repair

OBJECTIVE: To analyze the relative risk of reoperation for recurrence using 3 anesthetic alternatives, general anesthesia (GA), regional (spinal-, epidural-) anesthesia (RA), and local anesthesia (LA), and to study time trends for various anesthetic and operative methods, as well as other risk factors regarding reoperation for recurrence. BACKGROUND: The method of anesthesia used for hernia repair is generally assumed not to affect the long-term outcome. The few studies on the topic have rendered conflicting results. METHODS: Data from the Swedish Hernia Register was used. Relative risk was first estimated using univariate analysis for assumed risk variables and then selecting variables with the highest or lowest univariate risk for multivariate analysis. RESULTS: From 1992 through 2001, 59,823 hernia repairs were recorded. Despite the fact that univariate analysis showed a somewhat lower risk for reoperation in the LA group, the multivariate analysis showed that LA was associated with a significantly increased risk for reoperation in primary but not in recurrent hernia repair. The Lichtenstein technique carried a significantly lower reoperation risk than any other method of operation. CONCLUSIONS: LA was associated with a higher risk of reoperation for recurrence after primary hernia repair. The use of mesh techniques has increased considerably, and among these the Lichtenstein repair was associated with a significantly lower risk for reoperation than any other repair.     

Effects of training and supervision on recurrence rate after inguinal hernia repair

BACKGROUND: There is little information about the effects of operative experience and supervision of trainees on outcome in inguinal hernia surgery, one of the cornerstone operations of basic surgical training. METHODS: All primary inguinal hernia repairs carried out between 1994 and 2001 were registered prospectively in the Lothian Surgical Audit database. Subsequent problems that required re-referral were identified from this database. Patients who required reoperation for recurrence a median of 3 (range 1-7) years after surgery were identified. RESULTS: Some 4406 repairs, including 90 recurrences (2.0 per cent), were identified. Open mesh, open sutured and laparoscopic techniques were employed. Senior trainees (registrars and senior registrars) had similar recurrence rates to consultants; supervision did not affect outcome. Junior trainees (senior house officers) had similar recurrence rates to consultants as long as they were supervised by either a senior trainee or a consultant. Unsupervised junior trainees had unacceptably high recurrence rates (open mesh: relative risk (RR) 21.0 (95 per cent confidence interval (c.i.) 7.3 to 59.9), P < 0.001; open sutured: RR 16.5 (95 per cent c.i. 7.2 to 37.8), P < 0.001). CONCLUSION: Senior trainees may operate independently and supervise junior trainees, with recurrence rates equal to those of consultant surgeons. Junior trainees should be encouraged and given more practice in inguinal hernia repair with appropriate supervision.     

Randomized clinical trial comparing 5-year recurrence rate after laparoscopic versus Shouldice repair of primary inguinal hernia

BACKGROUND: The Shouldice technique is the 'gold standard' of open non-mesh hernia repair. The aim of this study was to compare 5-year recurrence rates after Shouldice and laparoscopic transabdominal preperitoneal patch (TAPP) repair for primary inguinal hernia. METHOD: Men with a primary unilateral inguinal hernia were randomized to either Shouldice or TAPP operation. An independent observer scored the surgeons' performance. Follow-up comprised clinical examination after 1 year, a questionnaire after 2 and 3 years, and a clinical examination after 5 years. RESULTS: Between February 1993 and March 1996, 1183 patients were included. Nine hundred and twenty patients were followed for 5 years, 454 in the TAPP group and 466 in the Shouldice group. Recurrences were evenly distributed between groups throughout the follow-up period. The cumulative recurrence rate after 5 years was 6.6 per cent in the TAPP group and 6.7 per cent in the Shouldice group. Postoperative pain was a risk factor for recurrence after Shouldice operation but not after TAPP repair. There was a correlation between a low surgeon's performance score and recurrence. CONCLUSION: The 5-year recurrence rate is acceptable, with no difference between TAPP and Shouldice repair. Poor operative performance resulted in a higher recurrence rate. The TAPP operation represents an excellent alternative for primary inguinal hernia repair.     

Mortality after groin hernia surgery

OBJECTIVE: To analyze mortality following groin hernia operations. SUMMARY BACKGROUND DATA: It is well known that the incidence of groin hernia in men exceeds the incidence in women by a factor of 10. However, gender differences in mortality following groin hernia surgery have not been explored in detail. METHODS: The study comprises all patients 15 years or older who underwent groin hernia repair between January 1, 1992 and December 31, 2005 at units participating in the Swedish Hernia Register (SHR). Postoperative mortality was defined as standardized mortality ratio (SMR) within 30 days, ie, observed deaths of operated patients over expected deaths considering age and gender of the population in Sweden. RESULTS: A total of 107,838 groin hernia repairs (103,710 operations), were recorded prospectively. Of 104,911 inguinal hernias, 5280 (5.1%) were treated emergently, as compared with 1068 (36.5%) of 2927 femoral hernias. Femoral hernia operations comprised 1.1% of groin hernia operations on men and 22.4% of operations on women. After femoral hernia operation, the mortality risk was increased 7-fold for both men and women. Mortality risk was not raised above that of the background population for elective groin hernia repair, but it was increased 7-fold after emergency operations and 20-fold if bowel resection was undertaken. Overall SMR was 1.4 (95% confidence interval, 1.2-1.6) for men and 4.2 (95% confidence interval, 3.2-5.4) for women, in accordance with a greater proportion of emergency operations among women compared with men, 17.0%, versus 5.1%. CONCLUSIONS: Mortality risk following elective hernia repair is low, even at high age. An emergency operation for groin hernia carries a substantial mortality risk. After groin hernia repair, women have a higher mortality risk than men due to a greater risk for emergency procedure irrespective of hernia anatomy and a greater proportion of femoral hernia.     

Laparoscopic versus open groin hernia repair: meta-analysis of randomised trials based on individual patient data

The EU Hernia Trialists Collaboration was established to provide reliable evaluation of newer methods of groin hernia repair. It involved 70 investigators in 20 countries. The aim was to perform systematic reviews and enhance the value of individual studies by reanalysis of data from randomised controlled trials in meta-analyses. Forty-one eligible trials of laparoscopic versus open groin hernia repair were identified involving 7161 participants (with individual patient data available for 4165). Meta-analysis was performed, using individual patient data where possible. Operation times for laparoscopic repair were longer and there was a higher risk of rare serious complications. Return to usual activities was faster, and there was less persisting pain and numbness. Hernia recurrence was less common than after open non-mesh repair but not different to open mesh methods. The review showed that laparoscopic repair takes longer and has more serious complications, but recovery is quicker with less persisting pain. Reduced hernia recurrence was related to the use of mesh rather than the method of mesh placement. Electronic Publication     

Prospective nationwide analysis of laparoscopic versus Lichtenstein repair of inguinal hernia

BACKGROUND: According to a Cochrane review, laparoscopic inguinal hernia repair compares favourably with open mesh repair, but few data exist from surgical practice outside departments with a special interest in hernia surgery. This study compared nationwide reoperation rates after laparoscopic and Lichtenstein repair, adjusting for factors predisposing to recurrence. METHODS: Some 3606 consecutive laparoscopic repairs were compared with 39 537 Lichtenstein repairs that were prospectively recorded in a nationwide registry between 1998 and 2003. Patients were subgrouped according to type of hernia: primary or recurrent and unilateral or bilateral. Overall reoperation rates and 95 per cent confidence intervals were calculated. Long-term reoperation rates were estimated using the Kaplan-Meier method. RESULTS: The overall reoperation rates after laparoscopic and Lichtenstein repair of unilateral primary indirect hernia (0 versus 1.0 per cent), primary direct hernia (1.1 versus 3.1 per cent), unilateral recurrent hernia (4.6 versus 4.8 per cent) and bilateral recurrent hernia (2.6 versus 7.6 per cent) did not differ. However, laparoscopic repair of a bilateral primary hernia was associated with a higher reoperation rate than Lichtenstein repair (4.8 versus 3.0 per cent) (P = 0.017). CONCLUSION: Laparoscopic repair compared favourably with Lichtenstein repair for primary indirect and direct hernias, and unilateral and bilateral recurrent hernias, but was inferior for primary bilateral hernias.