FRIDAY, May 9, 2003 (HealthDayNews) -- Repairing hernias with laparoscopic surgery results in far fewer complications than conventional surgery.
Five years after going under the knife, patients in a randomized, controlled study reported the same number of recurrences but with less pain or discomfort when they underwent a laparoscopic procedure, reports a study in the May 10 issue of the British Medical Journal.
The findings challenge the recommendations of the National Institute for Clinical Excellence (NICE) in Britain, which recently recommended that conventional "open repair" surgery be favored over other methods. And the data will almost certainly add momentum to a trend favoring laparoscopy for this type of procedure, says Dr. Celia M. Divino, director of minimally invasive surgery at Maimonides Medical Center in New York City.
Laparoscopic surgery involves making only a small incision, then placing a tiny video camera inside the abdominal cavity to guide the surgeon. Traditional surgery to repair inguinal hernias, when part of the intestine bulges through muscles in the groin area, has involved repairing the opening in the muscle wall. Sometimes the area is also reinforced with a mesh patch.
"Open repair is still standard for several reasons," Divino says. "Open repair is usually done under local anesthesia. Laparoscopy is done under general [in which the patient is unconscious], so you have to choose your patients because not everybody is a candidate for general anesthesia."
In the United Kingdom, says Dr. David L. Stoker, study author and a director of surgery at North Middlesex University Hospital in London, 95 percent of the 100,000 or so hernia repairs done every year are still open repair. Hernia repair is considered an intermediate type surgery -- not major, but not like having a tooth pulled. "They're very important because there are so many of them. It mainly affects working males, so economically it's a very important operation. It's important to get people back to work," Stoker says.
In 1993, Stoker compared laparoscopic surgery with the conventional surgical technique that was standard at the time. "We compared that with the keyhole [laparoscopic] operation and we had extremely good results," he says.
The current study compares laparoscopic surgery with a newer form of open repair, Lichtenstein mesh repair in individuals who have groin-area hernias.
Stoker and his colleagues randomly assigned 403 patients to either open hernia repair or laparoscopic surgery at two London hospitals between May 1995 and December 1996. At the end of five years, they reviewed the progress of 242 patients, 120 of whom had had open repair and 122 of whom had had the laparoscopic procedure.
Forty-three percent of the patients in the open repair group had complications, compared with only 11 percent in the laparoscopic group. Only patients in the open repair group experienced serious complications.
"Recurrence rates were virtually identical in both groups, no better, no worse," Stoker says. "Because the incisions are smaller, you have less pain, get back to work quickly and, in the long term, they have less in the area of long-term pain. It dramatically reduces complications." With conventional surgery, some patients have pain for years because the cutting is done so close to the nerves.
Even if laparoscopic surgery starts to cut into the business of open repair, it may never be for everybody.
"I do both, and I tailor to the patient population," Divino says. "If I have a 79-year-old who doesn't want to go under general anesthesia
obviously you just want to do an open repair. A 42-year-old, strapping young man with two hernias, he's a perfect candidate for laparoscopy. The quality-of-life issues are very significant. There's really significantly less pain with laparoscopy."
More information
For more on hernia and hernia repair, visit the National Institute of Diabetes & Digestive & Kidney Diseases or the British Hernia Centre.
