Laparoscopic or open repair of inguinal hernias?

Randomized clinical trial comparing totally extraperitoneal inguinal hernia repair with the Shouldice technique

BACKGROUND

The optimal technique for inguinal hernia repair remains contentious. This study compared the Shouldice repair with the totally extraperitoneal endoscopic (TEP) method in a randomized clinical trial, with quality of life (QoL) and cost analysis.

METHODS

Two hundred patients were randomized to Shouldice or TEP repair. Patients were assessed after operation by questionnaire to determine operative outcomes, complications, QoL, and return to work and normal lifestyle.

RESULTS

There were 117 TEP and 115 Shouldice repairs. Median operating time was longer for TEP repair (70 versus 56 min; P = 0.0001), but patients were discharged earlier (68 versus 48 per cent within 1 day; P = 0.0065), and had a quicker return to work (14 versus 30 days; P = 0.0001) and normal lifestyle (21 versus 35 days; P = 0.0001). Open repair was nearly 40 per cent cheaper. Late follow-up in 171 patients (86 per cent) at a median of 1.3 years found that TEP repair led to fewer complications at 1 year (9 versus 21 per cent; P = 0.05) and was associated with significant improvement for the QoL components of work performance and satisfaction, physical symptoms and sense of well-being.

CONCLUSION

TEP repair results in fewer complications and an earlier return to work and normal lifestyle, but is more expensive and takes longer to perform.

Inflammatory responses in open versus laparoscopic herniorrhaphy

The aim of this study is to verify whether differences could be found or not as concerns of the postoperative surgical stress between the conventional open herniorrhaphy and laparoscopic herniorrhaphy. We therefore compared the immunological and inflammatory responses to open and laparoscopic procedures in this study. The sex, age, weight, and height characteristics of group 1 (open surgery group) matched those of group 2 (laparoscopic surgery group), and no statistically significant differences were found between them. Nor were there any statistically significant differences in operating time or the postoperative hospitalization. Blood samples were collected preoperatively [postoperative day (POD)0], POD 1 and 5, and the following parameters were assessed: total leukocyte (WBC) count, including neutrophil and lymphocyte subpopulations, HLA-DR+CD3+, IL-6, C-reactive protein (CRP), serum albumin, and body temperature. No differences were detected between two groups in leukocyte, neutrophil, or lymphocyte count, HLA-DR+CD3+, IL-6, albumin, or body temperature or any of the postoperative days. The only statistically significant difference was a higher CRP value in the laparoscopy group than the open group only on POD 1 (p < 0.05). It can be concluded that the laparoscopic approach appears to offer no advantages over the open approach to herniorrhaphy from the standpoint of immunological and inflammatory responses.

The evolution of laparoscopic surgery in routine health care

While laparoscopic cholecystectomy is now widely used, diffusion of other laparoscopic surgical methods has been more modest. Uptake of most laparoscopic methods has been influenced by considerations of effectiveness compared with open surgery, competing minimally invasive therapies, and the inconvenience and cost of technical change.