Inguinal Hernia Repair
Inguinal herniorrhaphy is sufficiently common that all primary care clinicians will encounter patients who will need advice and referral about which procedure is best suited to their needs. In the first year after surgery, recurrence rates generally range from 1% to 10% but may be up to 15% after five years. Beginning in about 1993, laparoscopic surgery for hernia repair was introduced, and, though initial reports suggested that this method produced superior postoperative pain levels and recovery than traditional methods, studies were too small to provide a definitive answer.
Liem analyzed data from a multicenter prospective trial of laparoscopic vs. conventional anterior open repair in 992 patients. End points were postoperative recovery, complications, and recurrence rates.
Mean duration of surgery was modestly shorter for conventional repair than laparoscopy (5 minutes). Seven percent of laparoscopic patients sustained peritoneal tears causing loss of pnemopreperitoneum, requiring change to another technique. Chronic pain postoperatively was seven times as common (14% vs 2%) in the conventional surgery group. The most serious postoperative consequenceswound infection or wound infection requiring rehospitalizationoccurred only in the conventional surgery group (about 1% of patients).
Postoperatively, the laparoscopic group reported less pain, required less analgesia, and were able to resume normal activity sooner than the conventional surgery group.
Recurrences were twice as frequent in the conventional surgery group, and the bulk of the recurrences in the laparoscopic group were procedures performed by surgeons recently trained (less experienced) in the technique.
Clinicians may wish to refer their patients for herniorrhaphy to a clinician experienced in laparoscopic repair.
Liem M. N Engl J Med 1996;336: 1541-1547.
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