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Long-Term Follow-Up of Laparoscopic Hernia Repair Confirms Benefits

Patients experienced fewer long-term complications, such as numbness or groin pain, after laparoscopic hernia repair than after open repair.

Since the introduction of the laparoscopic approach to inguinal hernia repair, results of several randomized trials and meta-analyses have shown that it is associated with less pain and more rapid recovery than is traditional surgery. In this long-term follow-up of a randomized trial, investigators show that pain reduction persists over time.

In the original study, performed in 1995-1996, laparoscopic transabdominal preperitoneal (TAPP) mesh repair under general anesthesia was compared with Lichtenstein open mesh repair under local anesthesia. Of 400 patients who were included in the original analysis, 374 were alive after 5 years, and data on 242 (122 TAPP patients and 120 open-surgery patients) were evaluated at a mean of 5.8 years by 3 surgeons who were not involved in the original study. Thirteen patients in the TAPP group and 52 in the open-surgery group suffered long-term complications. Four percent of the TAPP group experienced numbness or groin pain, compared with 33% of the open-surgery group: These symptoms were clinically important in 12 open-surgery patients and in no TAPP patients. Other complications, such as recurrence or infection, occurred infrequently in both groups.

Comment: Overall results were good in both groups, but pain and paresthesias were significantly more common in the open-surgery group after 5 years. Those particular complications appear to be the major problems that are associated with inguinal hernia repair and make the laparoscopic approach the favored technique. At the time of publication, the full text of the original article was available at http://bmj.com/cgi/content/full/326/7397/1012 free of charge.

— Keith I. Marton, MD

Published in Journal Watch General Medicine June 6, 2003

Citation(s):

Douek M et al. Prospective randomised controlled trial of laparoscopic versus open inguinal hernia mesh repair: Five year follow up. BMJ 2003 May 10; 326:1012-3.

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