THE QUESTION When a hernia occurs in the groin, it can be repaired with traditional open surgery or minimally invasive laparoscopy. Might one option yield better results than the other?
THIS STUDY involved 660 people, nearly all men and averaging 55 years old, who had chosen to have surgery to repair an inguinal hernia. They were randomly assigned to undergo open surgery (using a method known as the Lichtenstein repair) or laparoscopic surgery (with a procedure called a total extraperitoneal, or TEP, repair). During the first month after surgery, 23 percent of those who had laparoscopy reported pain, compared with 32 percent of the open surgery group. Five years later, 15 percent in the laparoscopic group had chronic pain, compared with 28 percent for open surgery. Incidents of numbness or loss of sensitivity were found among 22 percent of those who had open surgery, compared with 1 percent of the laparoscopic group. Short-term complications developed more often after laparoscopic than open surgery (6 percent vs. 2 percent), but people returned to their daily routines and to work more quickly after a laparoscopic procedure and they were happier with their surgical scar. Hernias recurred more often in the laparoscopic group (8 percent vs. 5 percent); but among only those whose operations were done by an experienced surgeon, the rates were reversed (less than 1 percent for laparoscopy vs. 5 percent).
WHO MAY BE AFFECTED? Men with an inguinal hernia, which occurs when a weak area of muscle allows part of an internal organ, such as the intestine, to bulge through. Hernias most often occur in the abdomen, and an inguinal hernia (involving the groin) is the most common, developing about five times as often in men as in women. About 70,000 surgeries to repair inguinal hernias are done in the United States each year.
CAVEATS The study may not have been long enough to reflect all recurrences, which may develop up to 10 years after a hernia has been repaired.
FIND THIS STUDY March issue of Archives of Surgery (www.
The research described in Quick Study comes from credible, peer-reviewed journals. Nonetheless, conclusive evidence about a treatment's effectiveness is rarely found in a single study. Anyone considering changing or beginning treatment of any kind should consult with a physician.