Repair of inguinal hernias in men is a common surgical procedure, but the most effective surgical technique is unknown.
In this study, investigators from the United States randomly assigned 2164 men with inguinal hernias at 14 Veterans Affairs medical centers to either open mesh or laparoscopic mesh repair.
The team measured any recurrence of hernias at 2 years. They also evaluated complications and patient-centered outcomes.
|Recurrences were more common in the laparoscopic group.|
|New England Journal of Medicine|
Of the 2164 patients, 1983 underwent an operation. The team was able to collect 2-year follow-up data for 86% of the patients
The investigators found that recurrences were more common in the laparoscopic group (10%) than in the open group (5%).
Furthermore, the rate of complications was higher in the laparoscopic group (39%) than in the open group (33%).
The team found that the laparoscopic group had less pain initially, both on the day of surgery and at 2 weeks.
These patients also returned to normal activities one day earlier.
Using prespecified analyses, the team found that there was a significant interaction between the surgical approach and the type of hernia (primary or recurrent).
The investigators determined that although recurrence was more common after laparoscopic repair than open repair of a primary hernia (10% versus 4%), the rates of recurrence after repair of recurrent hernias were similar in the 2 groups.
Dr Leigh Neumayer and colleagues concluded, "The open technique is superior to the laparoscopic technique for mesh repair of primary hernias".