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Previous Volume 350:1819-1827 April 29, 2004 Number 18 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Jacobs, D. O. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Repair of inguinal hernias in men is a common surgical procedure, but the most effective surgical technique is unknown.

Methods We randomly assigned men with inguinal hernias at 14 Veterans Affairs (VA) medical centers to either open mesh or laparoscopic mesh repair. The primary outcome was recurrence of hernias at two years. Secondary outcomes included complications and patient-centered outcomes.

Results Of the 2164 patients who were randomly assigned to one of the two procedures, 1983 underwent an operation; two-year follow-up was completed in 1696 (85.5 percent). Recurrences were more common in the laparoscopic group (87 of 862 patients [10.1 percent]) than in the open group (41 of 834 patients [4.9 percent]; odds ratio, 2.2; 95 percent confidence interval, 1.5 to 3.2). The rate of complications was higher in the laparoscopic-surgery group than in the open-surgery group (39.0 percent vs. 33.4 percent; adjusted odds ratio, 1.3; 95 percent confidence interval, 1.1 to 1.6). The laparoscopic-surgery group had less pain initially than the open-surgery group on the day of surgery (difference in mean score on a visual-analogue scale, 10.2 mm; 95 percent confidence interval, 4.8 to 15.6) and at two weeks (6.1 mm; 95 percent confidence interval, 1.7 to 10.5) and returned to normal activities one day earlier (adjusted hazard ratio for a shorter time to return to normal activities, 1.2; 95 percent confidence interval, 1.1 to 1.3). In prespecified analyses, there was a significant interaction between the surgical approach (open or laparoscopic) and the type of hernia (primary or recurrent) (P=0.012). Recurrence was significantly more common after laparoscopic repair than after open repair of primary hernias (10.1 percent vs. 4.0 percent), but rates of recurrence after repair of recurrent hernias were similar in the two groups (10.0 percent and 14.1 percent, respectively).

Conclusions The open technique is superior to the laparoscopic technique for mesh repair of primary hernias.

Source Information

From the Veterans Affairs (VA) Medical Center and the Department of Surgery, University of Utah, Salt Lake City (L.N.); the VA Cooperative Studies Program Coordinating Center, Hines, Ill. (A.G.-H., D.R.); the Department of Surgery, University of Illinois College of Medicine, Chicago (O.J.); the Department of Surgery, Creighton University, Omaha, Nebr. (R.F.); the Institute for Health Services Research and Policy Studies, Northwestern University Feinberg School of Medicine, Chicago (D.D., J.G.); and the Health Outcomes Program, University of Colorado, Aurora (W.H.).

Address reprint requests to Dr. Neumayer at VAMC-112, 500 Foothill Dr., Salt Lake City, UT 84148, or at leigh.neumayer{at}hsc.utah.edu.

Full Text of this Article

Related Letters:

Open Mesh versus Laparoscopic Mesh Hernia Repair
Kumar S., Strate T., Mann O., Izbicki J. R., Alvarez C., Neumayer L., Giobbie-Hurder A., Jonasson O.
Extract | Full Text | PDF  
N Engl J Med 2004; 351:1463-1465, Sep 30, 2004. Correspondence

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