FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Volume 336:1541-1547 May 29, 1997 Number 22 Next

	Full Text PDF Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Inguinal hernias can be repaired by laparoscopic techniques, which have had better results than open surgery in several small studies.

Methods We performed a randomized, multicenter trial in which 487 patients with inguinal hernias were treated by extraperitoneal laparoscopic repair and 507 patients were treated by conventional anterior repair. We recorded information about postoperative recovery and complications and examined the patients for recurrences one and six weeks, six months, and one and two years after surgery.

Results Six patients in the open-surgery group but none in the laparoscopic-surgery group had wound abscesses (P = 0.03), and the patients in the laparoscopic-surgery group had a more rapid recovery (median time to the resumption of normal daily activity, 6 vs. 10 days; time to the return to work, 14 vs. 21 days; and time to the resumption of athletic activities, 24 vs. 36 days; P<0.001 for all comparisons). With a median follow-up of 607 days, 31 patients (6 percent) in the open-surgery group had recurrences, as compared with 17 patients (3 percent) in the laparoscopic-surgery group (P = 0.05). All but three of the recurrences in the latter group were within one year after surgery and were caused by surgeon-related errors. In the open-surgery group, 15 patients had recurrences during the first year, and 16 during the second year. Follow-up was complete for 97 percent of the patients.

Conclusions Patients with inguinal hernias who undergo laparoscopic repair recover more rapidly and have fewer recurrences than those who undergo open surgical repair.

Source Information

From the Department of Surgery, University Hospital Utrecht, Utrecht (M.S.L.L., T.J.M.V.V.); the Department of Epidemiology and Public Health, University of Utrecht, Utrecht (Y.G., A.J.P.S.); the Department of Surgery, Ikazia Hospital, Rotterdam (C.J.S., R.U.B., W.F.W.); the Department of Surgery, Diakonessenhuis, Utrecht (G.-J.C.); the Department of Surgery, St. Clara Hospital, Rotterdam (W.S.M.); the Department of Surgery, Reinier de Graaf Gasthuis, Delft (L.P.S.S.); and the Department of Surgery, Hofpoort Hospital, Woerden (J.P.V.) — all in the Netherlands.

Address reprint requests to Dr. Liem at the Department of General Surgery, University Hospital Utrecht, G04.228, P. O. Box 85.500, 3508 GA Utrecht, the Netherlands.

Full Text of this Article

Related Letters:

Conventional versus Laparoscopic Surgery for Inguinal-Hernia Repair
Avital S., Werbin N., Gilbert A. I., Graham M. F., Liem M. S.L., van Vroonhoven T. J.M.V.
Extract | Full Text  
N Engl J Med 1997; 337:1089-1090, Oct 9, 1997. Correspondence

This article has been cited by other articles:

• Iohom, G., Abdalla, H., O'Brien, J., Szarvas, S., Larney, V., Buckley, E., Butler, M., Shorten, G. D. (2006). The Associations Between Severity of Early Postoperative Pain, Chronic Postsurgical Pain and Plasma Concentration of Stable Nitric Oxide Products After Breast Surgery. Anesth. Analg. 103: 995-1000 [Abstract] [Full Text]  
• Moreno-Egea, A., Martinez, J. A. T., Cuenca, G. M., Albasini, J. L. A. (2004). Randomized Clinical Trial of Fixation vs Nonfixation of Mesh in Total Extraperitoneal Inguinal Hernioplasty. Arch Surg 139: 1376-1379 [Abstract] [Full Text]  
• O'Dwyer, P. J. (2004). Current status of the debate on laparoscopic hernia repair. Br Med Bull 70: 105-118 [Abstract] [Full Text]  
• Fujita, F., Lahmann, B., Otsuka, K., Lyass, S., Hiatt, J. R., Phillips, E. H. (2004). Quantification of Pain and Satisfaction Following Laparoscopic and Open Hernia Repair. Arch Surg 139: 596-600 [Abstract] [Full Text]  
• Kluin, J., den Hoed, P. T., van Linschoten, R., IJzerman, J. C., van Steensel, C. J. (2004). Endoscopic Evaluation and Treatment of Groin Pain in the Athlete. Am J Sports Med 32: 944-949 [Abstract] [Full Text]  
• Gottlieb, S. (2004). Open surgery better than laparoscopic for repair of inguinal hernia. BMJ 328: 1033-1033 [Full Text]  
• Neumayer, L., Giobbie-Hurder, A., Jonasson, O., Fitzgibbons, R. Jr., Dunlop, D., Gibbs, J., Reda, D., Henderson, W., the Veterans Affairs Cooperative Studies Program 4, (2004). Open Mesh versus Laparoscopic Mesh Repair of Inguinal Hernia. NEJM 350: 1819-1827 [Abstract] [Full Text]  
• Jacobs, D. O. (2004). Mesh Repair of Inguinal Hernias -- Redux. NEJM 350: 1895-1897 [Full Text]  
• Parra, J A, Revuelta, S, Gallego, T, Bueno, J, Berrio, J I, Farinas, M C (2004). Prosthetic mesh used for inguinal and ventral hernia repair: normal appearance and complications in ultrasound and CT. Br. J. Radiol. 77: 261-265 [Abstract] [Full Text]  
• Callesen, T., Bech, K., Kehlet, H. (2001). One-Thousand Consecutive Inguinal Hernia Repairs Under Unmonitored Local Anesthesia. Anesth. Analg. 93: 1373-1376 [Abstract] [Full Text]  
• Dexter, F., Gan, T. J., Naguib, M., Lubarsky, D. A. (2001). Cost Identification Analysis for Succinylcholine. Anesth. Analg. 92: 693-699 [Abstract] [Full Text]  
• Mack, M. J. (2001). Minimally Invasive and Robotic Surgery. JAMA 285: 568-572 [Abstract] [Full Text]  
• Yen, C.-F., Wang, C.-J., Chang, P.-C., Lee, C.-L., Soong, Y.-K. (2001). Concomitant closure of patent canal of Nuck during laparoscopic surgery: Case report. Hum Reprod 16: 357-359 [Abstract] [Full Text]  
• Hollis, S., Campbell, F. (1999). What is meant by intention to treat analysis? Survey of published randomised controlled trials. BMJ 319: 670-674 [Abstract] [Full Text]  
• Rothschild, J. G. (1998). What Alternatives Has Minimally Invasive Surgery Provided the Surgeon?. Arch Surg 133: 1156-1159 [Abstract] [Full Text]  
• Clarke, M., Chalmers, I. (1998). Discussion Sections in Reports of Controlled Trials Published in General Medical Journals: Islands in Search of Continents?. JAMA 280: 280-282 [Abstract] [Full Text]  
• Avital, S., Werbin, N., Gilbert, A. I., Graham, M. F., Liem, M. S.L., van Vroonhoven, T. J.M.V. (1997). Conventional versus Laparoscopic Surgery for Inguinal-Hernia Repair. NEJM 337: 1089-1090 [Full Text]  
• (1997). CONVENTIONAL VS. LAPAROSCOPIC HERNIA SURGERY. JWatch General 1997: 3-3 [Full Text]  
• Meakins, J. L., Barkun, J. S. (1997). Old and New Ways to Repair Inguinal Hernias. NEJM 336: 1596-1597 [Full Text]