Document Detail

Laparoscopic compared with open methods of groin hernia repair: systematic review of randomized controlled trials.
MedLine Citation:
PMID:  10931019     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The place of laparoscopic groin hernia repair remains controversial. Individual randomized controlled trials alone have not provided statistically reliable results when considering recurrence, potentially serious complications and chronic pain. METHODS: A rigorous systematic review was performed of published data from all relevant randomized or quasi-randomized trials. Electronic databases were searched and members of the EU Hernia Trialists Collaboration consulted to identify trials. Prespecified data items were extracted from reports and, where possible, quantitative meta-analysis was performed. RESULTS: Thirty-four published reports of eligible trials were included, involving 6804 participants. Sample sizes ranged from 20 to 1051, with follow-up from 6 weeks to 36 months. Duration of operation was longer in the laparoscopic groups (P < 0.001, Sign test). Operative complications were uncommon for both methods, but visceral and vascular injuries were more frequent in the laparoscopic group (4.7 per 1000 versus 1. 1 per 1000). Postoperative pain was less among laparoscopic groups (P = 0.08). Length of hospital stay did not differ significantly between groups (P = 0.50), but return to usual activity was earlier for laparoscopic groups (P < 0.001). Chronic pain and numbness were reported for only a small minority of trials. Overall, recurrences did not differ between groups, but comparison of laparoscopic with open non-mesh repair favoured laparoscopic methods, significantly so for transabdominal preperitoneal repair (Peto odds ratio 0.56 (95 per cent confidence interval 0.33-0.93); P = 0.026). CONCLUSION: Although the rigorous search maximized trial identification, variation in trial reporting made formal meta-analysis difficult. Laparoscopic repair was associated with less postoperative pain and more rapid return to normal activities, but it takes longer to perform and may increase the risk of rare, but serious, complications.
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Publication Detail:
Type:  Comment; Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  The British journal of surgery     Volume:  87     ISSN:  0007-1323     ISO Abbreviation:  Br J Surg     Publication Date:  2000 Jul 
Date Detail:
Created Date:  2000-08-22     Completed Date:  2000-08-22     Revised Date:  2010-09-16    
Medline Journal Info:
Nlm Unique ID:  0372553     Medline TA:  Br J Surg     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  860-7     Citation Subset:  AIM; IM    
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MeSH Terms
Hernia, Inguinal / rehabilitation,  surgery*
Laparoscopy / methods*
Pain, Postoperative / etiology,  prevention & control
Patient Satisfaction
Randomized Controlled Trials as Topic
Comment On:
Br J Surg. 2000 Jul;87(7):854-9   [PMID:  10931018 ]
Comment In:
Br J Surg. 2001 Mar;88(3):471   [PMID:  11269269 ]
Br J Surg. 2001 Mar;88(3):470-1   [PMID:  11260123 ]

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