Open Surgery, Not Laparoscopy, Better for Most Hernias

A large study has shown fewer recurrences and complications overall in hernia-repair operations conducted with open surgery than with laparoscopic surgery. The findings were published in the April 29, 2004, issue of The New England Journal of Medicine.

The study involved nearly 1,700 operations to repair inguinal, or groin, hernias, the most common form. In two years of followup, the laparoscopic group (862 operations) had a 10% recurrence rate and a 39% complications rate, compared to about 5% and 33%, respectively, for the open-surgery group (834 operations).

"Based on these findings, we'd recommend that men with a hernia that has never been repaired before should undergo an open repair,” said study leader Leigh Neumayer, M.D., of the Salt Late City VA Medical Center and the University of Utah (Salt Lake City, USA). The numbers for recurrent hernias, which account for about 10% of groin hernias, were too small to make recommendations.

What counted most in the study about laparoscopy was the experience of the surgeons. For the 20 who reported having done more than 250 repairs, the recurrence rate was below 5%, similar to open repairs. However, this percentage was consistently above 10% for the 58 laparoscopic surgeons who reported less experience with the procedure. Open surgery was far less experience-dependent.




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