The international surgical journal with global reach

This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Prospective nationwide analysis of laparoscopic versus Lichtenstein repair of inguinal hernia. BJS 2005; 92: 1277-1281.

Published: 7th July 2005

Authors: P. Wara, M. Bay‐Nielsen, P. Juul, J. Bendix, H. Kehlet

Background

According to a Cochrane review, laparoscopic inguinal hernia repair compares favourably with open mesh repair, but few data exist from surgical practice outside departments with a special interest in hernia surgery. This study compared nationwide reoperation rates after laparoscopic and Lichtenstein repair, adjusting for factors predisposing to recurrence.

Method

Some 3606 consecutive laparoscopic repairs were compared with 39 537 Lichtenstein repairs that were prospectively recorded in a nationwide registry between 1998 and 2003. Patients were subgrouped according to type of hernia: primary or recurrent and unilateral or bilateral. Overall reoperation rates and 95 per cent confidence intervals were calculated. Long‐term reoperation rates were estimated using the Kaplan–Meier method.

Results

The overall reoperation rates after laparoscopic and Lichtenstein repair of unilateral primary indirect hernia (0 versus 1·0 per cent), primary direct hernia (1·1 versus 3·1 per cent), unilateral recurrent hernia (4·6 versus 4·8 per cent) and bilateral recurrent hernia (2·6 versus 7·6 per cent) did not differ. However, laparoscopic repair of a bilateral primary hernia was associated with a higher reoperation rate than Lichtenstein repair (4·8 versus 3·0 per cent) (P = 0·017).

Conclusion

Laparoscopic repair compared favourably with Lichtenstein repair for primary indirect and direct hernias, and unilateral and bilateral recurrent hernias, but was inferior for primary bilateral hernias. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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