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Laparoscopic techniques versus open techniques for repair of a hernia in the groin

McCormack K, Scott N, Go PM.N.Y.H, Ross SJ, Grant A, Collaboration the EU Hernia Trialists
Published Online: 
8 October 2008

Repair of a hernia in the groin (an inguinal hernia) is the most frequently performed operation in general surgery. The hernia is repaired (with suturing or placing a synthetic mesh over the hernia in one of the layers of the abdominal wall) using either open surgery or minimal access laparoscopy. The most common laparoscopic techniques for inguinal hernia repair are transabdominal preperitoneal (TAPP) repair and totally extraperitoneal (TEP) repair. In TAPP the surgeon goes into the peritoneal cavity and places a mesh through a peritoneal incision over possible hernia sites. TEP is different as the peritoneal cavity is not entered and mesh is used to seal the hernia from outside the thin membrane covering the organs in the abdomen (the peritoneum). The mesh, where used, becomes incorporated by fibrous tissue. Minor postoperative problems occur. More serious complications such as damage to the spermatic cord, a blood vessel or nerves, are occasionally reported with open surgery and nerve or major vascular injuries, bowel obstruction, and bladder injury have been reported with laparoscopic repair. Reoccurrence of a hernia is a major drawback.
The review authors identified 41 eligible controlled trials in which a total of 7161 participants were randomized to laparoscopic or open surgery repair. The mean or median duration of follow up of patients ranged from 6 to 36 months.
Return to usual activities was faster for laparoscopic repair, by about seven days, and there was less persisting pain and numbness than with open surgery. However, operation times were some 15 minutes longer (range 14 to 16 minutes) with laparoscopy and there appeared to be a higher number of serious complications of visceral (especially bladder) and vascular injuries. Using a mesh for repair reduced the risk of a recurring hernia rather than the method of placement (open or laparoscopic surgery).

This record should be cited as: 
McCormack K, Scott N, Go PM.N.Y.H, Ross SJ, Grant A, Collaboration the EU Hernia Trialists. Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD001785. DOI: 10.1002/14651858.CD001785
Assessed as up to date: 
6 November 2002