Standard Hernia Surgery Works Best in Men
Laparoscopic Hernia Surgery May Increase Risk of Complications
April 26, 2004 -- Hernia "keyhole" surgery may be less
painful for men initially, but a new study shows that the standard,
open-surgery technique is superior in terms of long-term effectiveness and
In a large study published in the April 29 issue of TheNew England Journal of Medicine, researchers found men who had
laparoscopic, or what's known as "keyhole" hernia surgery were more
than twice as likely to suffer another hernia compared with those who had
conventional hernia surgery.
The study shows that although men who undergo laparoscopic
hernia surgery may experience less pain immediately after surgery and return to
normal activities slightly earlier, their overall risk of complications is
Hernia surgery repair in men is very common, but the most
effective surgical technique is not known. The researchers compared the two
types of surgeries for repair of an inguinal hernia, a common type of hernia
where tissue bulges out because of a weak spot of the abdominal wall. It can
occur on one or both side of the groin and is often the result of heavy lifting
or the normal wear and tear associated with aging.
Laparoscopic vs. Conventional Hernia Surgery
Researchers say more than 800,000 hernia operations were
performed in the U.S. in 2000, and most of them were performed in men and on an
outpatient basis. During conventional, open hernia surgery, the hernia is
repaired through an incision made in the groin under local anesthesia.
Typically, the patient is numbed from the waist down but is not asleep.
In recent years, a laparoscopic technique of hernia repair has
been developed, in which the surgeon inserts a thin, lighted scope through an
incision in the abdomen and repairs the hernia through another incision in the
abdomen. The procedure requires general anesthesia.
In the study, researchers randomly assigned about 2,000 men to
either laparoscopic or conventional hernia surgery using mesh prostheses and
followed them for two years. The procedures were performed at 14 Veterans
Affairs (VA) medical centers throughout the U.S.
Overall, 36% of the men who underwent a hernia repair had at
least one complication, but complication rates were significantly higher among
those who had laparoscopic surgery (39%) compared with those who had open
Researchers found complications during and immediately after
surgery as well as potentially life-threatening complications occurred
significantly more frequently in the laparoscopic group than in the open group.
But rates of long-term complications were similar between the two groups.
Men who had open surgery reported more pain in the two weeks
following surgery than those in the laparoscopic group, but by three months
after surgery reported pain levels were similar in both groups.
Other findings of the study include:
Men who had laparoscopic hernia surgery returned to normal activities one
day earlier than those who had open surgery.
- Time to return to sexual activity was similar in the two groups.
- More men in the laparoscopic group were able to perform specific
activities, such as climbing stairs, shoveling, or weight lifting, at two weeks
after the procedure, but differences in activity level function between the
groups disappeared after three months of follow-up.
- Both groups had improved function at three months after surgery compared to
before the procedure, and there were no differences in improvement scores after
Based on the results of their study, the researchers conclude
that for first-time hernias, the standard, open technique of surgical repair
"is superior to the laparoscopic technique, both in terms of recurrence
rates and in terms of safety."