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Standard Hernia Surgery Works Best in Men

Laparoscopic Hernia Surgery May Increase Risk of Complications
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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 safety.

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 significantly greater.

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 surgery (33%).

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