Surgical Endoscopy

, Volume 13, Issue 4, pp 323–327

Open or laparoscopic preperitoneal mesh repair for recurrent inguinal hernia?

A randomized controlled trial

Authors

  • G. L. Beets
    • Department of Surgery, University Hospital of Maastricht, Post Office Box 5800, 6202 AZ Maastricht, The Netherlands
  • C. D. Dirksen
    • Department of Surgery, University Hospital of Maastricht, Post Office Box 5800, 6202 AZ Maastricht, The Netherlands
  • P. M. N. Y. H. Go
    • Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
  • F. E. A. Geisler
    • Department of Anaesthesiology, Ignatius Hospital, Breda, The Netherlands
  • C. G. M. I. Baeten
    • Department of Surgery, University Hospital of Maastricht, Post Office Box 5800, 6202 AZ Maastricht, The Netherlands
  • G. Kootstra
    • Department of Surgery, University Hospital of Maastricht, Post Office Box 5800, 6202 AZ Maastricht, The Netherlands
Article

DOI: 10.1007/s004649900981

Cite this article as:
Beets, G., Dirksen, C., Go, P. et al. Surg Endosc (1999) 13: 323. doi:10.1007/s004649900981

Abstract

Background: Giant prosthetic reinforcement of the visceral sac (GPRVS), an open preperitoneal mesh repair, is a very effective groin hernia repair. Laparoscopic transabdominal preperitoneal repair (TAPP), based on the same principle, is expected to combine low recurrence rates with minimal postoperation morbidity.

Methods: Seventy-nine patients with 93 recurrent and 15 concomitant primary inguinal hernias were randomized between GPRVS (37 patients) and TAPP (42 patients). Operating time, complications, pain, analgesia use, disability period, and recurrences were recorded.

Results: Mean operating time was 56 min with GPRVS versus 79 min with TAPP (p < 0.001). Most complications were minor, except for a pulmonary embolus and an ileus, both after GPRVS. Patients experienced less pain after a laparoscopic repair. Average disability period was 23 days with GPRVS versus 13 days with TAPP (p= 0.03) for work, and 29 versus 21 days, respectively (p= 0.07) for physical activities. Recurrence rates at a mean follow-up of 34 months were 1 in 52 (1.9%) for GPRVS versus 7 in 56 (12.5%) for TAPP (p= 0.04). Hospital costs in U.S. dollars were comparable, with GPRVS at $1,150 and TAPP at $1,179.

Conclusions: Laparoscopic repair of recurrent inguinal hernia has a lower morbidity than GPRVS. However, laparoscopic repair is a difficult operation, and the potential technical failure rate is higher. With regard to recurrence rates, the open preperitoneal prosthetic mesh repair remains the best repair.

Key words: Inguinal hernia — Laparoscopy — Mesh — Randomized trial
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Copyright information

© Springer-Verlag New York Inc. 1999