Laparoscopic compared with open methods of groin hernia repair: systematic review of randomized controlled trials

A  Grant; P  Go; A  Fingerhut; A  Kingsnorth; J  Merello; P  O'Dwyer; J  Payne; K  Webb; N  Scott; S  Ross; P  Aitola; B  Anderberg; D  Arvidsson; J  Barkun; M  Bay-Nielsen; G  Beets; R  Bittner; S  Bringman; C  Castoro; G  Champault; C  Dirksen; C  Filipi; R  Fitzgibbons; R  Girao; E  Hatzitheoklitos; P  Hauters; T  Heikkinen; H  Jeekel; B  Johansson; A  Kald; H  Kehlet; A  Klingler; R  Kozol; B  Leibl; J  McGillicuddy; I  Macintyre; G  Maddern; B  Millat; E  Nilsson; P  Nordin; A  Paganini; G  Pappalardo; J S  Pedros; R  Schmitz; A  Schwarz; S  Shah; R  Simmermacher; Z  Sledzinski; D  Stoker; A  Tanner; EU Hernia Trialists Collaboration

Laparoscopic compared with open methods of groin hernia repair: systematic review of randomized controlled trials

A Grant, P Go, A Fingerhut, A Kingsnorth, J Merello, P O'Dwyer, J Payne, K Webb, N Scott, S Ross, P Aitola, B Anderberg, D Arvidsson, J Barkun, M Bay-Nielsen, G Beets, R Bittner, S Bringman, C Castoro, G ChampaultC Dirksen, C Filipi, R Fitzgibbons, R Girao, E Hatzitheoklitos, P Hauters, T Heikkinen, H Jeekel, B Johansson, A Kald, H Kehlet, A Klingler, R Kozol, B Leibl, J McGillicuddy, I Macintyre, G Maddern, B Millat, E Nilsson, P Nordin, A Paganini, G Pappalardo, J S Pedros, R Schmitz, A Schwarz, S Shah, R Simmermacher, Z Sledzinski, D Stoker, A Tanner, EU Hernia Trialists Collaboration

Research output: Contribution to journal › Literature review

297 Citations (Scopus)

Abstract

Background: The place of laparoscopic groin hernia repair remains controversial. Individual randomized controlled trials alone have not provided statistically reliable results when considering recurrence, potentially serious complications and chronic pain.

Methods: A rigorous systematic review was performed of published data from all relevant randomized or quasi-randomized trials. Electronic databases were searched and members of the EU Hernia Trialists Collaboration consulted to identify trials. Prespecified data items were extracted from reports and, where possible, quantitative meta-analysis was performed.

Results: Thirty-four published reports of eligible trials were included, involving 6804 participants. Sample sizes ranged from 20 to 1051, with follow-up from 6 weeks to 36 months. Duration of operation was longer in the laparoscopic groups (P < 0.001, Sign test). Operative complications were uncommon for both methods, but visceral and vascular injuries were more frequent in the laparoscopic group (4.7 per 1000 versus 1.1 per 1000). Postoperative pain was less among laparoscopic groups (P = 0.08). Length of hospital stay did not differ significantly between groups (P = 0.50), but return to usual activity was earlier for laparoscopic groups (P < 0.001). Chronic pain and numbness were reported for only a small minority of trials. Overall, recurrences did not differ between groups, but comparison of laparoscopic with open non-mesh repair favoured laparoscopic methods, significantly so for transabdominal preperitoneal repair (Peto odds ratio 0.56 (95 per cent confidence interval 0.33-0.93); P = 0.026).

Conclusion: Although the rigorous search maximized trial identification, variation in trial reporting made formal meta-analysis difficult. Laparoscopic repair was associated with less postoperative pain and more rapid return to normal activities, but it takes longer to perform and may increase the risk of rare, but serious, complications.

Original language	English
Pages (from-to)	860-867
Number of pages	8
Journal	British Journal of Surgery
Volume	87
Publication status	Published - 2000

Keywords

OPEN INGUINAL HERNIORRHAPHY
DAY SURGICAL-PROCEDURE
TRANSABDOMINAL PREPERITONEAL
SHOULDICE TECHNIQUE
POSTOPERATIVE PAIN
MULTICENTER TRIAL
MESH REPAIR
OPERATION
HERNIOPLASTY
SURGERY

Cite this

Grant, A., Go, P., Fingerhut, A., Kingsnorth, A., Merello, J., O'Dwyer, P., Payne, J., Webb, K., Scott, N., Ross, S., Aitola, P., Anderberg, B., Arvidsson, D., Barkun, J., Bay-Nielsen, M., Beets, G., Bittner, R., Bringman, S., Castoro, C., ... EU Hernia Trialists Collaboration (2000). Laparoscopic compared with open methods of groin hernia repair: systematic review of randomized controlled trials. British Journal of Surgery, 87, 860-867.

Grant, A, Go, P, Fingerhut, A, Kingsnorth, A, Merello, J, O'Dwyer, P, Payne, J, Webb, K, Scott, N, Ross, S, Aitola, P, Anderberg, B, Arvidsson, D, Barkun, J, Bay-Nielsen, M, Beets, G, Bittner, R, Bringman, S, Castoro, C, Champault, G, Dirksen, C, Filipi, C, Fitzgibbons, R, Girao, R, Hatzitheoklitos, E, Hauters, P, Heikkinen, T, Jeekel, H, Johansson, B, Kald, A, Kehlet, H, Klingler, A, Kozol, R, Leibl, B, McGillicuddy, J, Macintyre, I, Maddern, G, Millat, B, Nilsson, E, Nordin, P, Paganini, A, Pappalardo, G, Pedros, JS, Schmitz, R, Schwarz, A, Shah, S, Simmermacher, R, Sledzinski, Z, Stoker, D, Tanner, A & EU Hernia Trialists Collaboration 2000, 'Laparoscopic compared with open methods of groin hernia repair: systematic review of randomized controlled trials', British Journal of Surgery, vol. 87, pp. 860-867.

@article{290be0eff2ac4d3fb53e305258e54e2b,

title = "Laparoscopic compared with open methods of groin hernia repair: systematic review of randomized controlled trials",

abstract = "Background: The place of laparoscopic groin hernia repair remains controversial. Individual randomized controlled trials alone have not provided statistically reliable results when considering recurrence, potentially serious complications and chronic pain.Methods: A rigorous systematic review was performed of published data from all relevant randomized or quasi-randomized trials. Electronic databases were searched and members of the EU Hernia Trialists Collaboration consulted to identify trials. Prespecified data items were extracted from reports and, where possible, quantitative meta-analysis was performed.Results: Thirty-four published reports of eligible trials were included, involving 6804 participants. Sample sizes ranged from 20 to 1051, with follow-up from 6 weeks to 36 months. Duration of operation was longer in the laparoscopic groups (P < 0.001, Sign test). Operative complications were uncommon for both methods, but visceral and vascular injuries were more frequent in the laparoscopic group (4.7 per 1000 versus 1.1 per 1000). Postoperative pain was less among laparoscopic groups (P = 0.08). Length of hospital stay did not differ significantly between groups (P = 0.50), but return to usual activity was earlier for laparoscopic groups (P < 0.001). Chronic pain and numbness were reported for only a small minority of trials. Overall, recurrences did not differ between groups, but comparison of laparoscopic with open non-mesh repair favoured laparoscopic methods, significantly so for transabdominal preperitoneal repair (Peto odds ratio 0.56 (95 per cent confidence interval 0.33-0.93); P = 0.026).Conclusion: Although the rigorous search maximized trial identification, variation in trial reporting made formal meta-analysis difficult. Laparoscopic repair was associated with less postoperative pain and more rapid return to normal activities, but it takes longer to perform and may increase the risk of rare, but serious, complications.",

keywords = "OPEN INGUINAL HERNIORRHAPHY, DAY SURGICAL-PROCEDURE, TRANSABDOMINAL PREPERITONEAL, SHOULDICE TECHNIQUE, POSTOPERATIVE PAIN, MULTICENTER TRIAL, MESH REPAIR, OPERATION, HERNIOPLASTY, SURGERY",

author = "A Grant and P Go and A Fingerhut and A Kingsnorth and J Merello and P O'Dwyer and J Payne and K Webb and N Scott and S Ross and P Aitola and B Anderberg and D Arvidsson and J Barkun and M Bay-Nielsen and G Beets and R Bittner and S Bringman and C Castoro and G Champault and C Dirksen and C Filipi and R Fitzgibbons and R Girao and E Hatzitheoklitos and P Hauters and T Heikkinen and H Jeekel and B Johansson and A Kald and H Kehlet and A Klingler and R Kozol and B Leibl and J McGillicuddy and I Macintyre and G Maddern and B Millat and E Nilsson and P Nordin and A Paganini and G Pappalardo and Pedros, {J S} and R Schmitz and A Schwarz and S Shah and R Simmermacher and Z Sledzinski and D Stoker and A Tanner and {EU Hernia Trialists Collaboration}",

year = "2000",

language = "English",

volume = "87",

pages = "860--867",

journal = "British Journal of Surgery",

issn = "0007-1323",

publisher = "Oxford University Press (OUP)",

}

TY - JOUR

T1 - Laparoscopic compared with open methods of groin hernia repair: systematic review of randomized controlled trials

AU - Grant, A

AU - Go, P

AU - Fingerhut, A

AU - Kingsnorth, A

AU - Merello, J

AU - O'Dwyer, P

AU - Payne, J

AU - Webb, K

AU - Scott, N

AU - Ross, S

AU - Aitola, P

AU - Anderberg, B

AU - Arvidsson, D

AU - Barkun, J

AU - Bay-Nielsen, M

AU - Beets, G

AU - Bittner, R

AU - Bringman, S

AU - Castoro, C

AU - Champault, G

AU - Dirksen, C

AU - Filipi, C

AU - Fitzgibbons, R

AU - Girao, R

AU - Hatzitheoklitos, E

AU - Hauters, P

AU - Heikkinen, T

AU - Jeekel, H

AU - Johansson, B

AU - Kald, A

AU - Kehlet, H

AU - Klingler, A

AU - Kozol, R

AU - Leibl, B

AU - McGillicuddy, J

AU - Macintyre, I

AU - Maddern, G

AU - Millat, B

AU - Nilsson, E

AU - Nordin, P

AU - Paganini, A

AU - Pappalardo, G

AU - Pedros, J S

AU - Schmitz, R

AU - Schwarz, A

AU - Shah, S

AU - Simmermacher, R

AU - Sledzinski, Z

AU - Stoker, D

AU - Tanner, A

AU - EU Hernia Trialists Collaboration

PY - 2000

Y1 - 2000

N2 - Background: The place of laparoscopic groin hernia repair remains controversial. Individual randomized controlled trials alone have not provided statistically reliable results when considering recurrence, potentially serious complications and chronic pain.Methods: A rigorous systematic review was performed of published data from all relevant randomized or quasi-randomized trials. Electronic databases were searched and members of the EU Hernia Trialists Collaboration consulted to identify trials. Prespecified data items were extracted from reports and, where possible, quantitative meta-analysis was performed.Results: Thirty-four published reports of eligible trials were included, involving 6804 participants. Sample sizes ranged from 20 to 1051, with follow-up from 6 weeks to 36 months. Duration of operation was longer in the laparoscopic groups (P < 0.001, Sign test). Operative complications were uncommon for both methods, but visceral and vascular injuries were more frequent in the laparoscopic group (4.7 per 1000 versus 1.1 per 1000). Postoperative pain was less among laparoscopic groups (P = 0.08). Length of hospital stay did not differ significantly between groups (P = 0.50), but return to usual activity was earlier for laparoscopic groups (P < 0.001). Chronic pain and numbness were reported for only a small minority of trials. Overall, recurrences did not differ between groups, but comparison of laparoscopic with open non-mesh repair favoured laparoscopic methods, significantly so for transabdominal preperitoneal repair (Peto odds ratio 0.56 (95 per cent confidence interval 0.33-0.93); P = 0.026).Conclusion: Although the rigorous search maximized trial identification, variation in trial reporting made formal meta-analysis difficult. Laparoscopic repair was associated with less postoperative pain and more rapid return to normal activities, but it takes longer to perform and may increase the risk of rare, but serious, complications.

AB - Background: The place of laparoscopic groin hernia repair remains controversial. Individual randomized controlled trials alone have not provided statistically reliable results when considering recurrence, potentially serious complications and chronic pain.Methods: A rigorous systematic review was performed of published data from all relevant randomized or quasi-randomized trials. Electronic databases were searched and members of the EU Hernia Trialists Collaboration consulted to identify trials. Prespecified data items were extracted from reports and, where possible, quantitative meta-analysis was performed.Results: Thirty-four published reports of eligible trials were included, involving 6804 participants. Sample sizes ranged from 20 to 1051, with follow-up from 6 weeks to 36 months. Duration of operation was longer in the laparoscopic groups (P < 0.001, Sign test). Operative complications were uncommon for both methods, but visceral and vascular injuries were more frequent in the laparoscopic group (4.7 per 1000 versus 1.1 per 1000). Postoperative pain was less among laparoscopic groups (P = 0.08). Length of hospital stay did not differ significantly between groups (P = 0.50), but return to usual activity was earlier for laparoscopic groups (P < 0.001). Chronic pain and numbness were reported for only a small minority of trials. Overall, recurrences did not differ between groups, but comparison of laparoscopic with open non-mesh repair favoured laparoscopic methods, significantly so for transabdominal preperitoneal repair (Peto odds ratio 0.56 (95 per cent confidence interval 0.33-0.93); P = 0.026).Conclusion: Although the rigorous search maximized trial identification, variation in trial reporting made formal meta-analysis difficult. Laparoscopic repair was associated with less postoperative pain and more rapid return to normal activities, but it takes longer to perform and may increase the risk of rare, but serious, complications.

KW - OPEN INGUINAL HERNIORRHAPHY

KW - DAY SURGICAL-PROCEDURE

KW - TRANSABDOMINAL PREPERITONEAL

KW - SHOULDICE TECHNIQUE

KW - POSTOPERATIVE PAIN

KW - MULTICENTER TRIAL

KW - MESH REPAIR

KW - OPERATION

KW - HERNIOPLASTY

KW - SURGERY

M3 - Literature review

SN - 0007-1323

VL - 87

SP - 860

EP - 867

JO - British Journal of Surgery

JF - British Journal of Surgery

ER -

Laparoscopic compared with open methods of groin hernia repair: systematic review of randomized controlled trials

Abstract

Keywords

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