Laparoscopic versus open repair of groin hernia: a randomised comparison

P O'Dwyer, I Macintyre, A Grant, C Donaldson, J Baxter, S Ross, N Scott, A S Grant, P O'Dwyer, D Wright, E McIntosh, C Donaldson, I MacIntyre, D Knight, T Crofts, S Nixon, G Fullarton, D Greig, G Wilson, A HedgesD Hamer-Hodges, J Murphy, A Samy, P Carey, J. Wallace, M Landsdown, G Sunderland, R Mohammed, T Baker, R Spychal, C Moran, W Murray, A Darzi, J Macfie, G Bell, H Ornstein, T Gorey, S Kumar, M Campbell, A Kennedy, N Scott, D Toryerson, L Fife, C Paterson, D Wright, L Jaap, K Zarins, E McIntosh, MRC Laparoscopic Groin Hernia Trial Grp

Research output: Contribution to journalArticle

308 Citations (Scopus)

Abstract

Background Repair of a groin hernia is one of the most common elective operations performed in general surgery. Our aim was to compare laparoscopic repair with open repair of groin hernia.

Methods 928 patients with groin hernia, from 26 hospitals in the UK and Ireland, were randomly assigned to laparoscopic repair (n=468) or to open hernia repair (n=460 of which 433 were tension-free mesh repairs). Patients were clinically assessed at 1 week and 1 year after surgery, and were sent questionnaires at 3 months and 1 year. The primary endpoints were: complications; return to usual activities of social life las the most generally applicable example of return to usual activities); hernia recurrence; groin pain that persisted at 1 year; and costs to the health services. All analyses were by intention to treat.

Findings At 1 week, at least one complication was found in 108 (29.9%) patients allocated to laparoscopic repair and in 155 (43.5%) patients allocated to open repair (95% CI for difference -20.6% to -6.6%, p<0.001). There were three serious surgical complications all of which occurred in the laparoscopic group. Patients in the laparoscopic group returned to the usual activities of social life sooner than the patients in the open repair group (10 [IQR 7-21] vs 14 [7-28] days. p=0.004). At 1 year after the operation, the laparoscopic group had a lower rate of persistent groin pain than those who had open repair (28.7% vs 36.7% [95% CI for difference -14.7% to -1.4%], p=0.018). However, all seven hernia recurrences occurred in the laparoscopic group and not in the open repair group (1.9% vs 0.0% [95% CI for difference 0.5% to 3.4%], p=0.017).

Interpretation Although laparoscopic hernia repair has advantages for patients, concerns about safety indicate that open repair is the more appropriate option for the general surgeon. Our findings lend support to the move towards laparoscopic hernia surgery becoming part of the domain of specialist surgeons.

Original languageEnglish
Pages (from-to)185-190
Number of pages6
JournalThe Lancet
Volume354
Publication statusPublished - 1999

Keywords

  • inguinal-hernia
  • prospective trial
  • follow-up
  • cost
  • extraperitoneal
  • herniorrhaphy
  • hernioplasty
  • shouldice
  • surgery

Cite this

O'Dwyer, P., Macintyre, I., Grant, A., Donaldson, C., Baxter, J., Ross, S., ... MRC Laparoscopic Groin Hernia Trial Grp (1999). Laparoscopic versus open repair of groin hernia: a randomised comparison. The Lancet, 354, 185-190.

Laparoscopic versus open repair of groin hernia : a randomised comparison. / O'Dwyer, P ; Macintyre, I ; Grant, A ; Donaldson, C ; Baxter, J ; Ross, S ; Scott, N ; Grant, A S ; O'Dwyer, P ; Wright, D ; McIntosh, E ; Donaldson, C ; MacIntyre, I ; Knight, D ; Crofts, T ; Nixon, S ; Fullarton, G ; Greig, D ; Wilson, G ; Hedges, A ; Hamer-Hodges, D ; Murphy, J ; Samy, A ; Carey, P ; Wallace, J. ; Landsdown, M ; Sunderland, G ; Mohammed, R ; Baker, T ; Spychal, R ; Moran, C ; Murray, W ; Darzi, A ; Macfie, J ; Bell, G ; Ornstein, H ; Gorey, T ; Kumar, S ; Campbell, M ; Kennedy, A ; Scott, N ; Toryerson, D ; Fife, L ; Paterson, C ; Wright, D ; Jaap, L ; Zarins, K ; McIntosh, E ; MRC Laparoscopic Groin Hernia Trial Grp.

In: The Lancet, Vol. 354, 1999, p. 185-190.

Research output: Contribution to journalArticle

O'Dwyer, P, Macintyre, I, Grant, A, Donaldson, C, Baxter, J, Ross, S, Scott, N, Grant, AS, O'Dwyer, P, Wright, D, McIntosh, E, Donaldson, C, MacIntyre, I, Knight, D, Crofts, T, Nixon, S, Fullarton, G, Greig, D, Wilson, G, Hedges, A, Hamer-Hodges, D, Murphy, J, Samy, A, Carey, P, Wallace, J, Landsdown, M, Sunderland, G, Mohammed, R, Baker, T, Spychal, R, Moran, C, Murray, W, Darzi, A, Macfie, J, Bell, G, Ornstein, H, Gorey, T, Kumar, S, Campbell, M, Kennedy, A, Scott, N, Toryerson, D, Fife, L, Paterson, C, Wright, D, Jaap, L, Zarins, K, McIntosh, E & MRC Laparoscopic Groin Hernia Trial Grp 1999, 'Laparoscopic versus open repair of groin hernia: a randomised comparison', The Lancet, vol. 354, pp. 185-190.
O'Dwyer P, Macintyre I, Grant A, Donaldson C, Baxter J, Ross S et al. Laparoscopic versus open repair of groin hernia: a randomised comparison. The Lancet. 1999;354:185-190.
O'Dwyer, P ; Macintyre, I ; Grant, A ; Donaldson, C ; Baxter, J ; Ross, S ; Scott, N ; Grant, A S ; O'Dwyer, P ; Wright, D ; McIntosh, E ; Donaldson, C ; MacIntyre, I ; Knight, D ; Crofts, T ; Nixon, S ; Fullarton, G ; Greig, D ; Wilson, G ; Hedges, A ; Hamer-Hodges, D ; Murphy, J ; Samy, A ; Carey, P ; Wallace, J. ; Landsdown, M ; Sunderland, G ; Mohammed, R ; Baker, T ; Spychal, R ; Moran, C ; Murray, W ; Darzi, A ; Macfie, J ; Bell, G ; Ornstein, H ; Gorey, T ; Kumar, S ; Campbell, M ; Kennedy, A ; Scott, N ; Toryerson, D ; Fife, L ; Paterson, C ; Wright, D ; Jaap, L ; Zarins, K ; McIntosh, E ; MRC Laparoscopic Groin Hernia Trial Grp. / Laparoscopic versus open repair of groin hernia : a randomised comparison. In: The Lancet. 1999 ; Vol. 354. pp. 185-190.
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title = "Laparoscopic versus open repair of groin hernia: a randomised comparison",
abstract = "Background Repair of a groin hernia is one of the most common elective operations performed in general surgery. Our aim was to compare laparoscopic repair with open repair of groin hernia.Methods 928 patients with groin hernia, from 26 hospitals in the UK and Ireland, were randomly assigned to laparoscopic repair (n=468) or to open hernia repair (n=460 of which 433 were tension-free mesh repairs). Patients were clinically assessed at 1 week and 1 year after surgery, and were sent questionnaires at 3 months and 1 year. The primary endpoints were: complications; return to usual activities of social life las the most generally applicable example of return to usual activities); hernia recurrence; groin pain that persisted at 1 year; and costs to the health services. All analyses were by intention to treat.Findings At 1 week, at least one complication was found in 108 (29.9{\%}) patients allocated to laparoscopic repair and in 155 (43.5{\%}) patients allocated to open repair (95{\%} CI for difference -20.6{\%} to -6.6{\%}, p<0.001). There were three serious surgical complications all of which occurred in the laparoscopic group. Patients in the laparoscopic group returned to the usual activities of social life sooner than the patients in the open repair group (10 [IQR 7-21] vs 14 [7-28] days. p=0.004). At 1 year after the operation, the laparoscopic group had a lower rate of persistent groin pain than those who had open repair (28.7{\%} vs 36.7{\%} [95{\%} CI for difference -14.7{\%} to -1.4{\%}], p=0.018). However, all seven hernia recurrences occurred in the laparoscopic group and not in the open repair group (1.9{\%} vs 0.0{\%} [95{\%} CI for difference 0.5{\%} to 3.4{\%}], p=0.017).Interpretation Although laparoscopic hernia repair has advantages for patients, concerns about safety indicate that open repair is the more appropriate option for the general surgeon. Our findings lend support to the move towards laparoscopic hernia surgery becoming part of the domain of specialist surgeons.",
keywords = "inguinal-hernia, prospective trial, follow-up, cost, extraperitoneal, herniorrhaphy, hernioplasty, shouldice, surgery",
author = "P O'Dwyer and I Macintyre and A Grant and C Donaldson and J Baxter and S Ross and N Scott and Grant, {A S} and P O'Dwyer and D Wright and E McIntosh and C Donaldson and I MacIntyre and D Knight and T Crofts and S Nixon and G Fullarton and D Greig and G Wilson and A Hedges and D Hamer-Hodges and J Murphy and A Samy and P Carey and J. Wallace and M Landsdown and G Sunderland and R Mohammed and T Baker and R Spychal and C Moran and W Murray and A Darzi and J Macfie and G Bell and H Ornstein and T Gorey and S Kumar and M Campbell and A Kennedy and N Scott and D Toryerson and L Fife and C Paterson and D Wright and L Jaap and K Zarins and E McIntosh and {MRC Laparoscopic Groin Hernia Trial Grp}",
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TY - JOUR

T1 - Laparoscopic versus open repair of groin hernia

T2 - a randomised comparison

AU - O'Dwyer, P

AU - Macintyre, I

AU - Grant, A

AU - Donaldson, C

AU - Baxter, J

AU - Ross, S

AU - Scott, N

AU - Grant, A S

AU - O'Dwyer, P

AU - Wright, D

AU - McIntosh, E

AU - Donaldson, C

AU - MacIntyre, I

AU - Knight, D

AU - Crofts, T

AU - Nixon, S

AU - Fullarton, G

AU - Greig, D

AU - Wilson, G

AU - Hedges, A

AU - Hamer-Hodges, D

AU - Murphy, J

AU - Samy, A

AU - Carey, P

AU - Wallace, J.

AU - Landsdown, M

AU - Sunderland, G

AU - Mohammed, R

AU - Baker, T

AU - Spychal, R

AU - Moran, C

AU - Murray, W

AU - Darzi, A

AU - Macfie, J

AU - Bell, G

AU - Ornstein, H

AU - Gorey, T

AU - Kumar, S

AU - Campbell, M

AU - Kennedy, A

AU - Scott, N

AU - Toryerson, D

AU - Fife, L

AU - Paterson, C

AU - Wright, D

AU - Jaap, L

AU - Zarins, K

AU - McIntosh, E

AU - MRC Laparoscopic Groin Hernia Trial Grp

PY - 1999

Y1 - 1999

N2 - Background Repair of a groin hernia is one of the most common elective operations performed in general surgery. Our aim was to compare laparoscopic repair with open repair of groin hernia.Methods 928 patients with groin hernia, from 26 hospitals in the UK and Ireland, were randomly assigned to laparoscopic repair (n=468) or to open hernia repair (n=460 of which 433 were tension-free mesh repairs). Patients were clinically assessed at 1 week and 1 year after surgery, and were sent questionnaires at 3 months and 1 year. The primary endpoints were: complications; return to usual activities of social life las the most generally applicable example of return to usual activities); hernia recurrence; groin pain that persisted at 1 year; and costs to the health services. All analyses were by intention to treat.Findings At 1 week, at least one complication was found in 108 (29.9%) patients allocated to laparoscopic repair and in 155 (43.5%) patients allocated to open repair (95% CI for difference -20.6% to -6.6%, p<0.001). There were three serious surgical complications all of which occurred in the laparoscopic group. Patients in the laparoscopic group returned to the usual activities of social life sooner than the patients in the open repair group (10 [IQR 7-21] vs 14 [7-28] days. p=0.004). At 1 year after the operation, the laparoscopic group had a lower rate of persistent groin pain than those who had open repair (28.7% vs 36.7% [95% CI for difference -14.7% to -1.4%], p=0.018). However, all seven hernia recurrences occurred in the laparoscopic group and not in the open repair group (1.9% vs 0.0% [95% CI for difference 0.5% to 3.4%], p=0.017).Interpretation Although laparoscopic hernia repair has advantages for patients, concerns about safety indicate that open repair is the more appropriate option for the general surgeon. Our findings lend support to the move towards laparoscopic hernia surgery becoming part of the domain of specialist surgeons.

AB - Background Repair of a groin hernia is one of the most common elective operations performed in general surgery. Our aim was to compare laparoscopic repair with open repair of groin hernia.Methods 928 patients with groin hernia, from 26 hospitals in the UK and Ireland, were randomly assigned to laparoscopic repair (n=468) or to open hernia repair (n=460 of which 433 were tension-free mesh repairs). Patients were clinically assessed at 1 week and 1 year after surgery, and were sent questionnaires at 3 months and 1 year. The primary endpoints were: complications; return to usual activities of social life las the most generally applicable example of return to usual activities); hernia recurrence; groin pain that persisted at 1 year; and costs to the health services. All analyses were by intention to treat.Findings At 1 week, at least one complication was found in 108 (29.9%) patients allocated to laparoscopic repair and in 155 (43.5%) patients allocated to open repair (95% CI for difference -20.6% to -6.6%, p<0.001). There were three serious surgical complications all of which occurred in the laparoscopic group. Patients in the laparoscopic group returned to the usual activities of social life sooner than the patients in the open repair group (10 [IQR 7-21] vs 14 [7-28] days. p=0.004). At 1 year after the operation, the laparoscopic group had a lower rate of persistent groin pain than those who had open repair (28.7% vs 36.7% [95% CI for difference -14.7% to -1.4%], p=0.018). However, all seven hernia recurrences occurred in the laparoscopic group and not in the open repair group (1.9% vs 0.0% [95% CI for difference 0.5% to 3.4%], p=0.017).Interpretation Although laparoscopic hernia repair has advantages for patients, concerns about safety indicate that open repair is the more appropriate option for the general surgeon. Our findings lend support to the move towards laparoscopic hernia surgery becoming part of the domain of specialist surgeons.

KW - inguinal-hernia

KW - prospective trial

KW - follow-up

KW - cost

KW - extraperitoneal

KW - herniorrhaphy

KW - hernioplasty

KW - shouldice

KW - surgery

M3 - Article

VL - 354

SP - 185

EP - 190

JO - The Lancet

JF - The Lancet

SN - 0140-6736

ER -