Page 29 - World Journal of Laparoscopic Surgery

Open vs Laparoscopic Inguinal Hernia Repair
reported with respect to inguinal hernia repair. In particular, while Table 1: Demographic and anthropometric data for patients who
obesity affects drug volume distribution and modifies anesthetic underwent open and laparoscopic surgery methods of inguinal hernia
24
requirements during surgery, little research has examined the repair. Mean ± standard deviation with range in parentheses
influence of BMI on postoperative analgesic use. Considering that Laparoscopic Between-
increased body weight is an independent risk factor for developing Open surgery surgery (n = 24; group
an inguinal hernia, this is an important factor to assess in this (n = 39; 62%) 38%) comparison
context. Age (years) 66 ± 16 (22–88) 47 ± 16 (20–83) p < 0.0001
A comprehensive examination of postoperative analgesia Weight (kg) 79 ± 13 84 ± 15 p = 0.126
consumption after open vs laparoscopic inguinal hernia repair (53–110) (78–112)
in Australia is lacking. The current study aims to compare open BMI (kg/m ) 27 ± 3 (18–37) 28 ± 4 (20–37) p = 0.274
2
vs laparoscopic surgical methods for inguinal hernia repairs in Hernia type: 41% vs 59% 46% vs 54% χ = 0.140
2
terms of the types and quantity of analgesia administered during direct vs indirect
the immediate postoperative recovery period (up to 1 hour post- p = 0.708
2
surgery) and for the duration of the patient’s hospital ward stay. In Previous hernia 21% 58% χ = 9.351
addition, patient characteristics of sex, age, weight, BMI, type of p = 0.002
inguinal hernia, and previous inguinal hernia repair were included
in analyzes for further comparison between open and laparoscopic
groups, and associations between subgroups. undergone laparoscopic surgery while 81% of those aged between
50 years and 88 years had open surgery.
MAterIAls And Methods Hernia Type and Previous Hernia

The project was undertaken after approval by the Human Research The majority (64%) of those with a previous hernia underwent
Ethics Committee of the University of Wollongong (LNR/16/ laparoscopic surgery, while the majority (76%) of those for whom
WGONG/253). Patient data were obtained from Griffith Base this was their first hernia repair had open surgery. A significantly
Hospital, a 114-bed regional hospital in New South Wales, Australia, higher proportion of patients with a direct hernia compared with
2
for all patients aged at least 18 years who had undergone an inguinal an indirect hernia had a previous hernia (68% vs 29%; χ = 8.853,
hernia repair during 2016–2017, using the hospital database p = 0.003). There were no significant effect of any of age, BMI, or
(SurgiNet). All records were deidentified and only anonymous data weight on having an indirect vs direct hernia.
were analyzed. Data collected included sex, age, weight, BMI, type
of inguinal hernia (direct or indirect), whether there had been a Hospital Stay Duration and Pain Medications
previous inguinal hernia repair, the surgical repair method (open Administered
or laparoscopic), and duration of hospital stay. Details pertaining Duration of hospital stay was not significantly different between
to analgesic medications given during recovery and while on the the open and laparoscopic surgeries (Table 2); however, there
hospital ward were obtained from the respective medication charts. was a significant correlation between age and duration of
The type(s) of medication and dosage (concentration and frequency) hospital stay (R = 0.314, p = 0.012). Medications given during the
were recorded, and total dose after surgery was calculated: (i) during immediate postoperative period and the hospital stay included
recovery and (ii) during the hospital stay. To compare between paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs),
doses of different opioid medications, an equivalent morphine and opioid medications (morphine or fentanyl). Participants’
dose was calculated, where 1 mg morphine = 1 mg oxycodone = analgesic medication for each time period was classified as (i)
10 μg fentanyl. none, (ii) paracetamol and/or NSAID, (iii) opioid medication, and
Data were analyzed using IBM SPSS Statistics 21. Results are (iv) a combination of opioid medication with either paracetamol
reported as means with standard deviations. Data between groups or NSAID.
(open vs laparoscopic surgery) were compared using Student’s
25
unpaired t tests. Patients’ BMIs were classified as healthy (BMI = Pain Medication in the Immediate Postoperative
2
2
18.5–24.9 kg/m ), overweight (BMI = 25–30 kg/m ), or obese (BMI > Period
2
30 kg/m ). The distributions of previous hernia, hernia type, During the first hour post-surgery, just over half (57%) of all
and type of analgesia medication (for the recovery and hospital patients did not receive any analgesia and 43% were given opioid
stay periods) were compared between surgery modes and BMI medication (fentanyl 20–200 μg or morphine 2.5–15 mg). There
categories using Chi-square tests. One-way ANOVA was used to was no significant difference between the open vs laparoscopic
2
compare analgesic doses per BMI category. surgery groups for medication type (χ = 0.140, p = 0.708), or
equivalent morphine dose total or per kg body weight (Table 2),
results or for equivalent morphine dose when only those who received
Demographic and Anthropometric Data opioid analgesic were considered (p = 0.64). There was a trend for
an inverse correlation between age and equivalent morphine dose
Data from a total of 63 patients (60 males and 3 females) were (R = −0.243, p = 0.055).
included in the study. Demographic and anthropometric data
are presented in Table 1. The majority of patients, including all Pain Medication during the Hospital Stay
three females, had undergone open surgery. There was a distinct During the hospital stay, the majority (57%) of all patients received a
difference in surgical mode for those younger vs older than 50 years combination of NSAIDs and opioids, 30% received only paracetamol
of age: 76% of patients aged between 20 years and 49 years had and/or NSAIDs, 5% received only opioids, and 8% did not receive

World Journal of Laparoscopic Surgery, Volume 13 Issue 1 (January–April 2020) 27