Page 44 - World Journal of Laparoscopic Surgery

Laparoscopic versus Open Mesh (Lichtenstein) Repair of Inguinal Hernia: Current Status from Literature Review
REVIEW ARTICLE
Laparoscopic versus Open Mesh (Lichtenstein)

Repair of Inguinal Hernia: Current Status from

Literature Review

Spencer EE Efem
Laparoscopic Hospital, New Delhi, India
Correspondence: Spencer EE Efem, FRCS, University Department of Surgery, University of Calabar, College of Medical
Sciences, Calabar, Nigeria, e-mail: spencerefem@yahoo.com

Abstract
The aim of this study was to review studies conducted recently in large centers which compared the laparoscopic approach to open
mesh method in the repair of inguinal hernia. Search from literature was conducted using Highwire press and Google search engine.
Analyses were made using parameters like type of anesthesia, operation time, hospital stay, early and late complication, pain and
narcotic usage, time of return to work, cost effectiveness and patients satisfaction. Result showed that laparoscopic group experienced
less pain, returned earlier to work and had more satisfactory outcome even though paid twice as much as the open mesh group. The
laparoscopic group also suffered more fatal complications such as visceral injury. Hemorrhage and bladder and intestinal injuries as well
as some deaths. In conclusion opinion was divided, some favored laparoscopic while others favored open mesh repair.
Keywords: Laparoscopic versus open mesh inguinal, hernia, Lichtenstein repair.

INTRODUCTION Shouldice and Basini repair and the Scandinavian studies which
compared laparoscopic versus shouldice repair were excluded.
Laparoscopic surgery is another example of how technology
invades medical practice forcing clinicians to adapt to usage of CONTENT
the newly introduced equipment sometimes to a great advantage
1
albeit with its attendant high cost. Eventually the patient, the In the MRC trial of 1000 cases compared laparoscopic mesh
government and the insurance companies pay for the over with Lichtenstein mesh repair reported that the laparoscopic
zealousness of clinicians. Sometimes this is done at the expense group had less pain and more rapid return to work than there
of relegating tested, satisfactory and excellent orthodox practice counterpart who had open mesh. However there was no
to the background in favor of what is new. It is for this reason recurrence in the open mesh group while 1.9% of patients in the
that the necessity for carrying out large scale multicenter laparoscopic group had recurrence after one year follow-up.
randomized studies comparing laparoscopic mesh repair with There were three major complications in the laparoscopic group
open mesh repair for the repair of inguinal hernia has become including one bladder perforation and trocar injury to the left
paramount. Analyses of the most recent studies are the subject common iliac artery.
of this review. The largest randomized trial was the one conducted by
Neunayer et al, 2000 patients. This trial also compared open
2
MATERIAL AND METHODS mesh with laparoscopic mesh repair of inguinal hernia. Ten
percent of laparoscopic group suffered recurrence compared
A literature search was conducted in BMJ, New England Journal with 4.9% in the open group at a median follow-up period of 2
of Medicine (NEJM), British Journal of Surgery and Journal of years. As with the MRC studies fatal complications were more
MAS using Highwire press and the search engine of Google. common with the laparoscopic group. There were two deaths in
The following search terms were used laparoscopic versus open the laparoscopic group one resulting from intestinal perforation
mesh repair of inguinal hernia. Lichtenstein mesh repair. Criteria and the other from pulmonary embolism on the third post-
for selection of literature for review were number of cases operative day. Neumayer et al concluded that open technique
(excluded if less than 100) method of analysis (statitcal or is superior to the laparoscopic for mesh repair of primary
nonstatitcal) operative procedure only universally accepted hernia.In their randomized control trial which compared
procedures were selected and institution where the studies were laparoscopic vs open mesh repair of 403 patients with inguinal
3
conducted (only large specialized institutions and studies hernia,Wellwood et al found that more patients in the open
conducted by MRC, NICE, and EU biomed were included which group (96%) than in the laparoscopic group. 89% were
compared laparoscopic mesh repair with open mesh repair. Large discharged on the same day of operation x2 = 6.7;1 df; p = 0.01.
studies like that of Liem et al which compared laparoscopic with Patients in the open group also suffered less pain on the early
World Journal of Laparoscopic Surgery, September-December 2009;2(3):53-55 53