Clinical studies comparing laparoscopic and open inguinal hernia repair
Twenty-seven consultants from the UK and Ireland contributed 928 patients to a multicentre randomised trial to compare laparoscopic hernia repair with currently used open repairs. The laparoscopic group developed less wound haematomas (7.6% vs. 15.7%; 99% CI: -14.3 to -2.0), but there was no difference in the incidence of wound infection or general complications such as urinary retention. The laparoscopic group reported lower levels of post-operative pain and this was reflected in significantly better 'Short Form 36' functional scores at one week. By one month the only significant difference between groups was a better score for physical function in the laparoscopic group, and by three months there was no significant difference in any of the 'Short Form 36' domains. The early functional advantages for the laparoscopic repair were reflected in an earlier return to normal activities (10 days vs. 14 days; p<0.01) and work (28 days vs. 42 days; p=0.001). A simulator was constructed to measure the ability to perform an emergency stop following totally extraperitoneal or open prosthetic inguinal hernia repaid. Measurements were made pre-operatively and at one, three and six days post-operatively. The laparoscopic group did not demonstrate any increase in reaction times following hernia repair. The open group had significantly prolonged reaction times on days one and three, but had returned to pre-operative levels by day six. Therefore, laparoscopic repair does not impair driver reaction times, and open prosthetic repair appears to allow an earlier return to driving than the ten days previously recommended for open sutured repair.