Long term recurrence may be lower with laparoscopic repair

BMJ 1996;312:309 (3 February)

Letters

Long term recurrence may be lower with laparoscopic repair

EDITOR,--In their study comparing laparoscopic with open repairof inguinal hernias Kate Lawrence and colleagues excluded 43%of patients considered for the trial.¹ This is a high proportion:in our study five patients (3%) seen during the trial fulfilledour exclusion criteria.²

More complications occurred in the group that had laparoscopyin the authors' study. The surgical technique used probablyaccounts for three of the complications reported. The 12x8 cmmesh is too small and will result in recurrences; a 15x10 cmmesh is now widely accepted for unilateral repairs. In addition,the surgeons interposed mesh between the inferior epigastricvessels and the abdominal wall, which is unnecessary for fixationand presumably led to another complication--namely, vessel injury.

Cord seromas or haematomas occur quite often but have no sequelaeand do not inhibit return to work. As the authors postulate,the problem may be prevented by transection of the sac . . . [Full text of this article]

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Relevant Article

Randomised controlled trial of laparoscopic versus open repair of inguinal hernia: early results: Kate Lawrence, Douglas McWhinnie, Alex Goodwin, Helen Doll, Andrew Gordon, Alistair Gray, Julian Britton, and Jack Collin
BMJ 1995 311: 981-985. [Abstract] [Full Text]