BMJ 1999;318:189 ( 16 January )

Letters

Laparoscopic versus open mesh repair of inguinal hernia

    For most patients hernias provoke minimal symptoms
    Recurrence rate is true test of hernia repair
    Laparoscopic repair is good when undertaken by experienced surgeons
    Laparoscopic repair can be made less expensive
    Unblinded trials may not be more reliable than observational studies
    Costs and outcomes should always be presented in disaggregated form
    Laparoscopic repair is much more expensive

For most patients hernias provoke minimal symptoms

The first 150 words of the full text of this article appear below.

EDITOR---In Wellwood et al's trial of laparoscopic hernia repair versus open mesh repair only patients fit for general anaesthesia were preselected.1 We do not know if the rejected patients were suitable for local anaesthesia, which is usually ideal for frail and elderly patients and those with high American Society of Anesthesiologists grades.

The type of anaesthesia used greatly affects morbidity associated with elective hernia repair.2 As the authors report, after laparoscopic repair with general anaesthesia, patients may have postoperative nausea, vomiting, and retention of urine. Disorientation and cognitive dysfunction may occur with elderly patients after general anaesthesia but are rare after local anaesthesia.

In Wellwood et al's trial postoperative discomfort after laparoscopic repair was reduced slightly, but does it matter? Assessment of postoperative pain is difficult, but elderly patients commonly experience less pain and require less analgesia than young adults after open hernia repair. This might be attributed . . . [Full text of this article]
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Relevant Article

Randomised controlled trial of laparoscopic versus open mesh repair for inguinal hernia: outcome and cost
James Wellwood, Mark J Sculpher, David Stoker, Graham J Nicholls, Cathy Geddes, Anne Whitehead, Rameet Singh, and David Spiegelhalter
BMJ 1998 317: 103-110. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

  • Wellwood, J., Sculpher, M., Stoker, D. (1999). Laparoscopic versus open mesh repair of inguinal hernia. BMJ 318: 1214a-1214 [Full text]  

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Laparoscopic versus open mesh repair of inguinal hernia.
David L Stoker
bmj.com, 8 Feb 1999 [Full text]
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