Open mesh versus laparoscopic mesh repair of inguinal hernia

Leigh Neumayer, Anita Giobbie-Hurder, Olga Jonasson, Robert Joseph Fitzgibbons, Dorothy Dunlop, James Gibbs, Domenic Reda, William Henderson

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Abstract

BACKGROUND: Repair of inguinal hernias in men is a common surgical procedure, but the most effective surgical technique is unknown. METHODS: We randomly assigned men with inguinal hernias at 14 Veterans Affairs (VA) medical centers to either open mesh or laparoscopic mesh repair. The primary outcome was recurrence of hernias at two years. Secondary outcomes included complications and patient-centered outcomes. RESULTS: Of the 2164 patients who were randomly assigned to one of the two procedures, 1983 underwent an operation; two-year follow-up was completed in 1696 (85.5 percent). Recurrences were more common in the laparoscopic group (87 of 862 patients [10.1 percent]) than in the open group (41 of 834 patients [4.9 percent]; odds ratio, 2.2; 95 percent confidence interval, 1.5 to 3.2). The rate of complications was higher in the laparoscopic-surgery group than in the open-surgery group (39.0 percent vs. 33.4 percent; adjusted odds ratio, 1.3; 95 percent confidence interval, 1.1 to 1.6). The laparoscopic-surgery group had less pain initially than the open-surgery group on the day of surgery (difference in mean score on a visual-analogue scale, 10.2 mm; 95 percent confidence interval, 4.8 to 15.6) and at two weeks (6.1 mm; 95 percent confidence interval, 1.7 to 10.5) and returned to normal activities one day earlier (adjusted hazard ratio for a shorter time to return to normal activities, 1.2; 95 percent confidence interval, 1.1 to 1.3). In prespecified analyses, there was a significant interaction between the surgical approach (open or laparoscopic) and the type of hernia (primary or recurrent) (P=0.012). Recurrence was significantly more common after laparoscopic repair than after open repair of primary hernias (10.1 percent vs. 4.0 percent), but rates of recurrence after repair of recurrent hernias were similar in the two groups (10.0 percent and 14.1 percent, respectively). CONCLUSIONS: The open technique is superior to the laparoscopic technique for mesh repair of primary hernias.

Original languageEnglish
Pages (from-to)1819-1827+1922
JournalNew England Journal of Medicine
Volume350
Issue number18
DOIs
StatePublished - Apr 29 2004

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Inguinal Hernia
Confidence Intervals
Herniorrhaphy
Recurrence
Hernia
Laparoscopy
Odds Ratio
Veterans
Visual Analog Scale
Ambulatory Surgical Procedures
Pain

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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Neumayer, L., Giobbie-Hurder, A., Jonasson, O., Fitzgibbons, R. J., Dunlop, D., Gibbs, J., ... Henderson, W. (2004). Open mesh versus laparoscopic mesh repair of inguinal hernia. New England Journal of Medicine, 350(18), 1819-1827+1922. https://doi.org/10.1056/NEJMoa040093

Open mesh versus laparoscopic mesh repair of inguinal hernia. / Neumayer, Leigh; Giobbie-Hurder, Anita; Jonasson, Olga; Fitzgibbons, Robert Joseph; Dunlop, Dorothy; Gibbs, James; Reda, Domenic; Henderson, William.

In: New England Journal of Medicine, Vol. 350, No. 18, 29.04.2004, p. 1819-1827+1922.

Research output: Contribution to journalArticle

Neumayer, L, Giobbie-Hurder, A, Jonasson, O, Fitzgibbons, RJ, Dunlop, D, Gibbs, J, Reda, D & Henderson, W 2004, 'Open mesh versus laparoscopic mesh repair of inguinal hernia', New England Journal of Medicine, vol. 350, no. 18, pp. 1819-1827+1922. https://doi.org/10.1056/NEJMoa040093
Neumayer L, Giobbie-Hurder A, Jonasson O, Fitzgibbons RJ, Dunlop D, Gibbs J et al. Open mesh versus laparoscopic mesh repair of inguinal hernia. New England Journal of Medicine. 2004 Apr 29;350(18):1819-1827+1922. https://doi.org/10.1056/NEJMoa040093
Neumayer, Leigh ; Giobbie-Hurder, Anita ; Jonasson, Olga ; Fitzgibbons, Robert Joseph ; Dunlop, Dorothy ; Gibbs, James ; Reda, Domenic ; Henderson, William. / Open mesh versus laparoscopic mesh repair of inguinal hernia. In: New England Journal of Medicine. 2004 ; Vol. 350, No. 18. pp. 1819-1827+1922.
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abstract = "BACKGROUND: Repair of inguinal hernias in men is a common surgical procedure, but the most effective surgical technique is unknown. METHODS: We randomly assigned men with inguinal hernias at 14 Veterans Affairs (VA) medical centers to either open mesh or laparoscopic mesh repair. The primary outcome was recurrence of hernias at two years. Secondary outcomes included complications and patient-centered outcomes. RESULTS: Of the 2164 patients who were randomly assigned to one of the two procedures, 1983 underwent an operation; two-year follow-up was completed in 1696 (85.5 percent). Recurrences were more common in the laparoscopic group (87 of 862 patients [10.1 percent]) than in the open group (41 of 834 patients [4.9 percent]; odds ratio, 2.2; 95 percent confidence interval, 1.5 to 3.2). The rate of complications was higher in the laparoscopic-surgery group than in the open-surgery group (39.0 percent vs. 33.4 percent; adjusted odds ratio, 1.3; 95 percent confidence interval, 1.1 to 1.6). The laparoscopic-surgery group had less pain initially than the open-surgery group on the day of surgery (difference in mean score on a visual-analogue scale, 10.2 mm; 95 percent confidence interval, 4.8 to 15.6) and at two weeks (6.1 mm; 95 percent confidence interval, 1.7 to 10.5) and returned to normal activities one day earlier (adjusted hazard ratio for a shorter time to return to normal activities, 1.2; 95 percent confidence interval, 1.1 to 1.3). In prespecified analyses, there was a significant interaction between the surgical approach (open or laparoscopic) and the type of hernia (primary or recurrent) (P=0.012). Recurrence was significantly more common after laparoscopic repair than after open repair of primary hernias (10.1 percent vs. 4.0 percent), but rates of recurrence after repair of recurrent hernias were similar in the two groups (10.0 percent and 14.1 percent, respectively). CONCLUSIONS: The open technique is superior to the laparoscopic technique for mesh repair of primary hernias.",
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AU - Neumayer, Leigh

AU - Giobbie-Hurder, Anita

AU - Jonasson, Olga

AU - Fitzgibbons, Robert Joseph

AU - Dunlop, Dorothy

AU - Gibbs, James

AU - Reda, Domenic

AU - Henderson, William

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N2 - BACKGROUND: Repair of inguinal hernias in men is a common surgical procedure, but the most effective surgical technique is unknown. METHODS: We randomly assigned men with inguinal hernias at 14 Veterans Affairs (VA) medical centers to either open mesh or laparoscopic mesh repair. The primary outcome was recurrence of hernias at two years. Secondary outcomes included complications and patient-centered outcomes. RESULTS: Of the 2164 patients who were randomly assigned to one of the two procedures, 1983 underwent an operation; two-year follow-up was completed in 1696 (85.5 percent). Recurrences were more common in the laparoscopic group (87 of 862 patients [10.1 percent]) than in the open group (41 of 834 patients [4.9 percent]; odds ratio, 2.2; 95 percent confidence interval, 1.5 to 3.2). The rate of complications was higher in the laparoscopic-surgery group than in the open-surgery group (39.0 percent vs. 33.4 percent; adjusted odds ratio, 1.3; 95 percent confidence interval, 1.1 to 1.6). The laparoscopic-surgery group had less pain initially than the open-surgery group on the day of surgery (difference in mean score on a visual-analogue scale, 10.2 mm; 95 percent confidence interval, 4.8 to 15.6) and at two weeks (6.1 mm; 95 percent confidence interval, 1.7 to 10.5) and returned to normal activities one day earlier (adjusted hazard ratio for a shorter time to return to normal activities, 1.2; 95 percent confidence interval, 1.1 to 1.3). In prespecified analyses, there was a significant interaction between the surgical approach (open or laparoscopic) and the type of hernia (primary or recurrent) (P=0.012). Recurrence was significantly more common after laparoscopic repair than after open repair of primary hernias (10.1 percent vs. 4.0 percent), but rates of recurrence after repair of recurrent hernias were similar in the two groups (10.0 percent and 14.1 percent, respectively). CONCLUSIONS: The open technique is superior to the laparoscopic technique for mesh repair of primary hernias.

AB - BACKGROUND: Repair of inguinal hernias in men is a common surgical procedure, but the most effective surgical technique is unknown. METHODS: We randomly assigned men with inguinal hernias at 14 Veterans Affairs (VA) medical centers to either open mesh or laparoscopic mesh repair. The primary outcome was recurrence of hernias at two years. Secondary outcomes included complications and patient-centered outcomes. RESULTS: Of the 2164 patients who were randomly assigned to one of the two procedures, 1983 underwent an operation; two-year follow-up was completed in 1696 (85.5 percent). Recurrences were more common in the laparoscopic group (87 of 862 patients [10.1 percent]) than in the open group (41 of 834 patients [4.9 percent]; odds ratio, 2.2; 95 percent confidence interval, 1.5 to 3.2). The rate of complications was higher in the laparoscopic-surgery group than in the open-surgery group (39.0 percent vs. 33.4 percent; adjusted odds ratio, 1.3; 95 percent confidence interval, 1.1 to 1.6). The laparoscopic-surgery group had less pain initially than the open-surgery group on the day of surgery (difference in mean score on a visual-analogue scale, 10.2 mm; 95 percent confidence interval, 4.8 to 15.6) and at two weeks (6.1 mm; 95 percent confidence interval, 1.7 to 10.5) and returned to normal activities one day earlier (adjusted hazard ratio for a shorter time to return to normal activities, 1.2; 95 percent confidence interval, 1.1 to 1.3). In prespecified analyses, there was a significant interaction between the surgical approach (open or laparoscopic) and the type of hernia (primary or recurrent) (P=0.012). Recurrence was significantly more common after laparoscopic repair than after open repair of primary hernias (10.1 percent vs. 4.0 percent), but rates of recurrence after repair of recurrent hernias were similar in the two groups (10.0 percent and 14.1 percent, respectively). CONCLUSIONS: The open technique is superior to the laparoscopic technique for mesh repair of primary hernias.

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