Laparoscopic versus open inguinal herniorrhaphy: preliminary results of a randomized controlled trial.
BACKGROUND
Benefits of laparoscopic herniorrhaphy (LH) over open hernia repair (OH) remain unproved.


METHODS
Interim analysis of a prospective randomized controlled trial compared OH with LH where study outcomes were measured by third-party evaluators through patient interviews.


RESULTS
Both groups were well matched for all baseline parameters, although LH patients anticipated a quicker postoperative recovery than OH (p = 0.014). No significant difference was noted in operating time or surgeon operative satisfaction. The median duration of hospital stay was 1 day in both groups; LH patients made use of significantly less postoperative narcotics than OH (p = 0.02). No difference was observed in the durations of convalescence (LH, 9.6 +/- 7.6 days; OH, 10.9 +/- 7.4 days). Greater improvements in quality of life were exhibited in LH patients than OH patients 1 month after operation (p = 0.035), with one of the two measures used. A greater percentage of LH patients seemed "very satisfied with their operation" (p = 0.07). Complication rates were similar, and a single recurrence, in a patient in the OH group, has been observed after a median follow-up of 14 months.


CONCLUSIONS
Direct cost measurements showed LH to be 40% more expensive than OH in the context of a Canadian-type health care system. To date, benefits in postoperative pain and possibly quality of life have been detected in the LH group.
Barkun
J S
JS
Divisions of General Surgery, Royal Victoria Hospital, Montreal, Quebec, Canada.
Wexler
M J
MJ
Hinchey
E J
EJ
Thibeault
D
D
Meakins
J L
JL
D000328:Adult; D003289:Convalescence; D003362:Cost-Benefit Analysis; D004180:Direct Service Costs; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000191:economics / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000191:economics; D007902:Length of Stay; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D018855:Single-Payer System; D016896:Treatment Outcome
D009294:Narcotics