Laparoscopic or open inguinal herniorrhaphy? A randomized prospective trial.
OBJECTIVE
To determine whether transabdominal preperitoneal laparoscopic hernia repair can equal or surpass an established open method at an acceptable cost.


METHODS
A randomized, prospective comparison with a follow-up of 7 to 18 months (median, 10 months; planned, 5 years).


METHODS
Health maintenance organization hospital.


METHODS
One hundred patients between 20 and 70 years of age were randomized. No patient withdrew from the study after randomization.


METHODS
Transabdominal preperitoneal laparoscopic and open tension-free repairs using a polypropylene mesh.


METHODS
Operative and discharge times, costs, recovery, and morbidity. "Return to work" was supplemented by a performance assessment using a panel of exercises.


RESULTS
Operative and hospitalization times were not significantly different between the two types of repair. Patients with laparoscopic unilateral repairs returned to work faster (9 vs 17 days). At 1 week postoperatively, performance of straight-leg raises correlated well with time to return to work for patients with strenuous jobs. The laparoscopic repair was more expensive than the open approach ($3093 vs $2494).


CONCLUSIONS
Laparoscopic transabdominal preperitoneal hernia repair can be accomplished with operative and hospitalization times and a short-term recurrence rate similar to those of an established open technique. Perioperative exercise testing may be an important adjunct to return to work in the comparison of methods.
Payne
J H
JH
Kaiser Foundation Hospital, Honolulu.
Grininger
L M
LM
Izawa
M T
MT
Podoll
E F
EF
Lindahl
P J
PJ
Balfour
J
J
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000191:economics / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000191:economics; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies