title: Open mesh versus laparoscopic mesh repair of inguinal hernia.
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.
authors.affiliation: Veterans Affairs Medical Center and the Department of Surgery, University of Utah, Salt Lake City 84148, USA. leigh.neumayer@hsc.utah.edu
authors.forename: Leigh
authors.initials: L
authors.lastname: Neumayer
authors.forename: Anita
authors.initials: A
authors.lastname: Giobbie-Hurder
authors.forename: Olga
authors.initials: O
authors.lastname: Jonasson
authors.forename: Robert
authors.initials: R
authors.lastname: Fitzgibbons
authors.forename: Dorothy
authors.initials: D
authors.lastname: Dunlop
authors.forename: James
authors.initials: J
authors.lastname: Gibbs
authors.forename: Domenic
authors.initials: D
authors.lastname: Reda
authors.forename: William
authors.initials: W
authors.lastname: Henderson
mesh_terms: D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000401:mortality / Q000706:statistics & numerical data; D007813:Laparotomy / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D012008:Recurrence; D012086:Reoperation; D013526:Surgical Mesh; D016896:Treatment Outcome