Simon Marsh FRCS (Traditional)
Things to consider
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Technique
Early complications
Late complications
Serious complications
Economy
What does NICE say
Evolution of Open Hernia
Repair
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Bassini
Shouldice
Lichtenstein
Tension free
Mesh Plug
What do studies tell us?
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Maddern et al 1994: Both can be performed successfully as a day case.
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Added cost of laparoscopic does not warrant its use in unilateral hernias
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Lawrence et al 1995: longer theatre time and greater complication rate
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Wellwood et al 1998: Laparoscopic costs greater
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Wright et al 2002: Similar outcome; no difference in chronic pain or
recurrence
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Menon et al 2003: longer operating time and higher recurrence
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McKormak 2007: More serious complication rate
Meta-analysis of laparoscopic inguinal hernia trials
favors open hernia repair with
preperitoneal mesh prosthesis
C.Randle Voyles, M.D.
Brian J Hamilton, B.S.
William D Johnson, Ph.D.
Nobuyasu Kano, M.D.
2002
Conclusions:
Although LHR was associated with an earlier return to work
compared with conventional sutured OHR, more recent mesh OHRs
provide equivalent outcomes but at lower costs and potentially less
severe complications, supporting an open technique using
preperitoneal mesh prostheses as the optimal hernia repair.
NICE on Laparoscopic Hernia
Repair:
• Laparoscopic surgery can be used as an
option for repairing inguinal hernia.
• As with all surgery, there are some risks
involved, which may include serious
problems.
NICE on Mesh Plug Repair:
• Procedures do not fall within the
programme's remit if they are considered
standard clinical practice with an efficacy
and safety profile that is sufficiently well
known.