PROSPECTIVE RANDOMIZED STUDY COMPARING LAPAROSCOPIC AND OPEN TENSION-FREE INGUINAL-HERNIA REPAIR WITH SHOULDICES OPERATION

BACKGROUND: Although tension-free techniques of hernia repair using sy nthetic meshes revealed encouraging results, the best method of inguin al hernia repair is still unclear. METHODS: in a prospective randomize d phase-II-B study, early postoperative results of laparoscopic transa bdominal preperitoneal repair (n = 80), open plug and patch repair (n = 80), and Shouldice's operation (n = 80) were compared. Postoperative pain and patient's comfort were defined as main endpoints. RESULTS: T he laparoscopic approach had significantly longer operation time and w as more expensive (61 +/- 12 minutes; $1,211) than plug and patch repa ir (36 +/- 14 minutes; $124) and Shouldice's operation (47 +/- 17 minu tes; $69), Main postoperative complications were wound hematomas, sero mas, and superficial wound infection, without significant difference b etween the groups, postoperative pain, analgesia requirements, limitat ion of daily activities, and return to work did not differ between lap aroscopic and open tension-free repair brit were significantly lower i n both groups compared with Shouldice's operation. So far, no recurren ce was observed after a mean follow-up of 25 months. CONCLUSION: Open plus and patch repair is a promising technique of hernia repair in adu lts, because it offers the same excellent patient comfort as the lapar oscopic repair hut is less expensive and can be performed under local anesthesia. (C) 1998 by Excerpta Medics, Inc.