Laparoscopic versus open repair of groin hernia: a randomised comparison

Background Repair of a groin hernia is one of the most common elective oper ations performed in general surgery. Our aim was to compare laparoscopic re pair with open repair of groin hernia. Methods 928 patients with groin hernia, from 26 hospitals in the UK and Ire land, were randomly assigned to laparoscopic repair (n=468) or to open hern ia repair (n=460 of which 433 were tension-free mesh repairs). Patients wer e clinically assessed at 1 week and 1 year after surgery, and were sent que stionnaires at 3 months and 1 year. The primary endpoints were: complicatio ns; return to usual activities of social life las the most generally applic able example of return to usual activities); hernia recurrence; groin pain that persisted at 1 year; and costs to the health services. All analyses we re by intention to treat. Findings At 1 week, at least one complication was found in 108 (29.9%) pati ents allocated to laparoscopic repair and in 155 (43.5%) patients allocated to open repair (95% CI for difference -20.6% to -6.6%, p<0.001). There wer e three serious surgical complications all of which occurred in the laparos copic group. Patients in the laparoscopic group returned to the usual activ ities of social life sooner than the patients in the open repair group (10 [IQR 7-21] vs 14 [7-28] days. p=0.004). At 1 year after the operation, the laparoscopic group had a lower rate of persistent groin pain than those who had open repair (28.7% vs 36.7% [95% CI for difference -14.7% to -1.4%], p =0.018). However, all seven hernia recurrences occurred in the laparoscopic group and not in the open repair group (1.9% vs 0.0% [95% CI for differenc e 0.5% to 3.4%], p=0.017). Interpretation Although laparoscopic hernia repair has advantages for patie nts, concerns about safety indicate that open repair is the more appropriat e option for the general surgeon. Our findings lend support to the move tow ards laparoscopic hernia surgery becoming part of the domain of specialist surgeons.