Study Backs Standard Hernia Surgery

Groin hernias repaired by laparoscopic surgery are twice as likely to reopen as those fixed by the standard operation, a Veterans Affairs study has found. <br><br>There was one exception: Surgeons who

Monday, April 26th 2004, 12:00 am

By: News On 6

Groin hernias repaired by laparoscopic surgery are twice as likely to reopen as those fixed by the standard operation, a Veterans Affairs study has found.

There was one exception: Surgeons who had done more than 250 laparoscopic or ``keyhole'' hernia repairs had about the same recurrence rate as those who used an open incision, Dr. Leigh Neumayer of the VA Medical Center in Salt Lake City was to report at a conference Sunday.

Groin hernias, in which a gap in the muscle of the lower abdomen allows a bit of intestine to stick out, are common. U.S. doctors repair about 700,000 a year.

The VA patients in this study all had the standard basic repair: very thin, flexible mesh was placed behind the gap in the muscle to hold in the gut. Surgeons tacked the mesh in with a few stitches or with surgical tacks or staples, Neumayer said.

The difference was whether the surgeons worked through an open incision, usually 2 to 4 inches long, or used laparoscopic surgery, in which doctors make tiny incisions and insert slender instruments and a miniature camera.

Overall, 87 of the 862 patients who had laparoscopic surgery needed a second repair of the same hernia within two years, compared to 41 of the 834 who got open incision repairs. That works out to 10.1 percent and 4.9 percent.

Twenty of the 78 surgeons doing laparoscopic surgery had done more than 250 such operations for groin hernias, also called inguinal hernias, and their recurrence rate was less than 5 percent, said Neumayer, a staff surgeon at the VA hospital and associate professor of surgery at the University of Utah.

She was to present her study Sunday to the American College of Surgeons in Boston. It also will be published Thursday in the New England Journal of Medicine, which released it early.

The results aren't surprising _ there has been great debate for years about whether laparoscopic surgery would be safer for groin hernias, said Dr. Danny O. Jacobs of Duke University, who wrote an accompanying editorial.

Keyhole surgery started with operations to remove the gall bladder. Instead of a 4- to 6-inch incision in the abdomen, it used four small holes, none bigger than a dime.

That made a huge difference in the amount of pain and length of recovery. Patients could go home from the hospital in a day or less rather than five to eight days, and could return to work within a week instead of one to two months.

But hernia repair is already an outpatient procedure taking 45 minutes to an hour. The open incision version is generally done under local anesthetic, while laparoscopic surgery needs general anesthesia.

Neumayer found that laparoscopic surgery cut one day from the average time before people could resume normal activities _ four days, as opposed to five for open surgery.

There was less pain for about two weeks after surgery, but it was about the same after three weeks.

``There's less to be gained in those areas. So the difference in recurrence becomes a much bigger matter,'' she said.

Hernia repair is a more complicated laparoscopic operation than others, because there are more nearby bits and pieces that can be inadvertently injured, Jacobs said. These include part of the spermatic cord _ the 18-inch tube which holds mature sperm, plus the arteries, veins, nerves, and lymphatic vessels which surround it.

For Jacobs, the most striking discovery was the large number of operations needed to repair recurrences after keyhole surgery.

``We need to get a little more detail now about the nature of that relationship, and why it occurs,'' he said.