What type of hernia surgery is best

Importance Incisional hernia is the most frequent surgical complication after laparotomy. Objective To compare laparoscopic vs open ventral incisional hernia repair with regard to postoperative pain and nausea, operative results, perioperative and postoperative complications, hospital admission, and recurrence rate. Design Multicenter randomized controlled trial between May and December with a mean follow-up period of 35 months.

Setting All patients were operated on in a clinical setting at 1 of the 2 participating university medical centers or at the other 8 teaching hospitals.

Participants Two hundred six patients from 10 hospitals were randomized equally to laparoscopic or open mesh repair. Patients with an incisional hernia larger than 3 cm and smaller than 15 cm, either primary or recurrent, were included.

Patients were excluded if they had an open abdomen treatment in their medical histories. Main Outcome Measures The primary outcome of the trial was postoperative pain. Secondary outcomes were use of analgesics, perioperative and postoperative complications, operative time, postoperative nausea, length of hospital stay, recurrence, morbidity, and mortality. Visual analog scale scores for pain and nausea, completed before surgery and 3 days and 1 and 4 weeks postoperatively, showed no significant differences between the 2 groups.

Conclusions and Relevance During the operation, there was less blood loss and less need for a wound drain in the laparoscopic group. However, operative time was longer during laparoscopy. Perioperative complications were significantly higher in the laparoscopic group. Visual analog scores for pain and nausea did not differ between groups. The incidence of a recurrence was similar in both groups. The size of the defect was found to be an independent factor for recurrence of an incisional hernia.

Incisional hernia is the most frequent surgical complication after laparotomy. This is associated with discomfort, pain, respiratory restriction, and dissatisfactory cosmetic results. The introduction of minimally invasive surgery in the early s enabled the possibility of laparoscopic incisional hernia repair. Recent studies have shown that in the short term laparoscopic repair is superior to open repair in terms of less blood loss, fewer perioperative complications, and shorter hospital stay.

So far, level 1 randomized clinical trials for benefits or disadvantages of laparoscopic incisional hernia repair are scarce. The ongoing debate about the expected merits of laparoscopic vs open incisional hernia repair prompted the need for a level 1 randomized controlled trial. The aim of this study was to compare laparoscopic vs open ventral incisional hernia repair with regard to postoperative pain and nausea, operative time, blood loss, perioperative and postoperative complications, length of hospital stay, and recurrence rates.

Approval was obtained from the Erasmus Medical Center ethical committee and the local ethical committees of all 9 participating centers prior to enrollment of patients in this study. Informed consent was obtained for all patients. The consent form and consent process were carefully evaluated by the Erasmus Medical Center ethical committee and data monitoring committee on a continual basis.

All participating centers provided experienced and dedicated hernia surgeons. Inclusion criteria were hernia diameter between 3 and 15 cm, location at the ventral abdominal wall at least 5 cm from the costae and inguinal area, indication for elective repair, age 18 years or older, and written informed consent. Exclusion criteria included a contraindication for pneumoperitoneum, an absolute contraindication for general anesthesia, and a history of an open abdomen treatment.

Patients participating in other trials were also excluded. After obtaining informed consent, patients were randomized by computer-generated lists stratified by center and primary or recurrent incisional hernia. Patients and medical staff were not blinded to the allocated procedure.

Laparoscopic incisional hernia repair was performed through 3 to 5 abdominal trocars one 10 mm and 2 to four 5 mm.

Pneumoperitoneum was achieved by Veress needle or open introduction of a blunt-tip trocar for inflation with carbon dioxide to achieve intra-abdominal pressure up to 15 mm Hg. The additional 5-mm trocars were positioned at the opposite site of the hernia. The hernia port size was measured. Extensive adhesiolysis was performed if necessary using diathermy. The omentum and bowel were detached from the abdominal wall to expose the hernial defect. The hernia sac was not dissected. The mesh was introduced into the abdominal cavity through the mm trocar.

The mesh was then placed over the defect with at least 5-cm overlap at all sides. A concentric ring of tackers was placed in the peripheral margin of the mesh. Transfascial sutures were often used for mesh positioning and supplementary fixation. Hemostasis was achieved before removal of the trocars. All mm trocar fascial defects were closed.

Skin defects were closed with absorbable monofilament sutures. Incisions were made in the old scar depending on the localization and size of the hernia. The subcutaneous layer and scar tissue were dissected from the abdominal wall to identify and expose the hernia sac. Dissection of the hernia sac from beneath the rectus muscles was performed if possible. Opening and resection of the hernia sac was avoided.

Whenever possible, the posterior rectus sheath or peritoneum was dissected from the rectus muscles. After closing of the peritoneum or posterior rectus sheath, a mesh was positioned preperitoneally or in the sublay position, respectively, with at least 5-cm overlap at all sides. The mesh was fixated to the rectus muscle at each corner and side with nonabsorbable polypropylene sutures.

The anterior rectus sheath was closed only if tension-free repair was possible. Author: Healthwise Staff. Medical Review: E. This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Learn how we develop our content. To learn more about Healthwise, visit Healthwise. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.

Updated visitor guidelines. Top of the page. Surgery Overview For open hernia repair surgery, a single long incision is made in the groin. Open surgery is different from laparoscopic surgery for hernia repair in the following ways: An open surgery requires one larger incision instead of several small incisions.

If hernias are on both sides, a second incision will be needed to fix the other hernia. Laparoscopic surgery allows the surgeon to repair both hernias without making more incisions.

Open hernia repair can be done under general, spinal, or local anesthesia. Laparoscopic repair requires general anesthesia. What To Expect After Surgery Most people who have open hernia repair surgery are able to go home the same day.

As noted, the laparoscopic approach usually results in less pain, earlier return to normal activities and earlier return to work than the open approach. On the other hand, it does require general anesthesia and it costs more than the open approach. The open approach, on the other hand, is less costly to the insurance provider and can be performed under local anesthesia , while the patient is awake.

Once again, the answer to that question depends on what the patient's endpoint is for success. If the ultimate judge of superiority for one procedure over the other is preventing recurrence of the hernia, both procedures are equal, based on current research. It is important to note that long-term recurrence rates of 5 to 10 years are not available yet for laparoscopic hernia repairs. It is also important to note that some doctors recommend only the open approach because of the greater cost associated with laparoscopic repair.

Others recommend the open approach for unilateral hernias and the laparoscopic approach for bilateral hernias. How to get your child to put away toys.

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