Laparoscopic versus open inguinal herniorrhaphy: Preliminary results of a randomized controlled trial

• Published in: Surgery 1995-10, Vol.118 (4), p.703-710
• Main Authors: Barkun, Jeffrey S., Wexler, Marvin J., Hinchey, Edouard J., Thibeault, Diane, Meakins, Jonathan L.
• Format: Article
• Language: English
• Subjects: Adult; Convalescence; Cost-Benefit Analysis; Direct Service Costs; Feasibility Studies; Follow-Up Studies; Hernia, Inguinal - economics; Hernia, Inguinal - surgery; Humans; Laparoscopy - economics; Length of Stay; Life Tables; Male; Middle Aged; Narcotics - therapeutic use; Pain, Postoperative - drug therapy; Patient Satisfaction; Prospective Studies; Quality of Life; Single-Payer System; Treatment Outcome
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/S0039-6060(05)80038-8

Background. Benefits of laparoscopic herniorrhaphy (LH) over open hernia repair (OH) remain unproved. Methods. Interim analysis of a prospective randomized controlled trial compared OH with LH where study outcomes were measured by third-party evaluators through patient interviews. Results. Both groups were well matched for all baseline parameters, although LH patients anticipated a quicker postoperative recovery than OH (p=0.014). No significant difference was noted in operating time or surgeon operative satisfaction. The median duration of hospital stay was 1 day in both groups; LH patients made use of significantly less postoperative narcotics than OH (p=0.02). No difference was observed in the durations of convalescence (LH, 9.6±7.6 days; OH, 10.9±7.4 days). Greater improvements in quality of life were exhibited in LH patients than OH patients 1 month after operation (p=0.035), with one of the two measures used. A greater percentage of LH patients seemed “very satisfied with their operation” (p=0.07). Complication rates were similar, and a single recurrence, in a patient in the OH group, has been observed after a median follow-up of 14 months. Conclusions. Direct cost measurements showed LH to be 40% more expensive than OH in the context of a Canadian-type health care system. To date, benefits in postoperative pain and possibly quality of life have been detected in the LH group.