32. Progrip
Potential benefits
Reduced risk of nerve injury
Faster OR time
Potential disadvantages
Increased cost
Increased inflammatory reaction
Several single center RCTs
Underpowered
No difference in chronic pain or recurrence
Possible increase in foreign body sensation
42. Lap vs Open: What Does the Data Say?
Neumayer L et al. NEJM 2004: 350(18); 1819-1827.
Multicenter randomized trial, VA
1983 patients
Two year follow-up, recurrence rate Open 4.9% vs. Lap 10.1%
43. Lap vs Open: What Does the Data Say?
Neumayer L et al. NEJM 2004: 350(18); 1819-1827.
Multicenter randomized trial, VA
1983 patients
Two year follow-up, recurrence rate Open 4.9% vs. Lap 10.1%
Concluded: primary unilateral hernias should be repaired
with OIHR
44. Lap vs Open: What Does the Data Say?
Neumayer L et al. NEJM 2004: 350(18); 1819-1827.
Multicenter randomized trial, VA
1983 patients
Two year follow-up, recurrence rate Open 4.9% vs. Lap 10.1%
Concluded: primary unilateral hernias should be repaired
with OIHR
Critique:
Average age of pts was high, health related QOL low c/w general
population
VA Population
Surgeon inexperience/learning curve
Those with >250 cases had recurrence rate <5% in LIHR
45. Lap vs Open Inguinal Hernia
Kouhia STH et al. Ann Surg 2009; 249(3): 384-387
90 patients randomized
6.4% recurrence in OIHR vs. 0% for TEP (ns)
Higher incidence of chronic pain in OIHR group
TEP group with less analgesic requirement and shorter return
to work
46. META-ANALYSIS
RANDOMIZED CLINICAL TRIALS
29 trials
5588 patients (3017 laparoscopic)
6 outcomes evaluated
Operating time, Time to discharge, Return to normal activity, Return
to work, Postoperative complications, Recurrence rate
Favoring Lap:
postop complications, return to normal activity, return to work, time to discharge
Favoring Open:
OR time (15min)
No Difference in Recurrence
Memon, MA et al. Br J Surg 2003: 01: 1479-1492
COMPARING OPEN AND LAPAROSCOPIC
INGUINAL HERNIA REPAIR
47. Hernia Outcomes that Matter
Recurrence
2-5%
Highly dependent on Surgeon experience and volume
48. Lap vs. Open
Lap
Less Pain
Faster Recovery
Bilateral and Recurrent
More operator
dependant
Open
Easier to learn
Reproducible
Good results
Make a choice, don’t reserve lap for bilaterals and recurrence or you will never
overcome the learning curve