Keyhole ops 'worse for hernias'

Keyhole surgery usually allows quicker recovery

Complication rates after hernia operations are worse when keyhole surgery is used, a study suggests.

Researchers at the University of Utah therefore advised traditional open surgery for first hernia operations.

The New England Journal of Medicine reported patients having open surgery were less likely to suffer a recurrence of the problem.

However, some surgeons say keyhole techniques are better and may actually lead to less complications.

Keyhole, or laparoscopic, surgery uses pencil-thin tubes fitted with cutting tools and miniature cameras that enable the surgeon to see inside the abdomen or pelvis.

Men with a hernia that has never been repaired before should undergo an open repair Dr Leigh Neumayer

The procedure uses a few tiny cuts whereas open surgery requires a single incision about three inches long.

Laparoscopy is a more intricate procedure but usually involves less pain and faster recovery for patients.

Repair

The Utah researchers looked at 834 open and 862 laparoscopic operations to repair inguinal, or groin, hernias.

In two years of follow-up, those having a laparoscopic operation had a 10% recurrence rate and a 39% complication rate.

For patients who underwent open surgery, the recurrence rate was 5% and the complication rate 33%.

Dr Leigh Neumayer, who led the research, said: "Based on these findings, we'd recommend that men with a hernia that has never been repaired before should undergo an open repair."

She said that for recurrent hernias, the numbers were too small to make a recommendation.

Mr David Stoker, director of surgery at North Middlesex University Hospital, said many other studies had concluded keyhole operations were better.

He said: "My personal experience and that of most of my colleagues when doing laparoscopic hernia repairs is that the complication rates are comparable.

"If anything they are less than for open surgery."

There had been a "learning curve" while surgeons became aquainted with the new technique, but this had now passed, Mr Stoker said.

The National Institute for Clinical Excellence recommended in 2001 that people with first time hernias of the groin should have open surgery rather than keyhole surgery.

The institute said that for the repair of hernias that reoccur or are on both sides, keyhole surgery should be considered.

Surgeons said at the time that they would ignore the advice because open surgery was "barbaric" compared with modern techniques.

The Utah study suggested the more experienced the surgeon in performing keyhole surgery, the lower the recurrence rate.