Journal Club Review

1
Journal Club Review

• Laparoscopic compared with open methods of groin
  hernia repairsystematic review of randomised
  controlled trials
• Prof A. Grant British Journal of Surgery 2000,
  87, 860-867

2
Background

• Up until 20yrs ago Bassisni repair
• Lichtenstein repair has become the most widely
  used open repair in the last 20yrs
• Early 90s - laparoscopic techniques in hernia
  repair
• TAPP vs TEP

3
Background

• Last 10yrs - large no of trials comparing
  laparoscopic vs open repair
• No significant difference between laparoscopic
  and open groups
• recurrence
• serious complications
• chronic pain

4
Object

• Systematically review data from all relevant
  randomised or semi-randomised trials
• Pre-specified data items were analysed
• Where possible quantitative meta-analysis was
  performed

5
Object

• Trials grouped types of operation being compared
• TAPP vs Open mesh repair
• TAPP vs Open non mesh repair
• TEP vs Open mesh repair
• TEP vs Open non mesh repair
• Mixed laparoscopic vs Mixed open

6
Results

• 34 published trials were included
• 6804 pts
• Sample size 20 to 1051 with F/U from 6 weeks to
  36 months
• Duration of operation longer in Lap. Groups
  (Plt0.001)
• Visceral and vascular complications Laparoscopic
  (TAPP) gt Open

7
Results

• Post-op pain less in laparoscopic grp.(p0.08)
• Length of stay not significantly different
• Return to usual activity earlier for lap.group
  Plt0.001)
• Chronic pain and numbness - few trials
• Recurrences - no significant difference, BUT
  difference in lap (TAPP) vs non mesh open

8
Discussion

• Methodological problems in this meta-analysis
• Heterogeneity of the papers chosen for inclusion
  in this meta-analysis
• Variations in the data analysis of individual
  papers meant that direct comparisons were
  difficult
• Despite large trial no., few significant results
• few trials compared TEP vs Open groups
• data on outcome not always reported

9
Discussion

• Open hernia repair in 2000
• minimal tension
• increase use of regional anaesthesia
• day only procedure
• Laparoscopic hernia repair in 2000
• what situtations is increased risk and increased
  cost worth it?
• Recurrent hernias
• Bilateral hernias

10
Discussion

• Significant findings from this meta-analysis
• longer operative time for laparascopic group
• more serious complications for lap. Group
• earlier return to work for lap. group