Laparoscopic hernia surgery

Abstract

The MRC trial comparing laparoscopic and open repair of groin hernia1The MRC Laparoscopic Groin Hernia Trial Group.Laparoscopic versus open repair of groin hernia: a randomised comparison.Lancet. 1999; 354: 185-190Summary Full Text Full Text PDF PubMed Scopus (334) Google Scholar is a classic example of a pragmatic surgical trial. We were, however, unable to find the overall follow-up percentage after 1 year—in particular, the follow-up by physical examination. Physical examination is generally thought essential in the detection of hernia recurrence.2Hay J-M Boudet M-J Fingerhut A et al.Shouldice inguinal hernia repair in the male adult: the gold standard? A multicentre controlled trial in 1578 patients.Ann Surg. 1995; 222: 719-727Crossref PubMed Scopus (161) Google Scholar, 3Liem MSL van der Graaf Y van Steensel CJ et al.Comparison of conventional anterior surgery and laparsocopic surgery for inguinal-hernia repair.N Engl J Med. 1997; 336: 1541-1547Crossref PubMed Scopus (445) Google Scholar Postal questionnaire or telephone interview are regarded as highly unreliable to detect this primary outcome.4Vos PM Simons MP Luitse JSK vanGeldere D Koelemaij MJW Obertop H Follow-up after inguinal repair. Questionnaire compared with physical examination: a prospective study in 299 patients.Eur J Surg. 1998; 164: 533-536Crossref PubMed Scopus (31) Google ScholarIn the study, 337 men in the laparoscopic group and 334 men in the open group were physically examined for testicular atrophy. Therefore, we assume that the follow-up by physical examination was 79% in the laparoscopic group and 76% in the open group at most (including all women). This follow-up percentage after 1 year is somewhat disappointing. Another large trial succeeded in obtaining a follow-up percentage after physical examination after 2 years of no less than 97%.3Liem MSL van der Graaf Y van Steensel CJ et al.Comparison of conventional anterior surgery and laparsocopic surgery for inguinal-hernia repair.N Engl J Med. 1997; 336: 1541-1547Crossref PubMed Scopus (445) Google Scholar Patients refuse follow-up because they are either wholly satisfied or are dissatisifed, and may go elsewhere if they need reoperation for hernia recurrence. Hence, the present results on the primary outcome of hernia recurrence after 1 year cannot be thought completely reliable and the results should be interpreted with caution. The MRC trial comparing laparoscopic and open repair of groin hernia1The MRC Laparoscopic Groin Hernia Trial Group.Laparoscopic versus open repair of groin hernia: a randomised comparison.Lancet. 1999; 354: 185-190Summary Full Text Full Text PDF PubMed Scopus (334) Google Scholar is a classic example of a pragmatic surgical trial. We were, however, unable to find the overall follow-up percentage after 1 year—in particular, the follow-up by physical examination. Physical examination is generally thought essential in the detection of hernia recurrence.2Hay J-M Boudet M-J Fingerhut A et al.Shouldice inguinal hernia repair in the male adult: the gold standard? A multicentre controlled trial in 1578 patients.Ann Surg. 1995; 222: 719-727Crossref PubMed Scopus (161) Google Scholar, 3Liem MSL van der Graaf Y van Steensel CJ et al.Comparison of conventional anterior surgery and laparsocopic surgery for inguinal-hernia repair.N Engl J Med. 1997; 336: 1541-1547Crossref PubMed Scopus (445) Google Scholar Postal questionnaire or telephone interview are regarded as highly unreliable to detect this primary outcome.4Vos PM Simons MP Luitse JSK vanGeldere D Koelemaij MJW Obertop H Follow-up after inguinal repair. Questionnaire compared with physical examination: a prospective study in 299 patients.Eur J Surg. 1998; 164: 533-536Crossref PubMed Scopus (31) Google Scholar In the study, 337 men in the laparoscopic group and 334 men in the open group were physically examined for testicular atrophy. Therefore, we assume that the follow-up by physical examination was 79% in the laparoscopic group and 76% in the open group at most (including all women). This follow-up percentage after 1 year is somewhat disappointing. Another large trial succeeded in obtaining a follow-up percentage after physical examination after 2 years of no less than 97%.3Liem MSL van der Graaf Y van Steensel CJ et al.Comparison of conventional anterior surgery and laparsocopic surgery for inguinal-hernia repair.N Engl J Med. 1997; 336: 1541-1547Crossref PubMed Scopus (445) Google Scholar Patients refuse follow-up because they are either wholly satisfied or are dissatisifed, and may go elsewhere if they need reoperation for hernia recurrence. Hence, the present results on the primary outcome of hernia recurrence after 1 year cannot be thought completely reliable and the results should be interpreted with caution.