Intervention Review

Laparoscopic techniques versus open techniques for inguinal hernia repair

  1. Kirsty McCormack1,*,
  2. Neil Scott2,
  3. Peter M.N.Y.H Go3,
  4. Sue J Ross4,
  5. Adrian Grant5,
  6. Collaboration the EU Hernia Trialists6

Editorial Group: Cochrane Colorectal Cancer Group

Published Online: 20 JAN 2003

Assessed as up-to-date: 5 NOV 2002

DOI: 10.1002/14651858.CD001785


How to Cite

McCormack K, Scott N, Go PM, Ross SJ, Grant A, Collaboration the EU Hernia Trialists. Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD001785. DOI: 10.1002/14651858.CD001785.

Author Information

  1. 1

    University of Aberdeen, Health Services Research Unit, Aberdeen, UK

  2. 2

    Univ. of Aberdeen, Dept. of Publ. Health, Aberdeen, Scotland, UK

  3. 3

    St Antonius Ziekerhuis, Dept. of Chirurgie, EM Nieuwegein, Netherlands

  4. 4

    Mount Sinai Hospital and Samuel Lunenfeld Research Institute, Toronto, Canada

  5. 5

    University of Aberdeen, School of Medicine, Aberdeen, Scotland, UK

  6. 6

    University Of Aberdeen, Health Services Research Unit, Scotland, UK

*Kirsty McCormack, Health Services Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK. k.mccormack@abdn.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 JAN 2003

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Inguinal hernia repair is the most frequently performed operation in general surgery. The standard method for inguinal hernia repair had changed little over a hundred years until the introduction of synthetic mesh. This mesh can be placed by either using an open approach or by using a minimal access laparoscopic technique. Although many studies have explored the relative merits and potential risks of laparoscopic surgery for the repair of inguinal hernia, most individual trials have been too small to show clear benefits of one type of surgical repair over another.

Objectives

To compare minimal access laparoscopic mesh techniques with open techniques.

Search methods

We searched MEDLINE, EMBASE, and The Cochrane Central Controlled Trials Registry for relevant randomised controlled trials. The reference list of identified trials, journal supplements, relevant book chapters and conference proceedings were searched for further relevant trials. Through the EU Hernia Trialists Collaboration (EUHTC) communication took place with authors of identified randomised controlled trials to ask for information on any other recent and ongoing trials known to them.

Selection criteria

All published and unpublished randomised controlled trials and quasi-randomised controlled trials comparing laparoscopic groin hernia repair with open groin hernia repair were eligible for inclusion.

Data collection and analysis

Individual patient data were obtained, where possible, from the responsible trialist for all eligible studies. Where IPD were unavailable additional aggregate data were sought from trialists and published aggregate data checked and verified by the trialists. Where possible, time to event analysis for hernia recurrence and return to usual activities were performed on an intention to treat principle. The main analyses were based on all trials. Sensitivity analyses based on the data source and trial quality were also performed. Pre-defined subgroup analyses based on recurrent hernias, bilateral hernias and femoral hernias were also carried out.

Main results

Forty-one eligible trials of laparoscopic versus open groin hernia repair were identified involving 7161 participants (with individual patient data available for 4165). Meta-analysis was performed, using individual patient data where possible. Operation times for laparoscopic repair were longer and there was a higher risk of rare serious complications. Return to usual activities was faster, and there was less persisting pain and numbness. Hernia recurrence was less common than after open non-mesh repair but not different to open mesh methods.

Authors' conclusions

The review showed that laparoscopic repair takes longer and has a more serious complication rate in respect of visceral (especially bladder) and vascular injuries, but recovery is quicker with less persisting pain and numbness. Reduced hernia recurrence of around 30-50% was related to the use of mesh rather than the method of mesh placement.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Laparoscopic techniques versus open techniques for repair of a hernia in the groin

Repair of a hernia in the groin (an inguinal hernia) is the most frequently performed operation in general surgery. The hernia is repaired (with suturing or placing a synthetic mesh over the hernia in one of the layers of the abdominal wall) using either open surgery or minimal access laparoscopy. The most common laparoscopic techniques for inguinal hernia repair are transabdominal preperitoneal (TAPP) repair and totally extraperitoneal (TEP) repair. In TAPP the surgeon goes into the peritoneal cavity and places a mesh through a peritoneal incision over possible hernia sites. TEP is different as the peritoneal cavity is not entered and mesh is used to seal the hernia from outside the thin membrane covering the organs in the abdomen (the peritoneum). The mesh, where used, becomes incorporated by fibrous tissue. Minor postoperative problems occur. More serious complications such as damage to the spermatic cord, a blood vessel or nerves, are occasionally reported with open surgery and nerve or major vascular injuries, bowel obstruction, and bladder injury have been reported with laparoscopic repair. Reoccurrence of a hernia is a major drawback.
The review authors identified 41 eligible controlled trials in which a total of 7161 participants were randomized to laparoscopic or open surgery repair. The mean or median duration of follow up of patients ranged from 6 to 36 months.
Return to usual activities was faster for laparoscopic repair, by about seven days, and there was less persisting pain and numbness than with open surgery. However, operation times were some 15 minutes longer (range 14 to 16 minutes) with laparoscopy and there appeared to be a higher number of serious complications of visceral (especially bladder) and vascular injuries. Using a mesh for repair reduced the risk of a recurring hernia rather than the method of placement (open or laparoscopic surgery).

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

使用腹腔鏡技術和外科手術對於腹股溝疝修補的影響

腹股溝疝氣修補是一種常見的一般手術,在過去一百年間腹股溝疝氣修補治療的標準方法一直到人工網膜的出現才有重大改變,這個網膜可以藉由一般性方法或利用最小切口腹腔鏡技術來進行置放,雖然有許多研究已經探討使用腹腔鏡手術來進行腹股溝疝氣修補的相關效益與潛在風險,但是大多數的獨立試驗規模還是太小不足以明確的顯示其中一種手術方法優於另一種手術方法。

目標

本研究的主要目的在於比較最小切口腹腔鏡網膜技術和外科手術對腹股溝疝氣修補的影響。

搜尋策略

我們檢索了MEDLINE、EMBASE和Cochrane Central Controlled Trials Registry等資料庫以取得相關的隨機對照試驗資料,也會針對已確認試驗的參考文獻、期刊補充資料、相關書籍章節和研討會論文進行搜尋以獲得更多的相關資料,透過歐洲疝氣試驗研究委員會(EUHTC)會與已確認的隨機對照試驗作者進行聯繫以取得任何其他近期或是其所知正在進行的試驗資料。

選擇標準

針對腹腔鏡鼠蹊部疝氣修補和公開性鼠蹊部疝氣修補進行比較的所有已公開或未公開的隨機對照試驗和半隨機對照試驗,都適於納入本研究中。

資料收集與分析

如果可以的話,向所有的合乎本研究的試驗作者索取個別患者的數據,無法適用於其他整體表現資料的IPD,會經由搜尋試驗者和已公開的整體資料,並由試驗者加以確認和驗證,在可能的情形下,可以透過意向治療原則來表現出疝氣再發生或回復至正常活動能力之時間,所有的試驗都有進行主要的分析,根據數據來源進行的靈敏度分析和試驗品質也會呈現出來,基於現行預先設定的疝氣次要組別、股疝氣(femoral hernias)也都有進行分析。

主要結論

研究中共有51個針對腹腔鏡鼠蹊部疝氣修補與開放性鼠蹊部疝氣修補進行比較且適合納入研究的試驗,其中包括了7161位受試者,(其中可用的個別患者數據有4165筆),研究中也利用個別患者數據來呈現統合分析結果,腹腔鏡修補的手術時間會較久,並且出現罕見嚴重併發症風險也較高,但是回復一般正常活動所需時間較少,且較不容易具有持續性疼痛和麻木感,在進行外科手術非網膜修補不常會出現疝氣再發作的現象,但是這樣的結果與外科手術修補方法所得的結果並無差異。

作者結論

本文獻回顧顯示,腹腔鏡修補會需要較久的手術時間,並且在內臟(特別是膀胱)和血管損傷方面較容易出現嚴重的併發症發生率,但是接受腹腔鏡修補會較快復原,且較不容易出現持續性疼痛和麻木的感覺,使用網膜可以降低大約30至50%的疝氣再發作機率,而不是使用人工網膜置放手術。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

對於腹股溝疝氣施以腹腔鏡技術和外科手術進行治療的效果作比較。使用腹腔鏡手術和外科手術來治療發生於鼠蹊部的疝氣現象。治療發生於鼠蹊部的疝氣(一種腹股溝疝氣)是一種常見的一般性手術,要治療疝氣(利用縫合或是放置一人工網膜在腹腔壁的一內層)可以藉由外科手術或是小切口腹腔鏡手術來達成,最常見用來治療腹股溝疝氣的腹腔鏡技術包括了腹腔腹膜前疝氣修補手術(Transabdominal Preperitoneal Herniorrhaphy,TAPP)和全腹膜外疝氣修補手術(Total extraperitoneal approach,TEP) 手術,在TAPP方法中,手術試驗腹腔中進行,其係透過切開腹膜在可能的疝氣位置上放置一網膜,TEP則是完全不同的,因為手術不是發生在腹腔中,並且由覆蓋在腹腔內器官上的薄膜(腹膜)來縫合疝氣,而手術中使用的網膜會變成纖維組織的一部份,因此較不容易出現術後的可能發生的問題,諸如像對精索(spermatic cord)的傷害、血管或神經等嚴重的併發症有時候是外科手術的後遺症,而神經或是主要血管損傷、大腸阻塞和血管損身則可能是使用腹腔鏡復原手術中容易出現的嚴重併發症,疝氣的復發則是另一項主要缺點,本研究的作者確認了41個適當的對照性試驗,其中包括了7161位受試者,係隨機分配接受外科手術或腹腔鏡手術,患者術後的平均復原期間大約為6至36個月,使用腹腔鏡修補的復原速度會較快,一般大約是7天左右即可復原,復原後出現持續性疼痛和麻木的現象也比外科手術少,然而,進行腹腔鏡手術的時間大約為15分鐘(介於14至16分鐘之間),但是較可能出現對於內臟(特別是膀胱)和血管傷害的嚴重併發症,使用網膜來進行疝氣治療比一般放置法(外科手術或是腹腔鏡手術)更可以降低疝氣在發作的風險。