Original Communications| Volume 129, ISSUE 5, P530-536, May 2001

Hernioplasty and simultaneous laparoscopic cholecystectomy: A prospective randomized study of open tension-free versus laparoscopic inguinal hernia repair


      Background. The laparoscopic repair of unilateral primary groin hernia remains controversial. This randomized study evaluates the outcome of the laparoscopic technique in hernia repair in patients undergoing simultaneous laparoscopic cholecystectomy (LC) and compares laparoscopic repair with tension-free open groin hernia repair. Methods. Sixty-four low-risk patients with symptomatic chronic calculous cholecystitis and synchronous unilateral primary inguinal hernia were randomized to undergo either laparoscopic transabdominal preperitoneal mesh hernia repair (TAPP) and LC or LC and open tension-free hernia repair. Results. The operating time was longer in the TAPP and LC group (mean ± SD = 121 ± 32 minutes) than in the LC and open group (95 ± 27 minutes) (P <.01). The mean operating costs were higher in the TAPP and LC group ($1235 versus $1080) (P <.03). The intensity of postoperative pain at rest was greater in the LC and open group at 24 hours (P <.01) and 48 hours (P <.05), with a greater consumption of pain medication (P <.01). No differences between the 2 groups were found in terms of postoperative complications, disability period before return to work, or hernia recurrences. Conclusions. The totally laparoscopic procedure does not result in a significant benefit other than improved comfort in the first 2 postoperative days. However, laparoscopic hernia repair is considerably more difficult to perform than open tension-free hernioplasty. Thus, the totally laparoscopic approach should be performed only by experienced laparoscopic surgeons with special expertise in hernia surgery. (Surgery 2001;129:530-6.)
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        • Stoker DL
        • Spiegelhalter DJ
        • Singh R
        • Wellwood JM
        Laparoscopic versus open inguinal hernia repair: randomized prospective trial.
        Lancet. 1994; 343: 1243-1245
        • Liems MS
        • van der Graaf Y
        • Zwart RC
        • Geurts I
        • van Vroonhoveb TJ
        A randomized comparison of physical performance following laparoscopic and open inguinal hernia repair. The Coala Trial Group.
        Br J Surg. 1997; 84: 64-67
        • Kozol R
        • Lange PM
        • Kosir M
        • Beleski K
        • Mason K
        • Tennenberg S
        • et al.
        A prospective, randomized study of open vs laparoscopic inguinal hernia repair. An assessment of postoperative pain.
        Arch Surg. 1997; 132: 292-295
        • Liem MS
        • van der Graaf Y
        • van Steensel CJ
        • Boelhouwer RU
        • Clevers GJ
        • Meijer WS
        • et al.
        Comparison of conventional anterior surgery and laparoscopic surgery for inguinal-hernia repair.
        N Engl J Med. 1997; 336: 1541-1547
        • Paganini AM
        • Lezoche E
        • Carle F
        • Carlei F
        • Favretti F
        • Feliciotti F
        • et al.
        A randomized, controlled, clinical study of laparoscopic versus open tension-free inguinal hernia repair.
        Surg Endosc. 1998; 12: 979-986
        • Tanphiphat C
        • Tanprayoon T
        • Sangsubhan C
        • Chatamra K
        Laparoscopic vs open inguinal hernia repair. A randomized controlled trial.
        Surg Endosc. 1998; 12: 846-851
        • Khoury N
        A randomized prospective controlled trial of laparoscopic extraperitoneal hernia repair and mesh-plug hernioplasty: a study of 315 cases.
        J Laparoendosc Adv Surg Tech A. 1998; 8: 367-372
        • Beets GL
        • Dirksen CD
        • Go PM
        • Geisler FE
        • Baeten CG
        • Kootstra G
        Open or laparoscopic preperitoneal mesh repair for recurrent inguinal hernia? A randomized controlled trial.
        Surg Endosc. 1999; 13: 323-327
        • Juul P
        • Christensen K
        Randomized clinical trial of laparoscopic versus open inguinal hernia repair.
        Br J Surg. 1999; 86: 316-319
        • Picchio M
        • Lombardi A
        • Zolovkins A
        • Mihelsons M
        • La Torre G
        Tension-free laparoscopic and open hernia repair: randomized controlled trial of early results.
        World J Surg. 1999; 23: 1004-1007
        • The MRC laparoscopic Groin Hernia Trial Group
        Laparoscopic versus open repair of groin hernia: a randomized comparison.
        Lancet. 1999; 354: 185-190
        • Zieren J
        • Zieren HU
        • Jacobi CA
        • Wenger FA
        • Muller JM
        Prospective randomized study comparing laparoscopic and open tension-free inguinal hernia repair with Shouldice's operation.
        Am J Surg. 1998; 175: 330-333
        • Johansson B
        • Hallerback B
        • Glise H
        • Anesten B
        • Smeldberg S
        • Roman J
        Laparoscopic mesh versus open preperitoneal mesh versus conventional technique for inguinal hernia repair: a randomized multicenter trial (SCUR Hernia Repair Study).
        Ann Surg. 1999; 230: 225-231
        • Go PM
        Overview of randomized trials in laparoscopic inguinal hernia repair.
        Semin Laparosc Surg. 1999; 5: 238-241
        • Payne Jr, JH
        • Grininger Lm
        • Izawa MT
        • Podoll EF
        • Lindahl PJ
        • Balfour J
        Laparoscopic or open herniorrhaphy? A randomized prospective trial.
        Arch Surg. 1994; 129: 973-979
        • Heikkinen T
        • Haukipuro K
        • Leppala J
        • Hulkko A
        Total costs of laparoscopic and Lichtenstein inguinal hernia repairs: a randomized prospective study.
        Surg Laparosc Endosc. 1997; 7: 1-5
        • Bittner R
        • Leibl B
        • Kraft K
        • Schwarz J
        • Schmedt CG
        Update: what is left for laparoscopic hernia repair?.
        Dig Surg. 1998; 15: 167-171
        • Krahenbuhl L
        • Schafer M
        • Schilling M
        • Kuzinkovas V
        • Buchler MW
        Simultaneous repair of bilateral groin hernias: open or laparoscopic approach?.
        Surg Laparosc Endosc. 1998; 8: 313-318
        • Roslyn JJ
        Calculous biliary disease.
        in: Surgery: scientific principles and practice. : JB Lippincott Company, Philadelphia1993: 936-953
        • Knol JA
        • Eckhauser FE
        Inguinal anatomy and abdominal wall hernias.
        in: Surgery: scientific principles and practice. : JB Lippincott Company, Philadelphia1993: 1081-1107
        • Dubois F
        • Icard P
        • Berthelot G
        • Levard H
        Coelioscopic cholecystectomy, preliminary report of 36 cases.
        Ann Surg. 1990; 211: 60-65
        • Amid PK
        • Shulman AG
        • Lichtenstein IL
        Critical scrutiny of open “tension-free” hernioplasty.
        Am J Surg. 1993; 165: 369-371
        • Edwards CC
        • Bailey RW
        Laparoscopic hernia repair: the learning curve.
        Surg Laparosc Endosc. 2000; 10: 149-153
        • Kald A
        • Smedh K
        • Andemberg B
        Laparoscopic groin hernia repair: results of 200 consecutive herniorrhaphies.
        Br J Surg. 1995; 82: 618-620
        • Cunningham J
        • Pemple WJ
        • Mitchell P
        • Nixon JA
        • Preshaw RM
        • Hagen NA
        Cooperative hernia study.
        Ann Surg. 1996; 224: 598-602
        • Sampath P
        • Yeo CI
        • Campbell JN
        Nerve injury associated with laparoscopic inguinal herniorrhaphy.
        Surgery. 1995; 118: 829-833
        • Nyhus LM
        Individualization of hernia repair: a new era.
        Surgery. 1993; 114: 1-2
        • Tsimoyiannis EC
        • Grantzis E
        • Lekkas ET
        • Valakostas C
        • Economou N
        • Karayianni M
        Pefloxacin vs cefotaxime prophylaxis in elective biliary tract surgery.
        J Chemother. 1993; 5: 375-376