Keyhole hernia op: more complications than open surgery

New research from the UK has prompted calls for a curtailment of laparoscopic hernia repairs, in favour of general surgery.

In a large, multicentre, randomised trial conducted by the Medical Research Council Laparoscopic Hernia Group, laparoscopic surgery (using a type of endoscope through a small cut in the abdominal wall) was compared with open surgery in more than 900 patients. Some of their findings such as the fact that laparoscopic patients experienced less pain and could return to work earlier were not unique.

But what was startling was the high rate of serious complications and hernia recurrences from the less invasive surgery.

The recorded complications took the form of nerve damage, bladder injury and vascular injury. While there were seven recurrences of hernia during the one year follow up in the laparoscopic group, there were none in the open surgery group.

Interestingly, surgeons in the laparoscopic group tended to be more senior, throwing doubt on the commonly held belief that it is practitioner inexperience which leads to complications after keyhole procedures (Lancet, 1999; 354: 185-90).