Keyhole surgery, the gee-whiz technology that has transformed surgery, still doesn't work as well as the old-fashioned conventional surgery for hernia.
A randomised study of more than 2000 patients showed that standard open surgery did far better in the long run than minimally invasive or laparoscopic surgery (where a fibreoptic 'scope' is passed through a small incision, and the surgeon is guided by an enlarged image on a TV screen).
Although the keyhole group had less pain initially, and a shorter recovery time, their rate of complications was higher (39 per cent) than the open group (33 per cent). There were also three deaths in the keyhole group, including one due to intestinal injury sustained during the laparoscopic procedure, compared with one death in the open-surgery group. Some 10 per cent of the keyhole patients also suffered hernia recurrences - more than twice those given the open surgery (N Engl J Med, 2004; 350: 1819-27).