Simon Marsh FRCS (Traditional)

Things to consider Technique Early complications Late complications Serious complications Economy What does NICE say

Evolution of Open Hernia Repair Bassini Shouldice Lichtenstein Tension free Mesh Plug

What do studies tell us? Maddern et al 1994: Both can be performed successfully as a day case. Added cost of laparoscopic does not warrant its use in unilateral hernias Lawrence et al 1995: longer theatre time and greater complication rate Wellwood et al 1998: Laparoscopic costs greater Wright et al 2002: Similar outcome; no difference in chronic pain or recurrence Menon et al 2003: longer operating time and higher recurrence McKormak 2007: More serious complication rate

Meta-analysis of laparoscopic inguinal hernia trials favors open hernia repair with preperitoneal mesh prosthesis C.Randle VoylesC.Randle Voyles, M.D. Brian J HamiltonBrian J Hamilton, B.S. William D JohnsonWilliam D Johnson, Ph.D. Nobuyasu KanoNobuyasu Kano, M.D Conclusions: Although LHR was associated with an earlier return to work compared with conventional sutured OHR, more recent mesh OHRs provide equivalent outcomes but at lower costs and potentially less severe complications, supporting an open technique using preperitoneal mesh prostheses as the optimal hernia repair.

NICE on Laparoscopic Hernia Repair: Laparoscopic surgery can be used as an option for repairing inguinal hernia. As with all surgery, there are some risks involved, which may include serious problems.

NICE on Mesh Plug Repair: Procedures do not fall within the programme's remit if they are considered standard clinical practice with an efficacy and safety profile that is sufficiently well known.