1. In patients undergoing inguinal hernia repair, there was not a significant difference in postoperative complications between laparoscopic surgery, and open repair with local and general anesthesia.
Evidence Rating Level: 2 (Good)
Inguinal hernia repair continues to be one of the most common general surgery procedures in the United States. Unilateral inguinal hernias are usually repaired using an open surgery technique while laparoscopic methods are traditionally reserved for more complicated recurrent or bilateral hernias. However, recent evidence has suggested that laparoscopic surgery may improve postoperative outcomes, although this has not taken anesthesia modalities into consideration. This study aimed to compare short-term outcomes of open inguinal hernia repair performed with local anesthetic or general anesthetic and laparoscopic surgery performed with general anesthetic. In this retrospective cohort study, 107 073 participants who underwent inguinal hernia repair were divided into three groups for comparison: laparoscopic repair under general anesthesia, open repair under local anesthesia, and open repair under general anesthesia. The primary outcome of interest was any postoperative complication including infection, thromboembolism, bleeding, or wound complications within 30 days of surgery. The results of this study showed that laparoscopic hernia repair did not significantly reduce postoperative complications compared to open inguinal hernia repair under general anesthesia (difference 0.15%, 95%CI -0.39-0.09). Additionally, there was no difference identified in the incidence of postoperative complications between laparoscopic surgery and open hernia repair with local anesthesia (difference 0.05%, 95%CI -0.34-0.28). However, laparoscopic inguinal hernia repair was associated with a longer operative time compared with open repair surgery in general. In conclusion, this study depicts that laparoscopic surgery was not associated with a clear advantage compared with open repair and resulted in a significantly longer operative time. However, this study has several limitations which are important to note. Firstly, while general postoperative complications were discussed, this paper did not examine hernia-specific outcomes such as recurrence or pain. Additionally, some postoperative complications such as postoperative delirium or urinary retention which may be common following general anesthesia were not assessed. Nevertheless, this study presents evidence that laparoscopic and open surgeries in the context of hernia repair may have similar outcomes and supports taking patient factors as well as surgeon preference into consideration when making a decision regarding surgical technique.
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