Produced by the Royal College of Physicians of Edinburgh, Royal College of Surgeons of Edinburgh and Royal College of Physicians and Surgeons of Glasgow

KEYHOLE SURGERY FOR HERNIA – THE KEY IS GOOD TRAINING AND HOLE IS WHERE THE SURGEON AND POSSIBLY PATIENT MAY FIND THEMSELVES WHEN POORLY TRAINED

  • Mr S Nixon, Consultant Surgeon, Edinburgh, Scotland

Summary

In recent years, keyhole surgery techniques have been developed for a range of surgical procedures. However, it has been suggested that keyhole surgery for hernia carries an increased risk of complications over traditional, open, surgery. Mr Steve Nixon reviews the evidence

Key Points

  • Hernia repair is the most common surgical operation carried out in men, and 25 years have passed since the ìgold standardî operation for the condition was developed.
  • Open and laparoscopic (key-hole) surgery are used to repair hernias, and the latter has been promoted as likely to reduce complications and accelerate recovery.
  • # A UK hernia trial reported in 1999 showed complication rates of 30% for laparoscopic and 40% for open surgery, and a very recent trial reported in 2004 showed complication and recurrence rates to be higher for laparoscopic surgery (39% and 10%) than for open surgery (33% and 5%).
  • Analysis of these studies shows that the lessons are for surgeons rather than surgery. All surgery is demanding, especially laparoscopic surgery, and good well-supervised training is the key to excellence.

Declaration of interests: No conflict of interests declared

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