Laparoscopic or traditional (ordinary, with incision) hernia operation?
Randomized studies and meta-analysis at the mean statistical patients, who have undergone laparoscopic operation, show less post-operative pain as compared with the open surgery, absence of tension in recovery area and quicker return to the usual activity.
Potential advantages of laparoscopic procedure, however, should be interpreted, taking into account the possible disadvantages of the method like risk from injury of intestine or of a big vessel, the necessity of subjecting to general anesthesia and the higher price of the method related to the more expensive equipment.
On the other part, conventional intervention may be effected under local anesthesia and at ambulatory conditions, the risk of intra-abdominal complications is minimum one and the procedure price is lower. The bigger part of randomized clinical studies, directed to assessment of laparoscopic intervention, show comparable frequency of recurrences in laparoscopic and conventional tension free technics
(tension free operative technics, with implantation of polypropylene mesh).
May be the surgeon skills, than the peculiarities of the patient, are the most significant element in the selection of patients for laparoscopy or for open surgery. Laparoscopic hernioplastics technically is the bigger challenge than the ordinary open surgery.
Taking into account the comparable frequency of recurrences and the complications after laparoscopic plastics and the classic tension free plastis, by one and the same surgeon, all adult patients with inguinal hernia who may be operated under general anesthesia are practically indicated for laparoscopic correction of inguinal hernia.
Definite hernia types (I.e. recurring, bilateral or complicated by some other reason) are very suitable for laparoscopic intervention.
Intra-abdominal infection or coagulopathy are contraindications for performance of the latter. Among the relative contraindications are: intra-abdominal adhesions from previous interventions, ascites, as well as severe co-lesions (related to increased risk in general anesthesia). These patients are indicated more for conventional operation under local or regional anesthesia.
Dr Rosen Tushev