Randomised controlled trial of laparoscopic versus open mesh repair for inguinal hernia: outcome and cost

Wellwood, J. M.; Sculpher, Mark; Stoker, David L.; Nicholls, Graham J; Geddes, Cathy; Whitehead, Anne; Singh, Rameet; Spiegelhalter, David

doi:10.1136/bmj.317.7151.103

Cited by 271 publications

(181 citation statements)

References 20 publications

Supporting

Mentioning

165

Contrasting

Unclassified

Order By: Relevance

“…Although we know the difficulty of measuring postoperative pain due to its subjective nature, we used two methods to quantify it: the numerical scale of pain and the patient's need for rescue analgesia 1,6,8,11,12,14,15,19 . Although there was no difference between the groups regarding the pain scale, with 97.5% of the patients reporting mild to moderate pain and only one patient with severe pain in both groups, we noticed that the patients in the SF group requested more doses of analgesics than in the VL group, although this fact is also devoid of statistical significance.…”

Section: Discussionmentioning

confidence: 99%

“…Technological advances have also allowed the development of different types of surgical mesh, such as with resorbable material, self-fixating adhesives, low weight and fixation with fibrin glue 3,11,12 . This large arsenal of available material, associated with a wide variety of techniques (open or laparoscopic), raises questions about the gold standard for the treatment of inguinal hernia.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Herniorrafia inguinal convencional com tela autofixante versus videolaparoscópica totalmente extraperitoneal com tela de polipropileno: resultados no pós-operatório precoce

Cunha-e-Silva

Oliveira

Ayres

et al. 2017

Rev. Col. Bras. Cir.

View full text Add to dashboard Cite

RESUMO Objetivo: avaliar o resultado no pós-operatório precoce do tratamento da hérnia inguinal pela técnica convencional com tela autofixante versus videolaparoscópica totalmente extraperitoneal com uso da tela de polipropileno. Foram comparados, sobretudo, dor, tempo cirúrgico e complicações precoces. Métodos: estudo prospectivo, de série de casos, realizado na Clínica Cirúrgica A, do Hospital Universitário Gaffrée e Guinle (HUGG), no qual 80 casos consecutivos foram estudados. Apenas pacientes com hérnia inguinal unilateral, não recidivada e operadas em caráter eletivo foram incluídas no estudo. Os pacientes foram divididos em dois grupos, de 40 pacientes cada; grupo AF (técnica convencional com uso de tela autofixante) e grupo VL (técnica videolaparoscópica com uso de tela de polipropileno). Os pacientes foram acompanhados até o 45º dia de pós-operatório. Resultados: dos 80 pacientes operados no estudo, 98,7% pertenciam ao sexo masculino e a maioria era portadora de hérnia inguinal direita indireta (Nyhus II). Não houve diferença entre os grupos estudados no que diz respeito à dor e tempo operatório. No entanto, ocorreram mais complicações (seroma e hematoma) no grupo da cirurgia aberta. Conclusão: as duas operações realizadas se mostraram factíveis, seguras e estão relacionadas à mínima dor pós operatório e a um baixo tempo cirúrgico.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Herniorrafia inguinal convencional com tela autofixante versus videolaparoscópica totalmente extraperitoneal com tela de polipropileno: resultados no pós-operatório precoce

Cunha-e-Silva

Oliveira

Ayres

et al. 2017

Rev. Col. Bras. Cir.

View full text Add to dashboard Cite

show abstract

“…Another RCT from the United Kingdom by Wellwood et al [142] used the SF-36 to compare laparoscopic transabdominal with Lichtenstein repair (1b). The follow-up was 3 months and included 392 patients.…”

Section: Long-term Restoration Of Qol Is Not Different (El 1a)mentioning

confidence: 99%

Evaluation of quality of life after laparoscopic surgery: evidence-based guidelines of the European Association for Endoscopic Surgery

et al. 2004

View full text Add to dashboard Cite

Background: Measuring health-related quality of life (QoL) after surgery is essential for decision making by patients, surgeons, and payers. The aim of this consensus conference was twofold. First, it was to determine for which diseases endoscopic surgery results in better postoperative QoL than open surgery. Second, it was to recommend QoL instruments for clinical research. Methods: An expert panel selected 12 conditions in which QoL and endoscopic surgery are important. For each condition, studies comparing endoscopic and open surgery in terms of QoL were identified. The expert panel reached consensus on the relative benefits of endoscopic surgery and recommended generic and disease-specific QoL instruments for use in clinical research. Results: Randomized trials indicate that QoL improves earlier after endoscopic than open surgery for gastroesophageal reflux disease (GERD), cholecystolithiasis, colorectal cancer, inguinal hernia, obesity (gastric bypass), and uterine disorders that require hysterectomy. For spleen, prostate, malignant kidney, benign colorectal, and benign non-GERD esophageal diseases, evidence from nonrandomized trials supports the use of laparoscopic surgery. However, many studies failed to collect long-term results, used nonvalidated questionnaires, or measured QoL components only incompletely.

show abstract

“…After discussion within the EU Hernia Trialists Collaboration and the review of previous economic evaluations (24), several scenarios were developed. The principal scenario distinguished between laparoscopic surgery using disposable rather than reusable equipment as this is what had been used predominantly in the three trials.…”

Section: Data On Resource Use and Costmentioning

confidence: 99%

“…The probability that TEP is cost-effective for varying costs that society might be willing to pay for an additional day at usual activities is shown in Figure 3. It is highly likely that the cost per additional day at usual activities is less than €100 using the cost data derived from two of the studies (2;22) and less than €300 using data derived from Wellwood and colleagues (24).…”

Section: Laparoscopic Versus Open Mesh Flat Repairmentioning

confidence: 99%

Cost-effectiveness of alternative methods of surgical repair of inguinal hernia

Vale

Grant

McCormack

et al. 2004

Int J Technol Assess Health Care

View full text Add to dashboard Cite

(ii) open flat mesh with open non-mesh repair; and (iii) methods that used synthetic mesh to repair the hernia defect with those that did not. Data on costs were obtained from the authors of economic evaluations previously conducted alongside trials included in the reviews. A Markov model was used to model cost-effectiveness for a five-year period after the initial operation. The outcomes of the model were presented using a balance sheet approach and as cost per hernia recurrence avoided and cost per extra day at usual activities. Results: Open flat mesh was the most cost-effective method of preventing recurrences. Laparoscopic repair provided a shorter period of convalescence and less long-term pain compared with open flat mesh but was more costly. The mean incremental cost per additional day back at usual activities compared with open flat mesh was €38 and €80 for totally extraperitoneal and transabdominal preperitoneal repair, respectively. Conclusions: Laparoscopic repair is not cost-effective compared with open flat mesh repair in terms of cost per recurrence avoided. Decisions about the use of laparoscopic repair depend on whether the benefits (reduced pain and earlier return to usual activities) outweigh the extra costs and intraoperative risks. On the evidence presented here, these extra costs are unlikely to be offset by the short-term benefits of laparoscopic repair.

show abstract

Randomised controlled trial of laparoscopic versus open mesh repair for inguinal hernia: outcome and cost

Abstract: Objective: To compare tension-free open mesh hernioplasty under local anaesthetic with transabdominal preperitoneal laparoscopic hernia repair under general anaesthetic.

Cited by 271 publications

References 20 publications

Herniorrafia inguinal convencional com tela autofixante versus videolaparoscópica totalmente extraperitoneal com tela de polipropileno: resultados no pós-operatório precoce

Herniorrafia inguinal convencional com tela autofixante versus videolaparoscópica totalmente extraperitoneal com tela de polipropileno: resultados no pós-operatório precoce

Evaluation of quality of life after laparoscopic surgery: evidence-based guidelines of the European Association for Endoscopic Surgery

Cost-effectiveness of alternative methods of surgical repair of inguinal hernia

Contact Info

Product

Resources

About