Michael Reinhorn, MD FACS & Samantha Riordan
A few months ago, we published a blog post titled, “Do Both Sides of Your Hernia Really Need a Robot? New Study Says… Nope.” In that blog, we investigated an ACHQC paper which revealed there was no difference in outcomes between laparoscopic/robotic and open groin hernia repairs.
As of last week, a new study in Spain further proved this point.
As it currently stands, international guidelines recommend a laparoscopic repair. But here’s the problem: those guidelines were based on one small, non-randomized study. Not exactly the gold standard.
In their recent study, a team in Barcelona looked at 182 patients who underwent bilateral groin hernia repairs through either a laparoscopic or open preperitoneal approach.
This time, there was a slight difference in outcomes… and they favor the open preperitoneal repair.
As expected, there was no difference in recurrence rates and surgical site complications for the different approaches. However, they found that open preperitoneal repair was associated with a lower occurrence of early CPIP (Chronic Postoperative Inguinal Pain) 3-12 months following the hernia repair.
Though data suggests that there is a gradual resolution of pain in most patients regardless of their repair, the fact that pain is significantly lower for open preperitoneal patients allows them to recover quicker, easier, and gets patients to get back to their normal activities sooner.
What Does This Mean for You?
Well, results like these mean you should think again before undergoing a laparoscopic/robotic repair.
Though a laparoscopic repair is called a minimally invasive surgery, the open preperitoneal repair requires less anesthesia, takes less time to complete, and gets you back on your feet faster, while virtually eliminating intestinal complications by avoiding the peritoneal cavity. All of these factors indicate that the open preperitoneal repair is equal, if not superior, to the current recommendations.
Here at Boston Hernia, we have specialized in open preperitoneal repairs for over 20 years.
Robotic surgery has its place in inguinal hernia repairs. It can be the best option for complex repairs or for patients who have a higher BMI. For most people – especially those who want a faster, safer recovery, open preperitoneal repair is the better choice in hernia repair.
Why is Open Preperitoneal Repair so Much Better?
No general anesthesia.
Instead, this repair utilizes a combination of sedation and local anesthesia. That means you’ll be comfortably asleep during your surgery, but you’ll wake up feeling much more alert than you would with general anesthesia. This is a much safer and better alternative for most patients.
We keep things minimally invasive.
Your surgeon makes a small incision directly over the hernia and closes it with dissolvable stitches. In the open preperitoneal repair, no muscles are cut. Muscles are also not paralyzed like they do for laparoscopic surgery. This means a quicker recovery, less pain, and no stitches that need to be removed later.
Most patients don’t need opioids for pain.
Pain following an open preperitoneal repair is usually mild and short-lived. More than 95% of patients utilize Tylenol and/or Advil. The decrease in pain is due to the use of local anesthetic, which prevents the brain experiencing pain during the operation- therefore decreasing post operative pain (even after the local anesthetic wears off!).
You can return to full activity in about 2 weeks.
For most people, It’s recommended avoiding strenuous activity for 14 days, then gradually getting back to normal routine. If you work at a desk, you can often return to work in just a few days.
No catheter needed.
Laparoscopic and robotic hernia surgeries often require placing a catheter in the bladder, with almost 1 in 10 patients needing one afterward. With the Open Preperitoneal repair, that’s not necessary.