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Journal Club Review

Background. Up until 20yrs ago Bassisni repairLichtenstein repair has become the most widely used open repair in the last 20yrsEarly 90s - laparoscopic techniques in hernia repairTAPP vs TEP. Background. Last 10yrs - large no of trials comparing laparoscopic vs open repairNo significant differe

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Journal Club Review

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    1. Journal Club Review Laparoscopic compared with open methods of groin hernia repair:systematic review of randomised controlled trials Prof A. Grant British Journal of Surgery 2000, 87, 860-867

    2. Background Up until 20yrs ago Bassisni repair Lichtenstein repair has become the most widely used open repair in the last 20yrs Early 90s - laparoscopic techniques in hernia repair TAPP vs TEP

    3. Background Last 10yrs - large no of trials comparing laparoscopic vs open repair No significant difference between laparoscopic and open groups: recurrence serious complications chronic pain

    4. Object Systematically review data from all relevant randomised or semi-randomised trials Pre-specified data items were analysed Where possible quantitative meta-analysis was performed

    5. Object Trials grouped types of operation being compared: TAPP vs Open mesh repair TAPP vs Open non mesh repair TEP vs Open mesh repair TEP vs Open non mesh repair Mixed laparoscopic vs Mixed open

    6. Results 34 published trials were included 6804 pts Sample size 20 to 1051 with F/U from 6 weeks to 36 months Duration of operation longer in Lap. Groups (P<0.001) Visceral and vascular complications Laparoscopic (TAPP) > Open

    7. Results Post-op pain less in laparoscopic grp.(p=0.08) Length of stay not significantly different Return to usual activity earlier for lap.group P<0.001) Chronic pain and numbness - few trials Recurrences - no significant difference, BUT difference in lap (TAPP) vs non mesh open

    8. Discussion Methodological problems in this meta-analysis Heterogeneity of the papers chosen for inclusion in this meta-analysis Variations in the data analysis of individual papers meant that direct comparisons were difficult Despite large trial no., few significant results few trials compared TEP vs Open groups data on outcome not always reported

    9. Discussion Open hernia repair in 2000: minimal tension increase use of regional anaesthesia day only procedure Laparoscopic hernia repair in 2000: what situtations is increased risk and increased cost worth it? Recurrent hernias Bilateral hernias

    10. Discussion Significant findings from this meta-analysis longer operative time for laparascopic group more serious complications for lap. Group earlier return to work for lap. group

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