OLD-FASHIONED operations do a better job of repairing groin hernias than keyhole surgery, a study has suggested.

Recurrence of the hernia is more than twice as likely if the operation is done by keyhole techniques, according to the experience of nearly 1,700 patients chosen at random to have one or other of the two procedures.

Only the most experienced of keyhole surgeons — those who had done at least 250 operations using the technique — produced results as good as those achieved with “open” surgery, according to a team led by Leigh Neumayer, of the US Veterans Affairs Medical Centre at the University of Utah.

There has long been argument over the best way to repair an inguinal hernia, which appears as a lump in the groin at the site of a weakness in the abdominal wall. Every year more than 100,000 people in England and Wales develop the condition, the vast majority of them men.

Three years ago, to the anger of keyhole surgeons, the National Institute for Clinical Excellence (NICE) concluded that “open” operations, which involve an incision up to 4in long, should be preferred over laparoscopic (keyhole) procedures where the surgeon works though tiny incisions guided by television images.

The study, to be published in this week’s New England Journal of Medicine and released early for presentation at a medical conference, backs this judgment.

It shows that although post-operative pain is less in the days after a laparoscopic operation, and patients on average get back to work a day sooner, complications are more likely and a tenth of patients suffer a recurrence, compared with only 5 per cent of those having open operations. The patients in the study all had the standard basic repair: very thin, flexible mesh was placed behind the gap in the muscle to hold in the gut. Surgeons tacked the mesh in with a few stitches or with surgical tacks or staples, Dr Neumayer said.

Overall, 87 of the 862 patients who had laparoscopic surgery needed a second repair of the same hernia within two years, compared with 41 of the 834 who got open incision repairs. That works out at 10.1 per cent and 4.9 per cent. “Based on these findings, we’d recommend that men with a hernia that has never been repaired before should undergo an open repair,” Dr Neumayer said.

The British Hernia Centre, which specialises in such operations, does more open mesh repairs than anywhere else, with a recurrence rate of less than 1 per cent. Dudley Rogg, clinic director at the centre, said: “These results support our own larger and longer studies and concur with the advice published by NICE last year when it recommended open surgery over keyhole on the basis of both clinical excellence and cost effectiveness.

“Keyhole surgery creates such tissue trauma that it always has to be conducted under general anaesthetic, which rules out the elderly, those with cardiac or respiratory problems and also creates problems of its own. General anaesthetic is still one of the most dangerous elements of general surgery in the UK. We conduct more than 95 per cent of our hernia repairs under local anaesthesia.”

Dr Danny Jacobs, of Duke University, Durham, North Carolina, who wrote an accompanying editorial in the journal, says that one explanation is that hernia repair is a more complicated laparoscopic operation because there are more nearby body parts that can be inadvertently injured, including arteries, veins and nerves.

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