Laparoscopic herniorrhaphy. Diagnostic and therapeutic technology assessment

OBJECTIVE: To provide clinicians with a technology assessment of the safety and effectiveness of laparoscopic herniorrhaphy for the surgical repair of inguinal hernias. PARTICIPANTS: A literature review and a Diagnostic and Therapeutic Technology Assessment (DATTA) survey questionnaire were mailed to 75 physicians with expertise in surgical repair of inguinal hernias. These panelists had been nominated to the DATTA panel by the appropriate specialty societies and medical schools. A total of 55 panelists (73%) responded. EVIDENCE: Assessment was based on the expert opinion of the panelists, as well as on published literature (available as of February 8, 1996). Published studies were identified by a MEDLINE search using the terms laparoscopic surgery, inguinal hernia, and laparoscopic herniorrhaphy and by review of the references cited in these primary sources. CONSENSUS PROCESS: The respondents completed a DATTA survey questionnaire; the survey results were tabulated, analyzed, and interpreted by American Medical Association staff. CONCLUSIONS: The DATTA panelists rated the use of laparoscopic herniorrhaphy as promising for safety and investigational for effectiveness for two indications: the repair of primary inguinal hernias and the repair of bilateral inguinal hernias. The use of laparoscopic herniorrhaphy to repair recurrent inguinal hernias was rated as investigational for both safety and effectiveness by the panel. This technique was rated as promising for safety and effectiveness as a method for decreasing postoperative tenderness and time until return to full activity.