Less Invasive Hernia Procedure Easier on Patients: Study
Rating
Less Invasive Hernia Procedure Easier on Patients: Study
Our Review Summary
This study could have easily been reported as a clear case of new technology besting the old way of doing things. Thankfully, this story avoided that simplistic narrative by reaching out to an independent expert, who explained that the traditional approach is still the preferred option for certain patient groups who aren’t good candidates for general anesthesia. We thought the story could have delved deeper into certain issues that are relevant to patients — like how quickly people were able to return to work after undergoing each procedure, and whether everyone with this type of hernia even needs surgery.The story also would have done well to examine some other studies that don’t support the conclusions reached by these researchers.
Why This Matters
Innovation in medicine almost always means higher costs, but sometimes it doesn’t lead to higher quality or better outcomes. Good studies are needed to confirm the benefits of new approaches compared with the existing standard.
Most surgical studies comparing treatment options compare outcomes over short periods of time. This study presents results over an average of 5 years and addresses important longer-term outcomes of common surgical procedures used to repair groin hernias. Studies have shown that short-term outcomes of laparoscopic and standard surgical repair have similar outcomes though recovery with the laparoscopic is associated with less pain and potentially quicker return to usual activities. This article presents rates of recurrence and persistent pain after an average of about 5 years after surgery. Recurrence rates overall were low for both procedures and appeared to be influenced by the experience of the surgeon performing the laparoscopic procedure. Interestingly, more patients having the traditional procedure reported persistent pain. As the story correctly concludes, this doesn’t mean that one procedure is preferred over the other, but rather provides important data that patients may want to know when considering the options for elective surgical repair of groin hernias.
Criteria
Not Satisfactory
We’ll give credit to the story for attempting to compare the relative costs of the two procedures, but we thought the language used was just too vague to support a satisfactory rating. The story says the costs of the two procedures are “comparable,” but that “the laparoscopic procedure may cost more.” Unfortunately, it’s difficult to tell from this description if the procedures cost about the same or whether the laparoscopic procedure is, in fact, more expensive. Attaching a specific dollar figure to each procedure would have made the meaning more explicit. Given the nature of the long-term follow-up presented, one could have discussed both the short-term medical costs of the two procedures and then whether there were differences in care over the ensuing 5 years that may have changed the short-term comparison.
Satisfactory
The story quantified how often the hernias recurred in each group and how many patients had chronic pain at follow-up. It noted that “the vast majority of patients do well, regardless of the approach.” This is enough for a satisfactory, though the story could have provided data about how quickly patients were able to return to work with each procedure, and how satisfied they were overall with their results.
Satisfactory
The story explained that the less invasive surgery might not be appropriate for patients who face increased risk from general anesthesia, including the elderly or those with multiple health problems. We’ll rule this satisfactory, but the story could also have noted that the less invasive procedure produced a higher rate of operative complications than the standard procedure (6% vs. 2%).
Not Satisfactory
The story gave a reasonable account of the study design, and it noted that better outcomes were seen with more experienced surgeons — an important wrinkle. However, it didn’t really communicate just how critical the surgeon’s experience level is to the success of the laparoscopic procedure. According the Medscape’s coverage, there was a 25% recurrence rate for inexperienced surgeons using this approach, compared to just 0.5% for experienced surgeons. That’s an important detail for patients to keep in mind when deciding on a treatment plan.
In addition, the story didn’t make any attempt to square these findings with those of a much larger multicenter study that reported much higher recurrence rates with the laparoscopic procedure compared with the traditional procedure. Omitting this important research from the discussion may give readers a warped view of the evidence on this question.
Satisfactory
There was no disease-mongering.
Satisfactory
An independent source provided useful context about the important continuing role of the traditional “open” procedure.
Not Satisfactory
The study compared two major surgical approaches and the story mentioned the existence of a third approach that wasn’t tested. However, it didn’t mention nonsurgical management or “watchful waiting,” which may be an appropriate strategy for patients with minimal symptoms or who are asymptomatic. Since almost all hernia repairs are elective – meaning that they are designed to minimize pain and bulging rather than preventing a potentially serious medical problem (such as bowel obstruction or incarceration in the hernia) – it is appropriate to mention that for many patients part of the decision making process is whether to have surgery or not. Once one decides to have surgery, then the question of what is the best procedure becomes relevant. Some patients make the decision about whether to have surgery on not based upon the risks and benefits of the procedure, so that is why mentioning not having surgery is part of the comparison of treatment options.
Not Applicable
Both approaches seem to be widely available, so the fact that the story didn’t discuss this shouldn’t be held against it. We’ll rule it not applicable.
Satisfactory
The story notes that the laparoscopic approach has been around since the 1990s and that the traditional approach is older.
Satisfactory
This story wasn’t based on a press release.
Total Score: 6 of 9 Satisfactory
Comments
Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.
Our Comments Policy
But before leaving a comment, please review these notes about our policy.
You are responsible for any comments you leave on this site.
This site is primarily a forum for discussion about the quality (or lack thereof) in journalism or other media messages (advertising, marketing, public relations, medical journals, etc.) It is not intended to be a forum for definitive discussions about medicine or science.
We will delete comments that include personal attacks, unfounded allegations, unverified claims, product pitches, profanity or any from anyone who does not list a full name and a functioning email address. We will also end any thread of repetitive comments. We don”t give medical advice so we won”t respond to questions asking for it.
We don”t have sufficient staffing to contact each commenter who left such a message. If you have a question about why your comment was edited or removed, you can email us at feedback@healthnewsreview.org.
There has been a recent burst of attention to troubles with many comments left on science and science news/communication websites. Read “Online science comments: trolls, trash and treasure.”
The authors of the Retraction Watch comments policy urge commenters:
We”re also concerned about anonymous comments. We ask that all commenters leave their full name and provide an actual email address in case we feel we need to contact them. We may delete any comment left by someone who does not leave their name and a legitimate email address.
And, as noted, product pitches of any sort – pushing treatments, tests, products, procedures, physicians, medical centers, books, websites – are likely to be deleted. We don”t accept advertising on this site and are not going to give it away free.
The ability to leave comments expires after a certain period of time. So you may find that you’re unable to leave a comment on an article that is more than a few months old.
You might also like