{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T13:05:11Z","timestamp":1791205511733,"version":"4.1.0"},"reference-count":18,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2023,2,1]]},"abstract":"<jats:sec id=\"ab-soi220097-4\"><jats:title>Importance<\/jats:title><jats:p>Advocates of laparoscopic surgery argue that all inguinal hernias, including initial and unilateral ones, should be repaired laparoscopically. Prior work suggests outcomes of open repair are improved by using local rather than general anesthesia, but no prior studies have compared laparoscopic surgery with open repair under local anesthesia.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi220097-5\"><jats:title>Objective<\/jats:title><jats:p>To evaluate postoperative outcomes of open inguinal hernia repair under general or local anesthesia compared with laparoscopic repair.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi220097-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This retrospective cohort study identified 107\u202f073 patients in the Veterans Affairs Surgical Quality Improvement Program database who underwent unilateral initial inguinal hernia repair from 1998 to 2019. Data were analyzed from October 2021 to March 2022.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi220097-7\"><jats:title>Exposures<\/jats:title><jats:p>Patients were divided into 3 groups for comparison: (1) open repair with local anesthesia (n\u2009=\u200922\u202f333), (2) open repair with general anesthesia (n\u2009=\u200975\u202f104), and (3) laparoscopic repair with general anesthesia (n\u2009=\u20099636).<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi220097-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Operative time and postoperative morbidity were compared using quantile regression and inverse probability propensity weighting. A 2-stage least-squares regression and probabilistic sensitivity analysis was used to quantify and address bias from unmeasured confounding in this observational study.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi220097-9\"><jats:title>Results<\/jats:title><jats:p>Of 107\u202f073 included patients, 106\u202f529 (99.5%) were men, and the median (IQR) age was 63 (55-71) years. Compared with open repair with general anesthesia, laparoscopic repair was associated with a nonsignificant 0.15% (95% CI, \u22120.39 to 0.09; <jats:italic>P<\/jats:italic>\u2009=\u2009.22) reduction in postoperative complications. There was no significant difference in complications between laparoscopic surgery and open repair with local anesthesia (\u22120.05%; 95% CI, \u22120.34 to 0.28; <jats:italic>P<\/jats:italic>\u2009=\u2009.70). Operative time was similar for the laparoscopic and open general anesthesia groups (4.31 minutes; 95% CI, 0.45-8.57; <jats:italic>P<\/jats:italic>\u2009=\u2009.048), but operative times were significantly longer for laparoscopic compared with open repair under local anesthesia (10.42 minutes; 95% CI, 5.80-15.05; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001). Sensitivity analysis and 2-stage least-squares regression demonstrated that these findings were robust to bias from unmeasured confounding.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi220097-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this study, laparoscopic and open repair with local anesthesia were reasonable options for patients with initial unilateral inguinal hernias, and the decision should be made considering both patient and surgeon factors.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamasurg.2022.6616","type":"journal-article","created":{"date-parts":[[2022,12,21]],"date-time":"2022-12-21T16:02:22Z","timestamp":1671638542000},"page":"172","source":"Crossref","is-referenced-by-count":32,"title":["Comparison of Postoperative Outcomes of Laparoscopic vs Open Inguinal Hernia Repair"],"prefix":"10.1001","volume":"158","author":[{"given":"Jennie","family":"Meier","sequence":"first","affiliation":[{"name":"Department of Surgery, University of Texas Southwestern Medical Center, Dallas"},{"name":"North Texas VA Healthcare System, Dallas"},{"name":"University of Texas Southwestern Surgical Center for Outcomes, Implementation, and Novel Interventions (S-COIN), Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Audrey","family":"Stevens","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Texas Southwestern Medical Center, Dallas"},{"name":"North Texas VA Healthcare System, Dallas"},{"name":"University of Texas Southwestern Surgical Center for Outcomes, Implementation, and Novel Interventions (S-COIN), Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miles","family":"Berger","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos I.","family":"Makris","sequence":"additional","affiliation":[{"name":"Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas"},{"name":"Michael E. DeBakey Veterans Affairs Medical Center, Operative Care Line, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athanasios","family":"Bramos","sequence":"additional","affiliation":[{"name":"Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas"},{"name":"Michael E. DeBakey Veterans Affairs Medical Center, Operative Care Line, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan","family":"Reisch","sequence":"additional","affiliation":[{"name":"Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. Munro","family":"Cullum","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas"},{"name":"Department of Neurology, University of Texas Southwestern Medical Center, Dallas"},{"name":"Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon C.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celette","family":"Sugg Skinner","sequence":"additional","affiliation":[{"name":"Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herbert","family":"Zeh","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia J.","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Medicine, Louisiana State University\u2013New Orleans"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Courtney J.","family":"Balentine","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Texas Southwestern Medical Center, Dallas"},{"name":"North Texas VA Healthcare System, Dallas"},{"name":"University of Texas Southwestern Surgical Center for Outcomes, Implementation, and Novel Interventions (S-COIN), Dallas"},{"name":"Department of Surgery, University of Wisconsin\u2013Madison"},{"name":"Wisconsin Surgical Outcomes Research Program (WiSOR), 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