NHS to stop keyhole surgery for hernias

Hernia operations, the most common surgical procedures in the health service, should be performed using conventional open surgery rather than the newer keyhole techniques, a government agency has concluded.

Hernia operations, the most common surgical procedures in the health service, should be performed using conventional open surgery rather than the newer keyhole techniques, a government agency has concluded.

The decision by the National Institute for Clinical Excellence (Nice), set up to monitor new drugs and treatments, is a blow to proponents of keyhole techniques, which have been promoted as the future of surgery. Nice says they should be avoided in patients with first-time hernias.

Keyhole surgery involves a smaller incision than conventional open surgery, causes less pain and scarring and is quicker to heal. The surgical instruments are inserted through a small hole in the abdomen and manipulated with the aid of a miniature camera.

But in inexpert hands there is a risk of damage to internal organs and keyhole surgery is more expensive - £747 per operation on average compared with £412 for the conventional kind.

An estimated 105,000 people develop an inguinal hernia, a bulge in the groin caused by a weakness in the abdominal wall, every year in England and Wales.

The condition is much more common in men - who account for 98 out of 100 cases - and three out of 10 people who get a hernia on one side will develop a second on the other.

In guidance for the health service published yesterday, Nice says that for hernias that recur or affect both sides, keyhole surgery should be considered, but it recommends that a new technique, the totally extraperitoneal procedure, is to be preferred.

This technique avoids penetrating the abdominal cavity, and reduces the risk of damage to internal organs, but it is more difficult.

The agency's report says that keyhole surgery "should only be undertaken in surgical units with appropriately trained operating teams".