[Inguinal hernia treatment].
Efficacy of groin hernia repair is mainly evaluated by its recurrence rate. In the literature it depends on the type of surgery but also on the follow-up, which must last 5 years at least and has to be more than 90% complete. To acertain the clinical result, the patient must be examined by a surgeon. Among herniorraphies techniques, Shouldice procedure has the lowest recurrence rate. The Lichtenstein operation leads to less recurrence rate than McVay's, for mixt (direct and indirect) hernias. Post operative pain might be diminished after the former procedure. No randomized control trial has compared raphies and techniques involving a prosthesis, in groin hernia repair. Among laparoscopic techniques, the transabdominal and preperitoneal approaches have less recurrence rate than the entirely intra peritoneal one, which has been abandonned. Their recurrence rate is not different than recurrence rate of herniorraphies and techniques using a prosthesis. With them, post operative abdominal pain is diminished. Nevertheless no randomized control trial has demonstrated any superiority of laparoscopic techniques on the Shouldice procedure.
Département Médico-Chirurgical de pathologie digestive, Institut Mutualiste Montsouris, Paris. digestif@imm.fr
M J
MJ
Boudet
T
T
Perniceni
D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D016896:Treatment Outcome
Traitement des hernies inguinales.