What is next in inguinal hernia surgery?
Traditionally, the inguinal hernia repair is performed through an incision in the groin. Different kinds of operations are suggested as best repairs by using the patient's own tissue, or use of prosthetic mesh to reinforce the abdominal wall. The advent of the laparoscopic repair that also uses prosthetic mesh, made it even more complex to determine the best repair. Using the Evidence Based Medicine (EBM) principles, endpoints of the treatment are not only based on recurrence rates, but also on complications, patient satisfaction, convalescence, and costs. Several meta-analyses concluded that use of mesh is superior to the non-mesh operations. More difficult to determine is which mesh repair, open or laparoscopically, is the best. The laparoscopic repair is difficult and less suitable for general practice, but the open-mesh repair results in a higher percentage of chronic postoperative pain. Further research should be focused on making the laparoscopic repair less complicated, and development of new meshes for open surgery that reduce the amount of persistent postoperative pain.
Go
P M N Y H
PM
Department of Surgery, St. Antonius Hospital, Niewegein, The Netherlands.
D002986:Clinical Trials as Topic / Q000639:trends; D005544:Forecasting; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D020706:Laparoscopes / Q000639:trends*; D010535:Laparoscopy / Q000379:methods* / Q000639:trends*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D013526:Surgical Mesh / Q000639:trends; D019616:Thoracic Surgical Procedures / Q000295:instrumentation / Q000379:methods* / Q000639:trends*; D016896:Treatment Outcome