title: Do various mesh placement techniques affect the outcome in totally extraperitoneal hernia repair? What is the role of the surgeon?
abstract: BACKGROUND
  Various modifications of mesh placement are currently used in total extraperitoneal (TEP) groin hernia repair. The aim of this study was to compare three different variants of mesh placement with respect to rate of complications and clinical outcome.
  
  
  METHODS
  A series of 397 consecutive patients with a total of 534 preperitoneal groin hernia TEP repairs performed by four surgeons at a single institution between 1999 and 2003 were retrospectively analyzed. The mean follow-up was 19.7 +/- 7.5 months. A single-mesh technique was used in cases of hernial orifice <1.5 cm. Larger hernial defects were closed either in a double-mesh or a modified double-mesh placement technique. The three placement techniques were compared with respect to hospital stay, operative time, early and late complications, return-to-work time, and recurrence rate.
  
  
  RESULTS
  The modified double-mesh technique was associated with the longest hospital stay, the longest operative time, the slowest return to work, and significantly higher rates of early (5.6% vs. 4.6% vs. 2.9%) and late (19.1% vs. 11.3% vs. 7.9%) postoperative complications, when compared to double-and single-mesh placement. Overall recurrence rate was 1.3% after a mean follow-up of 19.7 months. The larger the experience of a surgeon with his preferred technique, the shorter the operative time and hospital stay were.
  
  
  CONCLUSIONS
  Mesh placement techniques appeared to have a direct impact on clinical outcome and hospital stay. The modified double-mesh technique showed the worst postoperative results, independent of the surgeon's experience. Which mesh placement technique is most appropriate for complex hernias remains to be answered by further randomized, controlled trials.
authors.affiliation: Department of Surgery, St. Josef Hospital, Ruhr University, Bochum, Germany. d.weyhe@elis-stiftung.de
authors.forename: Dirk
authors.initials: D
authors.lastname: Weyhe
authors.forename: Kirsten
authors.initials: K
authors.lastname: Meurer
authors.forename: Orlin
authors.initials: O
authors.lastname: Belyaev
authors.forename: Metin
authors.initials: M
authors.lastname: Senkal
authors.forename: Petra
authors.initials: P
authors.lastname: Harrer
authors.forename: Volker
authors.initials: V
authors.lastname: Zumtobel
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Bauer
mesh_terms: D000704:Analysis of Variance; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010819:Physician's Role; D011183:Postoperative Complications; D020127:Recovery of Function; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome