title: Inguinal hernia repair: current surgical techniques.
abstract: BACKGROUND
  Selection of an optimal surgical technique for inguinal hernia repair, allowing safe performance and rapid recovery without long-term complaints, may contribute significantly to the reduction of national health care costs.
  
  
  METHODS
  An analysis of current literature regarding surgical techniques, properties of modern meshes, operative complications, recurrence rates, occurrence of chronic pain, and quality of life after different surgical procedures was made. Evidence-based comparisons of suture and mesh techniques of open mesh and laparoscopic mesh repair and of laparoscopic (TAPP) and endoscopic (TEP) operation were made.
  
  
  RESULTS
  Recurrence rates after mesh implantation are significantly lower than after suture repair. Recurrence rates after flat open mesh repair are similar to those of laparoscopic techniques, but there is a significantly faster recovery after laparoscopy, and chronic pain is also present less frequently. Both TAPP and TEP are acceptable treatment options, but there is insufficient evidence to show superiority of one technique over the other. Material-reduced meshes seem to have advantages, at least during the early postoperative period. Besides the properties of the mesh implanted, the surgical technique applied and the skills of the surgeon performing the operation are the most important factors for achieving optimal and cost-efficient results.
  
  
  CONCLUSIONS
  With regard to recovery and occurrence of chronic pain, TAPP and TEP are superior to open mesh repair in most cases. Greater efforts should be undertaken to make laparoscopic repair easier, safer, and less expensive. If this can be achieved, health care costs could ultimately be reduced.
authors: Department of General, Visceral and Vascular Surgery, Herniacenter, EuromedClinic Fürth, Europaallee 1, 90763, Fürth, Germany. bittnerfamilie@web.de
authors: R
authors: R
authors: Bittner
authors: J
authors: J
authors: Schwarz
mesh_terms: D059350:Chronic Pain; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000175:diagnosis / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D008297:Male; D010149:Postoperative Pain / Q000453:epidemiology / Q000503:physiopathology; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011788:Quality of Life; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D013526:Surgical Mesh; D016896:Treatment Outcome