Prospective randomised controlled trial of laparoscopic versus open inguinal hernia mesh repair
Laparoscopy enables hernial orifices to be observed and
tension-free mesh repair to be carried out effectively. In
the first randomised controlled trial on hernia repair,
which compared laparoscopic transabdominal preperitoneal
(TAPP) mesh with open darn repairs, laparoscopic
repair was less painful and enabled patients to
return to work and normal activity more quickly.1 Since2 3 More4
then, several randomised controlled studies and systematic
reviews have largely confirmed these results.
recently in the United Kingdom, the National Institute
for Clinical Excellence reviewed the available early
results and published its guidance on the use of laparoscopic
surgery for inguinal hernias.
Definitive Surgical Treatment of Infected or Exposed Ventral Hernia MeshTo discuss the difficulties in dealing with infected or exposed
ventral hernia mesh, and to illustrate one solution using an
autogenous abdominal wall reconstruction technique.
Current Opinions About Laparoscopic Incisional Hernia Repair - A Survey of Practicing SurgeonsBackground—
Incisional hernias are common. The optimal repair is one of the most analyzed and
Methods—
(www.surveymonkey.com) to assess practices and opinions regarding incisional hernia repair.An IRB approved protocol was designed using an internet-based survey site
Results—
hospital. 85–96% performed basic laparoscopic procedures. The median percentage of laparoscopic
to total hernia repair was <10%. Use of the laparoscopic technique was associated with a higher
volume of hernia repair (r
(z
(z
hernia repair, 81% indicated “no”. In that group, 52% indicated that a lack of improved results was
the main reason, followed by risk of enterotomy > operative time > cost > experience. Those who
would start indicated that the main reason was patient request (54%). Among those that use the
laparoscopic technique, 85% indicated that they would perform more. The main reason for this was
a lower recurrence rate (42%).Of 766 surgeons, 204 (27%) responded. Most respondents practice in an academic, urbanSpearman’s=0.315, p=0.001), concurrent advanced laparoscopic experienceWilcoxon rank sum=−2.348, p=0.019) and completion of a laparoscopic fellowshipWilcoxon rank sum=−3.317, p=0.001). When asked how many would start to perform laparoscopic
Conclusions—
of incisional hernias. Surgeons with experience with advanced laparoscopic techniques, laparoscopic
fellowship training, and higher volume of hernia repair are more likely to use a laparoscopic approach.There continues to be a lack of consensus on the most appropriate repair method
debated topics. There is no consensus as to the appropriate surgical technique.