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PubMed · 10596334

First Hungarian, internet-based prospective, multicenter study: the hernia-project.

Abstract

In inguinal hernia repair, different laparoscopic and open techniques of tension-free repair using synthetic meshes have been reported to result in better patient comfort and lower recurrence rates compared with conventional procedures like Shouldice's or Bassini's operation. In comparison with the laparoscopic procedure, open tension-free repair can be performed under local anaesthesia and is less expensive. For these reasons, the recent trend in inguinal hernia surgery, has been towards using an open, mesh-based tensionless repair (Lichtenstein technique). To evaluate and support the widespread use of this technique in Hungary a large, prospective multicentre trial was initiated at 15 March 1999. Prospective registration of 1500 hernia operation using Lichtenstein technique is undertaken that is carried out in 15 hospitals. Postoperative outcome, complications and recurrence is recorded through a five years period. The case presentation and data collection is internet based. Each center participating in the study is connected by internet to the coordinating center and all information concerning this study is sent by this way. This system is able to generate actual statistical data in every moment of the study.

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G Weber, M Kassai, Z Csontos, C Czuczor, P O Horváth. 1999. First Hungarian, internet-based prospective, multicenter study: the hernia-project.. https://pubmed.ncbi.nlm.nih.gov/10596334/

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Treating recurrence after a totally extraperitoneal approach.

BACKGROUND: One of today's most highly regarded procedures for treating inguinal hernia is the totally extraperitoneal approach (TEP), but it can on occasion lead to recurrence. This is commonly managed with an open repair, a transabdominal preperitoneal procedure (TAPP), or another TEP. We report here on our years of experience with the latter. METHODS: The endeavor to a secondary TEP is much the same as to a primary one, but certain differences are encountered as the operation proceeds. For example, many anatomical landmarks found in a first TEP cannot be seen in a second. There can also be a diminished amount of working space, and this occasionally leads to an open conversion. RESULTS: From September 1991 to September 2005, we repaired 1,526 hernias in 1,156 male patients, using the TEP in every case. Of these, 21 were TEPs after a previous TEP. In 3 cases, the space could not be opened, and they were converted to the open Lichtenstein. One patient had peritoneal tears that led to conversion and another had conversion because of excessive bleeding. There were no complications, no bladder or bowel injuries, no transfusions, no preperitoneal hematomas, and no fatalities. All patients were discharged the same day. CONCLUSIONS: A secondary TEP, open repair, and TAPP are alternative solutions to the problem of recurrence after TEP. However, any TEP involves a very prolonged learning curve for general surgeons, since they must learn the anatomy as well as the procedure, both at the same time. This is doubly true for the TEP after a previous TEP.

Hernia, Inguinal↗