Full text PDF (4.6MB) - Jurnalul de Chirurgie

Articole multimedia Jurnalul de Chirurgie, Iasi, 2007, Vol. 3, Nr. 2 [ISSN 1584 – 9341]Choice of type of hernia repair---------------------------------------• Which type does one use?• Are there specific indications for this repair?• Are there specific complications with this repair?• What are the results with this repair?• ………..Why does one choose this type of repair?“Evidence” concerning Hernia Repair----------------------------------------------1. Prolific number of clinical trials!!!2. Various types of evidence-retrospective studies-prospective randomized trials-meta-analyses3. Different end-points-type and rate of complications-recurrence rate-costs and economic impact“Evidence” concerning hernia repair-------------------------------------------• Often studies give comparisons betweenincomparable hernia groups:a. mixing of uni- and bilateral herniasb. mixing of different Nyhus typesc. mixing of primary and recurrent herniasd. multicenter studies can be accompaniedby slight but important differences intechnique (mesh size, type, fixation etc.)Trials in Open non-mesh Repair---------------------------------------• Mostly before 1990• Comparing Bassini/Shouldice/McVay and othertechniques• Concluding evidence:Shouldice technique is best repair,with a recurrence rate of ~5% after 2 years,but often raising to 10-15% after 10 years!Results of Trials inOpen mesh Repair----------------------------------1. Lichtenstein repair (uni- or bilateral hernia)-recurrence rate of