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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
Articole multimedia Jurnalul de Chirurgie, Iasi, 2007, Vol. 3, Nr. 2 [ISSN 1584 – 9341]Types of trials comparingOpen and Laparoscopic techniques• General trials: comparisons including multipletypes of both techniques• Specific trials: comparisons between single orspecific techniques• Meta-analyses: always including several typesof techniquesGeneral Trials: open vs lap--------------------------------All open procedures vs. all laparoscopic procedures-on the short term lap techniques induce1. earlier return to work2. less chronic pain3. variable rate of recurrencesP.J.O’DwyerBrit.J.Surg. 2004,70:105-118General Trials: open vs lap technique--------------------------------All open procedures vs. all laparoscopic procedures-on the long term1. recurrences identical2. less chronic pain in lap techniquesP.J.O’DwyerBrit.J.Surg. 2004,70:105-118182
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