Full text PDF (4.6MB) - Jurnalul de Chirurgie

Articole multimedia Jurnalul de Chirurgie, Iasi, 2007, Vol. 3, Nr. 2 [ISSN 1584 – 9341]INGUINAL HERNIA REPAIRActual Status---------------------------------------Prof. Dr. R.Van HeeUniversity of AntwerpBelgiumEuropean Academy of Surgical SciencesINGUINAL HERNIA REPAIR - ACTUAL STATUS (Abstract): Even in in 2006, there are alot of of controversy about the best technique for inguinal hernia repair. The factors that influencethe choice of of the technique are: uni- or or bilateral hernia, “Nyhus” type of of hernia, complicatedhernia, large inguino-scrotal hernia, recurrent hernia or or previous surgery, preferred type of ofanaesthesia. Surgeon has to toanswer to tothree question when he he choices a type of of hernia repair:What are there specific indications for this repair? What are the specific complications of of therepair technique? What are the results with the repair technique? In In the literature there are a lotof of studies which give comparisons about the techniques of of hernia repair: type and rate of ofcomplications, recurrence rate, costs and economic impact. There are various types of ofevidence: retrospective studies, prospective randomized trials, meta-analyses. This paperreviews some of of the literature studies about: techniques of of open non-mesh hernia repair, typesof of open mesh repair, mesh vs vs non-mesh open techniques, open vs vs laparoscopique techniquesand types of of laparoscopic hernia repair techniques. Conclusion: Open non-mesh repairs shouldbe be avoided. Lichtenstein mesh repair is is the best open technique. Laparoscopic techniques(TAPP &TEP) induce: less pain, shorter hospital stay, earlier return to to work, more rapidresumption of of activities and lower recurrence rates but at at a higher cost, especially in in “nonworking”population.KEY WORDS: GROIN HERNIA, MESH REPAIR, TAPP, TEPInguinal Hernia Repair------------------------------In 2006 :Still much controversyStill many techniquesHernia Repair: Historical Overview-------------------------------------------• Eduardo Bassini (1844-1924): own technique 1877• Bassini modifications (Halsted,Kirschner,Houdard..)• Chester McVay (1911-1987): own technique 1948• Edward Shouldice (1890-1965): technique 1945-51• Lloyd Nyhus (°1923): type-related techniques 1955• Irving Lichtenstein (°1920): tension-free techn.1986Hernia Repair: actual situation---------------------------------------• Open techniquesShouldice repairLichtenstein repairPlug-mesh repairOther variants• Laparoscopic techniquesTAPP repairTEP repairPlug repairOther variantsFactors influencing type of repair----------------------------------------• Uni- or Bilateral hernia• “Nyhus” type of hernia• Incarceration of hernia• Large inguinoscrotal hernia• Recurrent hernia or Previous surgery• Preferred type of anaesthesia (patient/surgeon)•……180