Tension-free repair versus Bassini technique for strangulated inguinal hernia: A controlled randomized study. [Lichtenstein patch versus Shouldice technique in primary inguinal hernia with a high risk of recurrence]. Lichtenstein Hernioplasty Versus Totally Extraperitoneal Laparoscopic Hernioplasty in Treatment of Recurrent Inguinal Hernia—A Prospective Randomized Trial Effectivity of laparoscopic inguinal hernia repair (TAPP) in daily clinical practice: early and long-term result Comparison of laparoscopic and open tension-free repair of recurrent inguinal hernias: a prospective randomized study [Antibiotic prophylaxis in the surgical treatment of inguinal hernia: need or habit?]. A comparison of outcomes between open and laparoscopic surgical repair of recurrent inguinal hernias Comparison of conventional anterior surgery and laparoscopic surgery for inguinal-hernia repair. HERNIOPLASTY WITH AND WITHOUT MESH: ANALYSIS OF THE IMMEDIATE COMPLICATIONS IN A RANDOMIZED CONTROLLED CLINICAL TRIAL Factors associated with postoperative complications and hernia recurrence for patients undergoing inguinal hernia repair: a report from the VA Cooperative Hernia Study Group. Is It Possible to Eliminate Sutures in Open (Lichtenstein Technique) and Laparoscopic (Totally Extraperitoneal Endoscopic) Inguinal Hernia Repair? A Randomized Controlled Trial With Tissue Adhesive (n-Hexyl-α-Cyanoacrylate) Does Resident Post Graduate Year Influence the Outcomes of Inguinal Hernia Repair? Does nerve identification during open inguinal herniorrhaphy reduce the risk of nerve damage and persistent pain? [Total endoscopic pre-peritoneal mesh implant in primary or recurrent inguinal hernias]. Laparoscopic extraperitoneal inguinal hernia repair versus open mesh repair: a prospective randomized controlled trial. The Role of Antibiotic Prophylaxis in Prevention of Wound Infection After Lichtenstein Open Mesh Repair of Primary Inguinal Hernia: A Multicenter Double-Blind Randomized Controlled Trial The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery 
Totally extraperitoneal repair of recurrent inguinal hernia
 Laparoscopic repair of recurrent groin hernia: results of a prospective study Higher Recurrence Rate After Endoscopic Totally Extraperitoneal (TEP) Inguinal Hernia Repair With Ultrapro Lightweight Mesh: 5-Year Results of a Randomized Controlled Trial (TULP-trial) The Endoloop technique for the primary closure of direct inguinal hernia defect during the endoscopic totally extraperitoneal approach TEP versus Lichtenstein: Which technique is better for the repair of primary unilateral inguinal hernias in men? Low Recurrence Rate After Laparoscopic (TEP) and Open (Lichtenstein) Inguinal Hernia Repair: A Randomized, Multicenter Trial With 5-Year Follow-Up
UNLABELLED By Evidence Based Medicine ( EBM ) principles , several meta-analyses concluded that use of mesh is superior to the non-mesh operations in inguinal hernia surgery . Wound infection is a potential complication of all hernia repairs and deep-seated infection involving an inserted mesh may result in chronic groin sepsis . In the event of incarcerated or strangulated hernias , however ; placement of prosthetic material is presumed to increase that risk of infection . AIM Aim of the study is to compare the outcome of tension-free mesh repair to Bassini technique used to treat strangulated inguinal hernia . PATIENTS AND METHODS In the period from May 2004 to December 2006 , 54 patients were su bmi tted to emergency operation because of strangulated inguinal hernia . The patients were r and omized into two groups ( 27 patients in each group ) . Group A patients underwent open tension-free anterior repair utilizing a monofilament polypropylene mesh according to Lichtenstein " tension-free " technique , whereas group B patients underwent Bassini technique . Mesh hernioplasty was not attempted in patients with preoperative peritonitis , inflammatory hernia and for those in whom bowel resection was perfumed for ischemic necrosis caused by strangulated inguinal hernia and they were excluded from the study . Assessment of the primary outcome included surgical complications and hospital stay and secondary outcome was the recurrence of hernia . RESULTS Postoperative complication rate did not differ significantly between the two groups . Postoperative hospital stay was also significantly longer in group B compared to group A ( 5+/-3.4 days versus 3+/-2.1 days , p<0.01 ) . During the follow-up , ( mean 22+/-6months ) , three patients had recurrence after Bassini operation ( group B ) , but there was no recurrent hernia after mesh herniorrhaphy ( group A ) ( 0/27=0 % versus 3/27=7 , 11.1 % , p<0.001 ) . CONCLUSION The use of Lichtenstein " tension-free " technique in emergency treatment of strangulated inguinal hernia is safe , effective with an acceptably low rate of postoperative complications and without recurrence 209 primary inguinal hernias in patients older than 60 years with high risk for recurrence and for surgery were r and omly allocated to Shouldice repair ( 107 hernias ) or Lichtenstein patch ( 102 hernias ) . Over a 30 months period there was one recurrence in the Lichtenstein group . The amount of local anesthetic and postoperative pain medication was significantly reduced in the Lichtenstein group , 9.8 % of repairs requiring no pain medication at all , and 29.4 % none on the first postoperative day . No other hernia repair is as painless , innocuous , and easily performed under local anesthesia as the Lichtenstein patch . Both , Lichtenstein and Shouldice , serve their purpose almost ideally when done correctly Objective : To compare the Lichtenstein hernioplasty with a totally extraperitoneal preperitoneal laparoscopic technique ( TEP ) in treatment of recurrent inguinal hernias . Summary Background Data : Only a few studies thus far have compared an open and laparoscopic approach with the treatment of recurrent inguinal hernia in a prospect i ve r and omized study setting . Methods : Ninety-nine patients undergoing surgery for recurrent inguinal hernia were prospect ively r and omized into having either open or laparoscopic mesh repair .  Pre , peri- and postoperative factors were recorded in addition to 3-year follow-up data at the outpatient clinic . At 5–10 years , the patients were interviewed via telephone for recurrent symptoms . The primary end-points chosen were hernia recurrence and chronic pain . Results : Preoperative factors did not differ between the 2 groups . Rerecurrence rates were 3 in the Lichtenstein group and none in the TEP group ( 6.4 % versus 0.0 % , respectively ) , but this difference was statistically not significant . Chronic pain was more prevalent in the Lichtenstein group compared with the TEP group ( 13 [ 27.7 % ] versus 4 [ 8.2 % ] patients , respectively , P = 0.02 ) . Postoperatively , the Lichtenstein group needed more pain medication than the TEP group ( 4.4 versus 3.0 doses , respectively , P = 0.02 ) and returned to work later ( 17.9 versus 14.8 days , respectively , P = 0.05 ) . Conclusions : The laparoscopic technique with mesh in the treatment of recurrent inguinal hernia was proven superior to the open mesh repair in several important clinical aspects , with concomitant improvement in patient satisfaction Introduction The aim of the study was to investigate the effectiveness of laparoscopic inguinal hernia repair in daily clinical practice . Patients and methods All patients admitted to the hospital for surgery of an inguinal hernia during a 1-year period were prospect ively documented and included in a follow-up study . The follow-up was performed at least 5 years after surgery and consisted of a clinical examination , ultrasound investigation and a question naire . Results From January 2000 to January 2001 a total of 1208 inguinal hernias in 952 patients were consecutively operated by a total of 11 general surgeons in daily clinical routine . Of the patients , 98.02 % were operated on laparoscopically with the transabdominal preperitoneal patch plasty technique ( TAPP ) and 1.98 % had an open repair . The frequency of intraoperative and early postoperative complications was 2.8 % . The complication rate in the patients presenting a complex hernia was not higher than in patients with uncomplicated unilateral hernias . Life-threatening complications were seen in four patients ( bowel lesion—0.4 % ) , but all four patients presented extensive adhesions in the abdominal cavity after previous abdominal surgery . The follow-up rate after 5 years was 85.3 % . After 5 years the recurrence rate was 0.4 % and the rate of severe chronic pain 0.59 % . None of the patients took analgesics or had to change his occupation . Conclusion Laparoscopic repair can be applied to all types of inguinal hernia as a daily routine procedure with low rates of recurrences and chronic pain . Limiting factor may be extensive adhesions after previous major surgery in the lower abdomen Background The current prospect i ve r and omized controlled clinical study aim ed to assess the short- and long-term results of recurrent inguinal hernia repair , and to compare the results for transabdominal preperitoneal ( TAPP ) and totally extraperitoneal ( TEP ) procedures with those for open tension-free repair . Methods For this study , 82 patients were r and omly assigned to undergo TAPP ( group A , n = 24 ) , TEP ( group B , n = 26 ) , or open Lichtenstein hernioplasty ( group C , n = 32 ) . All the patients with recurrent inguinal hernias had undergone previous repair using conventional open procedures . Physical examination showed  Nyhus type II hernia in the vast majority of the patients ( 59 % ) . High-risk patients ( American Society of Anesthesiology [ ASA ] III or IV ) ; coagulation disorders ; previous abdominal or pelvic surgery ; and irreducible , congenital , and massive scrotal or sliding hernias were excluded from the study . Results There was a statistically significant difference ( p = 0.001 ) in operating time favoring the open procedure . The intensity of postoperative pain was greater in the open hernia repair group 24 h , 48 h , and 7 days after surgery ( p = 0.001 ) , with a greater consumption of pain medication among these patients ( p < 0.004 ) . The median time until return to work was 14 days for group A , 13 days for Group g , and 20 days for group C. The comparison was in favor of laparoscopically treated patients . Nine recurrences ( 4 in the laparoscopic groups and 5 in the open group ) were documented within 3 years of follow-up evaluation . Conclusion Laparoscopic inguinal hernia repair ( TAPP or TEP ) is the method of choice for dealing with recurrent inguinal hernia BACKGROUND Prophylactic antibiotics are recommended for clean-contaminated and selected contaminated surgery . In clean surgery antibiotics are suggested if the operation involves the insertion of prosthetic devices and a potential infection is expected to cause serious morbidity or mortality . Inguinal hernia repair is a clean operation , infections are rare ; they can usually be cured without removing the prosthesis and recurrence is uncommon even after removal of the mesh . Aim of the study is to evaluate whether the lack of antimicrobial prophylaxis increases the risk of postoperative infections in patients treated for groin hernia , compared to those treated with prophylaxis . METHODS One hundred and forty-eight patients underwent inguinal hernia repair with mesh : 64 patients ( 43 % ) received 2 g cefotaxime by intravenous bolus about 30 minutes before the operation , 84 patients ( 57 % ) did not receive any antimicrobic prophylaxis . Mean follow-up was 13 months ( range 1 - 31 months ) for both groups . RESULTS We did not observe any major complication . Among both groups , no patient had developed infection at one week and one month after surgery . CONCLUSIONS In personal experience , any advantage in terms of prevention of infections with antibiotic prophylaxis in patients operated on for groin hernia has been observed . A review of the literature showed no general agreement on this subject with different risk of infections in different trials . A new prospect i ve r and omized trial is necessary to clarify this topic Background Inguinal hernia recurrence after surgical repair is a major concern . The authors report their experience with open and laparoscopic repair of recurrent inguinal hernias . Methods After institutional review board approval , a retrospective review was performed with the charts of 197 patients who had undergone surgical repair of recurrent inguinal hernias from January 2000 through August 2009 , and the data for 172 patients who met the inclusion criteria were analyzed .  Surgical variables and clinical outcomes were compared using Student ’s t test , the Mann – Whitney U test , chi-square , and Fisher ’s exact test as appropriate . Results The review showed that 172 patients had undergone either open mesh repair ( n = 61 ) or laparoscopic mesh repair ( n = 111 ) for recurrent inguinal hernias . Postoperative complications were experienced by 8 patients in the open group and 17 patients in laparoscopic group ( p = 0.70 ) . Five patients ( 8.2 % ) in the open group and four patients ( 3.6 % ) in the laparoscopic group had re-recurrent inguinal hernias ( p = 0.28 ) . Four patients in the open group ( 9.5 % ) and no patients in the laparoscopic group had recurrence during long-term follow-up evaluation ( p = 0.046 ) . In the laparoscopic group , 76 patients ( 68.5 % ) underwent  total extraperitoneal  ( TEP ) repair , and 35 patients ( 31.5 % ) had  transabdominal preperitoneal ( TAPP ) repair . Postoperative complications were experienced by 13 patients in the TEP group and 4 patients in the TAPP group ( p = 0.44 ) . Two patients ( 2.6 % ) in the TEP group and two patients ( 5.7 % ) in the TAPP group had re-recurrent inguinal hernias ( p = 0.59 ) . Conclusions This retrospective review showed no statistical difference in the re-recurrence rate between the two techniques during short-term follow-up evaluation . However , the laparoscopic technique had a significantly lower re-recurrence rate than the open technique during long-term follow-up evaluation . Both procedures were comparable in terms of intra- and postoperative complications . Among laparoscopic techniques , TEP and TAPP repair are acceptable methods for the repair of recurrent inguinal hernia . A multicenter prospect i ve r and omized control trial is needed to confirm the findings of this study BACKGROUND Inguinal hernias can be repaired by laparoscopic techniques , which have had better results than open surgery in several small studies . METHODS We performed a r and omized , multicenter trial in which 487 patients with inguinal hernias were treated by extraperitoneal laparoscopic repair and 507 patients were treated by conventional anterior repair .  We recorded information about postoperative recovery and complications and examined the patients for recurrences one and six weeks , six months , and one and two years after surgery . RESULTS Six patients in the open-surgery group but none in the laparoscopic-surgery group had wound abscesses ( P=0.03 ) , and the patients in the laparoscopic-surgery group had a more rapid recovery ( median time to the resumption of normal daily activity , 6 vs. 10 days ; time to the return to work , 14 vs. 21 days ; and time to the resumption of athletic activities , 24 vs. 36 days ; P<0.001 for all comparisons ) . With a median follow-up of 607 days , 31 patients ( 6 percent ) in the open-surgery group had recurrences , as compared with 17 patients ( 3 percent ) in the laparoscopic-surgery group ( P=0.05 ) . All but three of the recurrences in the latter group were within one year after surgery and were caused by surgeon-related errors . In the open-surgery group , 15 patients had recurrences during the first year , and 16 during the second year . Follow-up was complete for 97 percent of the patients . CONCLUSIONS Patients with inguinal hernias who undergo laparoscopic repair recover more rapidly and have fewer recurrences than those who undergo open surgical repair Background : Inguinal hernia repair is the most common procedure in general surgery and 80,000 operations are performed annually in Great Britain , 100,000 in France and 700,000 in the US . Given its high frequency has a major impact , both in the medical and economic aspects . Aim : Analyze the immediate postoperative complications comparing mesh versus non mesh hernioplasty . Method : R and omized control trial , with the enrollment of 263 patients underwent surgery for inguinal hernia r and omized by r and omization table . Treatment ( mesh , Lichtenstein or without mesh , Bassini technique ) was assigned using sequentially numbered opaque envelopes having fulfilled the inclusion criteria . The variables analyzed were : postoperative pain , seroma , hematoma , infection , return to normal activities and recurrence . Results : The mean age was 55.5 years , 88 % patients were male and 12 % female . The pain was higher in patients operated with  mesh . Conclusions : The inguinal hernia repair mesh group had less immediate postoperative complications and significantly earlier return to work than hernioplasty without mesh , this being one of the most important conclusions BACKGROUND We sought to determine perioperative variables predictive of complications or recurrence for patients undergoing surgical repair of inguinal hernias . PATIENTS AND METHODS Using data from the Veterans Affairs trial , regression analyses were utilized to identify perioperative factors significantly associated with complications ( overall , short-term and long-term ) , long-term pain , and to develop a risk model for recurrence . RESULTS Recurrent and scrotal hernias were predictors for short term and overall complications , regardless of technique . Older age and higher Mental Component Score of the SF-36 were associated with higher risk of long term complications in the open group while prostatism and increased body mass index were the significant predictors in the laparoscopic group . Long-term pain complaints decreased as patient age increased in both groups . Patient and surgeon factors were predictive of recurrence but varied greatly depending on surgical technique . CONCLUSIONS Regardless of technique , scrotal and recurrent hernias were associated with a greater risk of complications and younger patients had more long-term pain . Predictors of recurrence vary based on surgical technique Background . The morbidity linked to the use of sutures in inguinal hernioplasty is well known . Tissue adhesives may be an alternative , so as to be able to improve levels of postoperative comfort , but clinical experience using them is limited . The aim of this study is to evaluate the efficiency of cyanoacrylate as a substitute for sutures in the treatment of inguinal hernias . Patients . R and omized clinical trial in abdominal wall unit . A total of 208 patients were operated upon for inguinal hernias of which 102 were unilateral hernias via open surgery using the Lichtenstein technique , r and omized to receive prolene sutures ( n = 52 ) or n-hexyl-α-cyanoacrylate glue ( n = 50 ) and 106 were patients with bilateral inguinal hernias operated upon via totally extraperitoneal laparoscopy and r and omized to receive either tackers ( n = 54 ) or glue ( n = 52 ) . Main Outcome Measures . The primary endpoints were pain and recurrence . Secondary endpoints were operating time , postoperative morbidity , pain , and analgesic consumption . Results . No morbidity associated with the use of the glue existed . The use of glue significantly reduced the mean of surgical time ( 12 minutes in open surgery , 13 minutes in laparoscopic surgery ) , pain , and analgesics consumption , both via the open and laparoscopic approaches ( P < .001 ) . After 1 year the adhesive did not change the recurrence rate in either of the approaches . The economic analysis shows potential yearly savings of 123 916.3 Euros . Conclusions . Substituting sutures with glue ( n-hexyl-α-cyanoacrylate ) in open or laparoscopic inguinal hernioplasty is safe with less postoperative pain and the same possibilities of recurrence Introduction : We evaluated the effect of the  postgraduate medical education level ( PGY ) of surgery residents  on recurrence of inguinal hernia , complications , and operative time . Methods : Post hoc analysis was performed on prospect ively collected data from a multicenter Veterans Affairs ( VA ) cooperative study . Men were r and omly assigned to open or laparoscopic inguinal hernia repairs with mesh . Surgery residents performed repairs with design ated attending surgeons present throughout all procedures . PGY level of the resident was recorded for each procedure . All patients were followed for 2 years for hernia recurrence and complications . PGY levels were grouped as follows : group I = PGY 1 and 2 ; group II = PGY 3 ; group III = PGY ≥ 4 ; rates of recurrence , complications and mean operative time were compared . Results : A total of 1983 patients underwent hernia repair . group III residents had significantly lower recurrence rates for open repairs when compared with group I ( adjusted odds ratio = 0.24 , 95 % confidence interval [ CI ] , 0.06 , 0.997 ) . The recurrence rate was similar among the groups for laparoscopic repair ( P > 0.05 ) Complication rates were not different for either repair ( P > 0.05 ) . Mean operative time was significantly shorter for group III compared with group I for both open ( −6.6 minutes ; 95 % CI , −11.7 , −1.5 ) and laparoscopic repairs ( −12.9 minutes ; 95 % CI , −19.8 , −6.0 ) and between group II and group I for laparoscopic repair ( −15.0 ; 95 % CI , −24.3 , −5.7 ) . Conclusions : Despite the presence of an attending surgeon , open hernia repairs performed by junior residents were associated with higher recurrence rates than those repaired by senior residents . Lower resident level was associated with increased operative time for both open and laparoscopic repair Purpose Nerve identification during open inguinal hernia herniorrhaphy  has been suggested as one of the factors that may reduce the risk of development of persistent postherniorrhaphy pain . In this prospect i ve study , we evaluated whether intraoperative inguinal nerve identification influenced the risk of development of persistent postherniorrhaphy pain , sensory dysfunction in the groin and functional ability score after open hernia repair . Methods A total of 244 men with a primary inguinal hernia underwent open Lichtenstein repair in a high-volume hernia surgery centre , where information on inguinal nerve identification was registered during operation . Before the operation and 6 months postoperatively , functional pain-related impairment was assessed with Activities Assessment Scale and pain intensity scores with Numeric Rating Scale ( NRS 0–10 ) . Quantitative sensory testing in the groin was performed before operation and 6 months postoperatively , in order to investigate intraoperative inguinal nerve damage . Results The intraoperative nerve identification rates for the iliohypogastric , ilioinguinal and genitofemoral nerves were 94.7 , 97.5 and 21.3 % , respectively . Thirty-nine patients ( 16.0 % ) had substantial pain-related functional impairment at 6 months follow-up . There was no difference in risk of development of substantial pain-related functional impairment in patients with identification compared with non- identification of the iliohypogastric nerve ( P = 1.0 ) , the ilioinguinal nerve ( P = 0.59 ) , the genitofemoral nerve ( P = 0.40 ) or all nerves ( P = 0.52 ) . There were no differences in regard to sensory loss in the groin area or in regard to improvement in functional outcome following surgery , between patients with and without nerve identification . Conclusions Although intraoperative inguinal nerve identification should be aim ed at , other factors may contribute to the risk of nerve damage and persistent pain after open groin hernia repair INTRODUCTION Since 1994 we perform laparoscopic total extraperitoneal hernia repair ( TEP ) for primary and recurrent inguinal hernias at our institution . The aim of this study was to investigate and compare the results of TEP in primary inguinal hernias and recurrent inguinal hernias and to determine whether there are differences in patient data , complication rates and outcome between these two groups . METHODS In a prospect i ve trial 338 patients were analyzed who underwent 500 laparoscopic TEP repairs .  In all , 431 TEP repairs were performed for primary inguinal hernias , and 69 for recurrent inguinal hernias . For data acquisition the SALTC study protocol was used . All patients were clinical ly examined 3 and 12 months after the operation . RESULTS The mean operation time was 67.3 min for TEP repair of primary hernias and 68.1 min for TEP repair of recurrent hernias , respectively . The conversion rate to an open procedure was 0 % . Conversion from TEP into TAPP was required in 0.5 % of patients with primary inguinal hernias and 1.4 % of patients with recurrent inguinal hernias . As the sole difference between the two groups the intraoperative complication rate could be identified . In the TEP repair group of recurrent inguinal hernias a higher incidence of injury to the peritoneum and a higher occurrence of bleeding from the epigastric vessels was found ( P = 0.03 ) . The postoperative complication rate was identical in the two groups , amounting to 5.1 % and 5.7 % , respectively . No differences were found in the 1 year follow-up between the two groups . The 1-year recurrence rate was 0.5 % for primary hernias . However , in the group of recurrent hernias there have been no recurrences to date . CONCLUSIONS The use of laparoscopic TEP repair has proven to be a safe and effective treatment in patients with primary and recurrent inguinal hernias . Because of scar tissue with possible adhesions a higher intraoperative complication rate was observed in the TEP repair of recurrent hernias than in TEP repair of primary inguinal hernias . However , no single recurrence was observed in the TEP repair group of recurrent hernias . In our opinion TEP is the optimal hernia repair for recurrent and bilateral inguinal hernias BACKGROUND This study was design ed to compare an open tension-free technique ( Lichtenstein repair ) with a laparoscopic totally extraperitoneal hernia repair ( TEP ) . METHODS One hundred sixty-eight men aged 30 to 65 years with primary or recurrent inguinal hernia were r and omized to TEP or open mesh technique in the manner of Lichtenstein . Follow-up was after 1 and 6 weeks , and 1 year . RESULTS Eighty-one patients were r and omized to TEP , and 87 to open repair . For 1 patient in each group , the operation was converted to a different type of repair . No difference was seen in overall complications between the 2 groups . However , 1 patient in the TEP group underwent operation for small bowel obstruction after surgery . A higher frequency of postoperative hematomas was seen in the open group ( P < .05 ) . Patients in the TEP group consumed less analgesic after surgery ( P < .001 ) , returned to work earlier ( P < .01 ) , and had a shorter time to full recovery ( P < .01 ) . Two recurrences occurred in the TEP group 1 year after surgery . CONCLUSION The TEP technique was associated with less postoperative pain , a shorter time to full recovery , and an earlier return to work compared with the open tension-free repair . No difference was seen in overall complications . However , 2 recurrences did occur after 1 year in the TEP group Objective : To determine whether the use of prophylactic antibiotics is effective in the prevention of postoperative wound infection after Lichtenstein open mesh inguinal hernia repair . Summary Background Data : A recent Cochrane meta- analysis ( 2003 ) concluded that “ antibiotic prophylaxis for elective inguinal hernia repair can not be firmly recommended or discarded . ” Methods : Patients with a primary inguinal hernia scheduled for Lichtenstein repair were r and omized to a preoperative single dose of 1.5 g intravenous cephalosporin or a placebo .  Patients with recurrent hernias , immunosuppressive diseases , or allergies for the given antibiotic were excluded . Infection was defined using the Centers for Disease Control and Prevention criteria . Results : We included 1040 patients in the study between November 1998 and May 2003 . According to the intention-to-treat principle , 1008 patients were analyzed . There were 8 infections ( 1.6 % ) in the antibiotic prophylaxis group and 9 ( 1.8 % ) in the placebo group ( P = 0.82 ) . There was 1 deep infection in the antibiotic prophylaxis group and 2 in the placebo group ( P = 0.57 ) . Statistical analysis showed an absolute risk reduction of 0.19 % ( 95 % confidence interval , −1.78%–1.40 % ) and a number needed to treat of 520 for the total number of infections . For deep infection , the absolute risk reduction is 0.20 % ( 95 % confidence interval , −0.87%–0.48 % ) with a number needed to treat of 508 . Conclusions : A low percentage ( 1.7 % ) of wound infection after Lichtenstein open mesh inguinal ( primary ) hernia repair was found , and there was no difference between the antibiotic prophylaxis or placebo group . The results show that , in Lichtenstein inguinal primary hernia repair , antibiotic prophylaxis is not indicated in low-risk patients Background The extent to which lifestyle factors such as tobacco consumption and obesity affect the outcome after inguinal hernia surgery has been poorly studied . This study was undertaken to assess the effect of smoking , smokeless tobacco consumption and obesity on postoperative complications after inguinal hernia surgery . The second aim was to evaluate the effect of tobacco consumption and obesity on the length of hospital stay . Methods A cohort of 12,697 Swedish construction workers with prospect ively collected exposure data on tobacco consumption and body mass index ( BMI ) from 1968 onward were linked to the Swedish inpatient register . Information on inguinal hernia procedures was collected from the inpatient register . Any postoperative complication occurring within 30 days was registered . In addition to this , the length of hospitalization was calculated . The risk of postoperative complications due to tobacco exposure and BMI was estimated using a multiple logistic regression model and the length of hospital stay was estimated in a multiple linear regression model . Results After adjusting for the other covariates in the multivariate analysis , current smokers had a 34 % ( OR 1.34 , 95 % CI 1.04 , 1.72 ) increased risk of postoperative complications compared to never smokers . Use of “ Swedish oral moist snuff ” ( snus ) and pack-years of tobacco smoking were not found to be significantly associated with an increased risk of postoperative complications . BMI was found to be significantly associated with an increased risk of postoperative complications ( P = 0.04 ) . This effect was mediated by the underweighted group ( OR 2.94 ; 95 % CI 1.15 , 7.51 ) . In a multivariable model , increased BMI was also found to be significantly associated with an increased mean length of hospital stay ( P < 0.001 ) . There was no statistically significant association between smoking or using snus , and the mean length of hospitalization after adjusting for the other covariates in the model . ConclusionS moking increases the risk of postoperative complications even in minor surgery such as inguinal hernia procedures . Obesity increases hospitalization after inguinal hernia surgery . The Swedish version of oral moist tobacco , snus , does not seem to affect the complication rate after hernia surgery at all Background : A variety of procedures with substantial differences in results are employed to treat recurrent inguinal hernia . The advantages of totally extraperitoneal patch repair ( TEP ) are even more evident when it is applied to recurrent compared to primary hernias . To investigate the superiority of this method more closely , we review ed our results obtained for recurrent inguinal hernias over a period of 2 years . Methods : We performed a prospect i ve single-center study using data obtained in consecutive patients with recurrent inguinal hernia who were operated on in 1997 and 1998 . Results : A total of 179 patients with recurrent inguinal hernia were recruited . Overall , 1329 patients with inguinal hernia were treated in the 2-year period , of whom 1270 underwent TEP .  The percentage of recurrent hernias was 14 % . The average age of the patients was 56 years . The follow-up rate was 87.5 % , and the mean follow-up period was 2.3 years . The 154 patients who were followed up underwent a total of 225 hernia repairs  , of which 181 were for recurrent hernias . The average operating time was 57 min . In 68 % ( 104/154 ) of the patients , adhesions , adherent epigastric vessels , or cicatricial changes were found , which result ed in the inadvertant opening of the peritoneum in 26.3 % of the patients . All the openings in the peritoneum were closed by endoscopic suturing . Intraoperative complications developed in 4 patients ( 2.3 % ) , including one injury to the bladder and three cases of bleeding from side branches of the epigastric vessels . The conversion rate was 0 % . The sole postoperative complication was treatment requiring hematomas in 7 patients , in 2 of whom reoperation became necessary . In both cases , a diffuse hemorrhage due to a preoperatively undiagnosed coagulation disorder was found . No cases of wound or patch infection were observed . In a patient undergoing both primary and recurrent hernia repair , displacement of a mesh led to a recurrence on the primary hernia side ( recurrence rate , 0.4 % ; re-recurrence rate , 0 % ) . Conclusions : Although for its definitive management , recurrent hernia requires a reliable operative technique , current data do not support the recommendation of any of the currently available procedures as the gold st and ard . In a representative patient population with recurrent hernia , we were able to demonstrate that TEP achieves very good results in terms of re-recurrence rate , intraoperative and postoperative complications , and rehabilitation . Prerequisites for the reliable and low-complication application of the method are a high level of st and ardization of the procedure and an advanced learning curve Background Recurrences continue to be seen after repair of inguinal hernias . The repair of these recurrent hernias is a more complex and dem and ing procedure , with a high re-recurrence rate . Definite advantage has been demonstrated with endoscopic repair of these hernias . Methods The results for this prospect i ve study from January 2003 to December 2006 were evaluated after  laparoscopic repair of 65 recurrent hernias in 61 patients . The patients were followed up for 1 year . Longer follow-up evaluation was performed for the patients who underwent surgery in the initial 3 years . Results In this study , 37 recurrent hernias were managed using the transabdominal preperitoneal technique ( TAPP ) technique and 28 using the totally extraperitoneal ( TEP ) technique .  There was no conversion and no cases of postoperative wound infection . Of the 12 metachronous hernias repaired simultaneously , 3 were occult . Seroma developed in five patients . At a follow-up assessment after 1 year , one patient had groin pain , and there was one re-recurrence . A longer follow-up period with a mean of 35.11 months failed to show any new re-recurrence . Conclusions Laparoscopic repair of recurrent inguinal hernia is safe and effective . The morbidity and recurrence rates for the procedure are as low as for laparoscopic repair of primary hernias . Laparoscopic repair should be the gold st and ard for these hernias Objective : The aim of this study was to determine inguinal hernia recurrence rates 5 years after endoscopic totally extraperitoneal ( TEP ) inguinal hernia repair when either lightweight or heavyweight mesh was used . Background : Recurrence is an important complication of inguinal hernia surgery . Higher recurrence rates of Ultrapro lightweight meshes after TEP repair have been demonstrated , yet data regarding long-term follow-up are limited . Methods : From 2010 to 2012 , 950 male adult patients with primary unilateral hernias were r and omized to TEP hernia repair with heavyweight ( Prolene ) or lightweight ( Ultrapro ) mesh . Five years postoperatively , the vali date d PINQ-PHONE telephone question naire was carried out . Participants with a positive question naire reply were scheduled for a clinical visit . A recurrence was defined as a clinical ly detectable bulge in the operated groin on physical examination . Results : Data on development of recurrence could be obtained from 790 patients ( 83.2 % 5-year follow – up rate ) . Four patients presented with a recurrence at the outpatient clinic between 2 and 5 years postoperatively . Thirty-five patients ( 4.6 % ) with a positive PINQ-PHONE reply ( 60.0 % lightweight vs 40.0 % heavyweight ) were physically examined at the outpatient clinic . In 2 patients ( lightweight ) a recurrence was detected . The total 5-year recurrence rate after TEP hernia repair was 2.4 % ( 3.8 % lightweight , 1.1 % heavyweight , P = 0.01 ) . A significantly higher recurrence rate  for lightweight mesh in primary direct hernias was found ( P = 0.003 ) . Conclusions : The overall recurrence rate 5 years after TEP repair was low . Ultrapro lightweight meshes showed higher recurrence rates than heavyweight meshes and are not recommended for endoscopic TEP inguinal hernia repair Introduction Seroma is a frequent complication of endoscopic totally extraperitoneal ( TEP ) mesh repair of direct inguinal hernia that may cause discomfort and anxiety . Its volume is proportional to the size of the preperitoneal dead space created after the reduction of the hernia . Attempts to reduce its incidence have included tacking the transversalis fascia ( TF ) to the pubic ramus or closed suction drainage of the preperitoneal space . Both of these techniques are not without problems . The aim of this study was to evaluate the efficiency of a new alternate technique that must be safe and easily reproducible , using a widely available and inexpensive pre-tied suture loop ( Endoloop ® Ligature ) for plication of the weakened TF . Methods This is a prospect i ve study of consecutive patients diagnosed with inguinal hernia during a 33-month period and eligible for endoscopic TEP repair . A single surgeon performed all operations . Each of the M2 or M3 direct defects , according to the European Hernia Society ( EHS ) , were systematic ally closed prior to the introduction of the prosthetic mesh and as follows : grasping and inversion of the attenuated TF at its apex , using a laparoscopic forceps and plication of the TF by placing a tight Endoloop of Polydioxanone ( PDS ) at its base . All meshes were secured with fibrin sealant only . Patients were review ed in the clinic 2 and 6 weeks after the operation . Further follow-up was scheduled if it was deemed necessary . The primary post-operative outcome parameter was seroma formation ; secondary outcome parameters included groin pain , surgical complications , and recurrence . Results Two hundred and fifty hernia repairs were prospect ively recorded during this period . All procedures were carried out endoscopically . Seventy-nine patients with 94 direct inguinal hernias were selected in a sequential manner . There were 75 males and four females , with a median age of 57 years . Of those , 55 were combined with an indirect inguinal defect . In total , Endoloops of PDS were used to close the weakened TF in 76 cases ( 30 M3 , 44 M2 , and two M1 ) . Only one patient ( 1.3 % ) complained of a residual seroma formation , which was still clinical ly present at 3 months post-operatively , but was not symptomatic . There were only two minor post-operative complications , which occurred in the same patient and were not related to the Endoloop technique . Finally , no patient complained of chronic groin pain and there was no hernia recurrence after a median follow-up of 18 months . Conclusions The primary closure of direct inguinal hernia defects with a pre-tied suture loop during endoscopic TEP repair is safe , efficient , and very reliable for the prevention of post-operative seroma formation , without increasing the risk of developing chronic groin pain or hernia recurrence . This technique should be the preferred method over stapling of the TF or the insertion of a closed suction drainage device in such a situation Abstract Introduction In the up date of the guidelines of the European Hernia Society , open Lichtenstein and endoscopic techniques continue to be recommended as the surgical technique of choice for repair of unilateral primary inguinal hernias in men despite the fact that a meta- analysis had identified a higher recurrence rate for TEP compared with Lichtenstein operation . The Guidelines Group had taken that decision because one surgeon in one of the r and omized controlled trials included in the meta- analysis had had a very high recurrence rate . Therefore , this study based on registry data now compares the outcome of TEP versus Lichtenstein repair . Patients and Methods The analysis of the Herniamed Registry compares the prospect i ve data collected for male patients undergoing primary unilateral inguinal hernia repair using either TEP or open Lichtenstein repair . Inclusion criteria were minimum age of 16 years , male patient , primary unilateral inguinal hernia , elective operation , and availability of data on 1-year follow-up . In total , 17,388 patients were enrolled between September 1 , 2009 , and August 31 , 2013 . Of these patients , 10,555 ( 60.70 % ) had a Lichtenstein repair and 6833 ( 39.30 % ) a TEP repair . Results On multivariable analysis , the surgical technique was not found to have had any significant effect on the recurrence rate ( p = 0.146 ) or on the chronic pain rate ( p = 0.560 ) . Nor did the complication-related reoperation rates differ significantly between the two techniques ( p = 0.084 ) . But TEP was found to have benefits as regards the postoperative complication rate ( p < 0.001 ) , pain at rest rate ( p = 0.011 ) , and pain on exertion rate ( p < 0.001 ) . Summary In the present registry study , no significant difference was identified in the recurrence rates between the TEP and Lichtenstein technique . TEP was found to have benefits compared with Lichtenstein repair as regards the postoperative complication rates , pain at rest , and pain on exertion Objectives : To compare a laparoscopic ( totally extraperitoneal patch ( TEP ) ) and an open technique ( Lichtenstein ) for inguinal hernia repair regarding recurrence rate and possible risk factors for recurrence . Summary Background Data : Laparoscopic hernia repair has been introduced as an alternative to open repair . Short-term follow-up suggests benefits for those patients operated with a laparoscopic approach compared with open techniques ; ie , less postoperative pain and a shorter convalescence period . Long-term results , however , are less well known . Methods : The study was conducted as a multicenter r and omized trial with a 5-year follow-up . A total of 1512 men aged 30 to 70 years , with a primary unilateral inguinal hernia , were r and omized to either TEP or Lichtenstein repair . Results : Overall , 665 patients in the TEP group and 705 patients in the Lichtenstein group were evaluable . The cumulative recurrence rate was 3.5 % in the TEP group and 1.2 % in the Lichtenstein group ( P = 0.008 ) . Test for heterogeneity revealed significant differences between individual surgeons . The exclusion of 1 surgeon , who was responsible for 33 % ( 7 of 21 ) of all recurrences in the TEP group , lowered the cumulative recurrence rate to 2.4 % in this group , which was not statistically different from that of the Lichtenstein group . Conclusions : The recurrence rate for both TEP and Lichtenstein repair was low . A higher cumulative recurrence rate in the TEP group was seen at 5 years . Further analysis revealed that this could be attributable to incorrect surgical technique
We found that female sex , direct inguinal hernias at the primary procedure , operation for a recurrent inguinal hernia , and smoking were significant risk factors for recurrence after inguinal hernia surgery .
Background .
Several factors influence the risk of recurrence after inguinal hernia surgery ; however , a systematic review and meta- analysis of patient-related risk factors for recurrence after inguinal hernia surgery has not been performed earlier .