Hernia : the journal of hernias and abdominal wall surgery
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Randomized Controlled Trial Multicenter Study Comparative Study
Recurrence and complications after laparoscopic versus open inguinal hernia repair: results of a prospective randomized multicenter trial.
The aim of this prospective randomized multicenter trial was to evaluate the recurrence rates and complications of open versus laparoscopic repairs of inguinal hernias. ⋯ In this multicenter study, no significant difference in the recurrence rate and complications between laparoscopic and open methods of hernia repair was revealed.
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Comparative Study
Ventralex mesh in umbilical/epigastric hernia repairs: clinical outcomes and complications.
Umbilical and epigastric hernias have historically been repaired without mesh resulting in recurrence rates in some series of up to 40%. Recent data suggests mesh repair of these hernias may decrease recurrent hernia rates. Ideal placement of the mesh is behind the defect, which is difficult to do without a large incision in these hernias unless done laparoscopically. The Ventralex hernia patch is a composite PTFE/polypropylene patch allowing intraperitoneal placement behind the hernia defect through a small incision, and without the cost of laparoscopy. To date, only one study exists evaluating this new prosthesis. ⋯ The composite PTFE/polypropylene hernia patch is effective in preventing hernia recurrence in umbilical, epigastric, and small ventral hernia repairs and can be accomplished with a low rate of complications.
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Comparative Study
Laparoscopic ventral hernia repair (LVHR) in morbidly obese patients.
The aim of this study was to evaluate our experience with LVHR in morbidly obese patients (BMI >40) and to compare their outcomes to those of patients with lower BMI. ⋯ LVHR in the morbidly obese population is both safe and feasible, although there is a higher, but still acceptable recurrence rate. Despite the increased risk for recurrence, LVHR in morbidly obese patients minimizes the potential wound and mesh complications that frequently occur for open mesh repair in this group of patients.
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There is little information available on recurrence rates following primary open inguinal hernia repair in women. Women are less prone to inguinal hernias than men; for the same reason, recurrences after hernia repair may also be lower so that the well-known advantage of using mesh could be lost on them. ⋯ The routine use of mesh for open indirect inguinal hernia repair in women may not be necessary.
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In groin hernia repair studies, chronic pain is a frequently used primary endpoint. However, its impact on daily life activities has been less investigated. Such an outcome is relevant for the patient and surgeon and cannot be extrapolated out of pain scores. The Pain Disability Index (PDI), a questionnaire wherein patients rate their impairment, could reveal the consequences of pain. The PDI was therefore introduced in a trial upon open mesh-based inguinal hernia repair. ⋯ The PDI is feasible in inguinal hernia repair and can be used as an adjuvant in pain measurement. It can identify patients still suffering postoperatively who might otherwise be missed. Furthermore, the PDI could serve as a predictor for chronic pain.