Long-term results of giant prosthetic reinforcement of the visceral sac for complex recurrent inguinal hernia.

Long-term results of giant prosthetic reinforcement of the visceral sac for complex recurrent inguinal hernia. Beets GL, van Geldere D, Baeten CG, Go PM. Department of Surgery, University Hospital Maastricht, The Netherlands. The results of recurrent inguinal hernia repair in a prospective cohort study were evaluated. From May 1986 to December 1990 75 patients with 150 hernias (24 primary, 126 recurrent) were operated using a technique based on Stoppa's preperitoneal mesh repair (giant prosthetic reinforcement of the visceral sac; GPRVS). All patients were at high risk for recurrence: they all had bilateral hernias, mostly bilateral recurrent and often repeatedly recurrent. All patients had a physical examination 1 week, 6 weeks and 1 year after operation. Sixty patients (94 per cent of surviving patients) had a physical examination after a mean follow-up of 5.7 (range 4-9) years. There were no major complications. There was one deep infection that healed without removing the mesh. One of the 75 patients (1 per cent) had a recurrence 2 months after the operation, due to a technical failure. Because of the excellent results, the ease of the procedure and the low complication rate, GPRVS is the authors' operation of choice for any recurrent inguinal hernia

Een beknopte geschiedenis van de liesbreukoperatie bij volwassenen

In aanvulling op het artikel van collega Bekker et al. (2007:924-31) vragen wij graag aandacht voor de Nederlandse medicus Petrus Camper (1722-1789), die wordt gezien als een sleutelfiguur in een belangrijke periode in de ontwikkeling van de liesbreukchirurgie. In de 2e helft van de 18e eeuw werd de anatomie van het lieskanaal nauwkeurig bestudeerd en beschreven, en werd de ontstaanswijze van liesbreuken ontdekt. Deze periode, ook wel ‘het anatomische tijdsperk’ genoemd, vormt de brug tussen de breuksnijders, die op barbaarse wijze patiënten castreerden, en degenen die een op anatomische kennis gebaseerde rationele behandeling van liesbreuken toepasten

A brief history of the inguinal hernia operation in adults

In aanvulling op het artikel van collega Bekker et al. (2007:924-31) vragen wij graag aandacht voor de Nederlandse medicus Petrus Camper (1722-1789), die wordt gezien als een sleutelfiguur in een belangrijke periode in de ontwikkeling van de liesbreukchirurgie. In de 2e helft van de 18e eeuw werd de anatomie van het lieskanaal nauwkeurig bestudeerd en beschreven, en werd de ontstaanswijze van liesbreuken ontdekt. Deze periode, ook wel ‘het anatomische tijdsperk’ genoemd, vormt de brug tussen de breuksnijders, die op barbaarse wijze patiënten castreerden, en degenen die een op anatomische kennis gebaseerde rationele behandeling van liesbreuken toepasten

Richtlijn 'Liesbreuk' van de Nederlandse Vereniging voor Heelkunde

The 'Inguinal hernia' guideline was written over a period of two years by nine surgeons (including one epidemiologist) from all regions of the Netherlands with demonstrable clinical and scientific expertise in the area of inguinal surgery after a training course on 'The development of evidence-based guidelines'. A draft of the guideline was on the website of the Association of Surgeons of the Netherlands for a period of three months, during which time the members of the society could comment on its contents interactively. The guideline comprises chapters on risk factors and prevention, diagnostics, indications for treatment, treatment, day surgery, antibiotics, thrombosis prophylaxis, training, anaesthesia, postoperative pain control, complications, costs, aftercare, and specific aspects of inguinal hernia in children. For the treatment of adult patients a mesh technique is recommended. The Lichtenstein technique is recommended as the first choice for uncomplicated primary inguinal hernia. Laparo-endoscopic techniques can be used by trained teams for specific indications. Other techniques have not been compared with the current methods of treatment sufficiently. It is recommended that the operations be carried out in daycare and that the use of local anaesthesia should be considered more often. The diagnosis of inguinal hernia in a child is based on the physical examination. It is recommended that the surgeon should not rely solely on the history but confirm the presence of a hernia personally. The treatment of a paediatric inguinal hernia is always operative. Generally, the younger the child, the more urgent the operation because of the increased risk of incarceration in infants, particularly premature babies. There is no indication for routine exploration of the contralateral groin. If an incarcerated hernia cannot be reduced, emergency operation is necessary and referral to a paediatric surgical centre must be considered. The implementation and effectiveness of the guideline will be measured by taking an inventory of all inguinal hernia operations performed in the Netherlands before and after its publicatio

Repair of large midline incisional hernias with polypropylene mesh: comparison of three operative techniques.

Contains fulltext : 57716.pdf (publisher's version ) (Closed access)Polypropylene mesh is widely used for the reconstruction of incisional hernias that cannot be closed primarily. Several techniques have been advocated to implant the mesh. The objective of this study was to evaluate, retrospectively, early and late results of three different techniques, onlay, inlay, and underlay. The records of 53 consecutive patients with a large midline incisional hernia -- 25 women and 28 men, mean age 60.4 (range 28-94) -- were reviewed. Polypropylene mesh was implanted using the onlay technique in 13 patients, inlay in 23 patients, and underlay in 17 patients. Either the greater omentum or a polyglactin mesh was interponated between the mesh and the viscera. The records of these 53 patients were reviewed with respect to: size and cause of the hernia, pre- and postoperative mortality and morbidity, with special attention to wound complications. Patients were invited to attend the outpatient clinic at least 12 months after implantation of the mesh for physical examination of the abdominal wall. Postoperative complications occurred in 14 (26.4%) patients. The onlay technique had significantly more complications, as compared to both other techniques. Reherniation occurred in 15 (28.3%) patients. The reherniation rate of the inlay technique was significantly higher than after the underlay technique (44% vs 12%, P=0.03) and tended to be higher than the onlay technique (44% vs 23%, P=0.22). Repair of large midline incisional hernias with the use of a polypropylene mesh carries a high risk of complications and has a high reherniation rate. The underlay technique seems to be the better technique