Chrościcki, Andrzej

Dąbrowicki, Stanisław

Fridiger, Jerzy

Matyja, Andrzej

Michalik, Maciej

Mitura, Kryspin

Solecki, Rafał

Trojanowski, Piotr

Wróblewski, Tadeusz

Śmietański, Maciej

Videosurgery and Other Miniinvasive Techniques

English

Jagiellonian Univeristy Repository

Videosurgery and other miniinvasive techniques 2009; 4 (Suppl 1) S13Working group (authors)Austria – Rene FortelnyBelgium – Marc MiserezDenmark – Morten Bay NielsenFinland – Timo HeikkinenFrance – Jean-Luc BouillotGermany – Joachim ConzeHungary – Georg WeberItaly – Giampiero CampanelliNetherlands – Theo Aufenacker/Maarten Simons/Diederik de LangePoland – Maciej SmietanskiSweden – Sam Smedberg/Par NordinSwitzerland – Jan KukletaUnited Kingdom – Andrew KingsnorthLegal significanceGuidelines are not legal requirements, butevidence-based insights and recommendations inorder to provide qualitatively good care. In this it isimportant to realise that there are different “levels ofevidence”, varying from the highest level (1A), thatwhich has been consistently demonstrated bysystematic review, and the lowest level (4), thatwhich is only based on the opinion of experts. Thisresults in different classes of recommendation. Asthese recommendations are based on the “averagepatient”, care providers can where necessary deviatefrom the guidelines in accordance with their profes-sional opinion. Indeed this can sometimes benecessary if the patient's situation requires that.When the guidelines are not followed, this shouldbe justified and documented.Full English text of the guidelines can be downloadedfrom the EHS webpage: www.herniaweb.org (due to thelegal issue of the copyright).Groin hernia treatment. European Hernia Society Guidelines and comments by the Polish Working Group for the guidelines’implementationComments and recommendations by Polish Working Group: Maciej Śmietański, Andrzej Chrościcki, Stanisław Dąbrowicki,Jerzy Fridiger, Andrzej Matyja, Maciej Michalik, Kryspin Mitura, Rafał Solecki, Piotr Trojanowski, Tadeusz Wróblewski Videosurgery and other miniinvasive techniques 2009; 4 (Suppl 1): S13–S15RecommendationsAddress for correspondence: Maciej Śmietański, MD, PhD, Department of Surgery, District Hospital of Puck, 1 Maja 13, 84-100 Puck, Poland, phone +48 58 673 48 30,e-mail: smietanski@herniaweb.orgVideosurgeryPart IHernia in adult patients. European Hernia Society Guidelines on the treatment of inguinal Videosurgery and other miniinvasive techniques 2009; 4 (Suppl 1)S14Maciej Śmietański, Andrzej Chrościcki, Stanisław Dąbrowicki, Jerzy Fridiger, Andrzej Matyja, Maciej Michalik, Kryspin Mitura, Rafał Solecki, Piotr Trojanowski, Tadeusz Wróblewski Level 1B Modification of Lichtenstein technique used for lightweight mesh implantation did not increase the recurrence rate compared to heavyweight mesh.Level 3 In the conditions of Polish hospitals use of infection prophylaxis decreases the risk of wound infection after open mesh repair.Valenti open mesh technique in short-term follow-up, and in small studies results in comparable outcome to the Lichtenstein technique.Desarda open non-mesh technique in short-term follow-up, in small studies results in comparable outcome to the Lichtenstein technique.Level 4 Prevalence of endoscopic techniques in Poland is insufficient due to lack of reimbursement by the National Heath Fund and insufficient number of teaching centres.Results published in Polish medical journals do not change the value of the EHS Guidelines.Grade A Use of lightweight mesh should be considered in all cases of primary inguinal hernioplasty. Grade C Use of antibiotics in infection prophylaxis should be carefully considered in general surgical wards in Poland. Other open techniques (Valenti, Desarda) may be considered as alternative methods in groin hernia repair(with respect to small described groups and short-term observation) for selected groups of patients. Grade D It is recommended to use EHS Guidelines in Poland.Due to the insufficient number of endoscopic centres endoscopic procedures should be used only when expertise isavailable.National Scientific Societies and Consultants should create the environment for education and spread of endoscopy in groin hernia treatment in Poland.Scientific Committee:Maciej Śmietański – coordinatorMembers:Dr Andrzej Chrościcki – LublinProf. Stanisław Dąbrowiecki – BydgoszczDr Jerzy Fridiger – KrakówDr Andrzej Matyja – KrakówDr Maciej Michalik – WejherowoDr Kryspin Mitura – Siedlce Dr Rafał Solecki – KrakówDr Piotr Trojanowski – WarszawaProf. Tadeusz Wróblewski – WarszawaGroin hernia surgery in PolandDatabase search For search of publications with the key words“groin hernia” and “inguinal hernia” Polish scientificdatabase SOWA was used. Records were checked forthe period from 1990 to 2008. Do the conducted and published Polish studieschange the EHS guidelines? Should the EHS Guidelines be implemented inPoland?RecommendationsConclusions Part IIComments and recommendations of the Polish Working GroupVideosurgery and other miniinvasive techniques 2009; 4 (Suppl 1) S15In Poland, hernia repairs are the most commonplanned general surgical procedures. Their numberis estimated at 60 000 procedures a year. Accordingto Polish NHS (NFZ) data, less than 60% of theseprocedures involve mesh implantation. During the last 20 years 300 papers, doctoraltheses and congress communications concerninginguinal hernia repair have been published inPoland. Unfortunately, most of them have limitedvalue due to the methods of patient selection andstatistical analysis. Only a few papers havesignificant scientific value and can influence EHSguidelines. The majority of the remaining publi-cations only confirm EHS conclusions.Lower rate of surgical site infections after single-dose cephalosporin administration prior to surgery isan important observation. A decrease in infectionrate from 3 to 0.6% has been seen. This observation,although concordant with EHS guidelines, demandscareful re-consideration of antibiotic use in generalsurgery departments of Polish hospitals.Another group of publications form notions onValenti and Desarda’s method, which proved efficacycomparable to Lichtenstein’s method. Althoughpublished data do not change EHS recommendationsdue to their lower level of evidence, this method canbe considered when choosing the operative methodin a selected groups of patients. Publication ofmethodologically better papers in the future mayinfluence the recommendations.The latest published work of the Polish HerniaStudy Group confirms the need for modification ofthe operative technique for lightweight mesh, whichprevents an increased recurrence rate with thesematerials. Finally, the Polish Work Group for Guidelines hasestablished (experts’ opinion) that EHS guidelinesshould be recommended in Poland. In the meantime,improvement of provided service quality should besought by specialist training and broadening of theendoscopic procedures offer in the future.    References1. Polska Grupa Badaczy Przepuklin. Zakażenia rany pooperacyjnejw chirurgii implantacyjnej przepuklin pachwiny – analiza dwóchserii chorych. Zakażenia 2006; 4: 51-55.2. Romańczuk M, Mitura K. Metoda Valentiego w leczeniu przepu-klin pachwinowych. Sposób nowy czy nowatorski? Ocenawczesnych wyników leczenia. Videosurgery and other miniinva-sive techniques 2007; 2: 145-149. 3. Szopiński J, Kapała A, Prywiński S, et al. Naprawa przepuklin pa-chwinowych metodą Desardy – pierwsze polskie doświadczenia.Pol Przegl Chir 2005; 77: 159-168.4. Mitura K, Romańczyk M. Porównanie dwóch metod operacyjne-go leczenia przepuklin pachwinowych – sposobem Lichtensteinai Desarda. Pol Merk Lek 2008; 24: 392.5. Mitura K, Romańczuk M, Wróblewski T. Wczesne wyniki leczeniaprzepuklin pachwinowych sposobem Desardy u 17 operowanychchorych. Doniesienie wstępne. Videosurgery and other minii-nvasive techniques 2006; 1: 18-22.6. Polska Grupa Badaczy Przepuklin. Influence of operative techni-que on recurrence rate in Lichtenstein hernioplasty using par-tially absorbable lightweight mesh. Videosurgery and other mi-niinvasive techniques 2009; 4: 10-15.Groin hernia treatment. European Hernia Society Guidelines  and comments by the Polish Working Group for the guidelines’ implementation

Groin hernia treatment : European Hernia Society Guidelines and comments by the Polish Working Group for the guidelines' implementation

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Groin hernia treatment : European Hernia Society Guidelines and comments by the Polish Working Group for the guidelines' implementation

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