Total Extraperitoneal Inguinal Hernia Repair Compared With Lichtenstein (the LEVEL-Trial)

Langeveld, Johannes; Riet, M. van’t; Weidema, W. F.; Stassen, Laurents P. S.; Steyerberg, Ewout W.; Lange, Johan F.; Bonjer, H. Jaap; Jeekel, J.

doi:10.1097/sla.0b013e3181d96c32

Cited by 192 publications

(162 citation statements)

References 24 publications

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“…Finally, the recurrence rate in our study was comparable to the recurrence rates reported in the literature for laparoscopic TEP, which range from 0% to around 9% [11,[21][22][23][24][25][26][27][28]. Comparison with our 1 year follow-up study indicates that the rate of recurrence decreases with time.…”

Section: Discussionsupporting

confidence: 76%

Long-Term Follow-Up of a Large Series of Patients Following ONSTEP Inguinal Hernia Repair

Lourenço¹,

Costa²

2016

J Clin Trials

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Purpose: Long-term (3-5 years) results following inguinal hernia repair in a large series of patients using a novel technique-the ONSTEP approach-are presented. In particular, the recurrence rate, long-term complications and patient satisfaction with the procedure are discussed. Methods:Adult patients underwent ONSTEP inguinal hernia repair using a PolySoft™ hernia patch. All procedures were performed by one of two surgeons. Patients were followed up for 3-5 years for recurrences and complications, including chronic and residual pain. Patients were also asked to rate their satisfaction with the procedure.Results: Data were available from 398 hernia repair procedures in 314 patients at the 3-5-year follow-up. The overall recurrence rate was 2.0% (8/398). Additionally, there were 14 cases (3.5%; 14/398) of residual pain and 5 cases (1.3%; 5/398) of wound infection. No patients experienced chronic pain and there were no cases of mesh infection. Patient satisfaction with the ONSTEP procedure was high, with 94.9% of patients rating it as excellent, very good or good.Conclusions: ONSTEP inguinal hernia repair produced consistent results in the long term, and was associated with a low recurrence rate, only minor complications and no chronic pain. The procedure offers an alternative approach to both Lichtenstein and laparoscopic repair.

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Section: Discussionsupporting

confidence: 76%

Long-Term Follow-Up of a Large Series of Patients Following ONSTEP Inguinal Hernia Repair

Lourenço¹,

Costa²

2016

J Clin Trials

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“…This paper has, therefore, been removed from the updated meta-analysis. Since our last analysis, two new studies, comparing Lichtenstein with TEP with long-term follow-up, have been published [6][7][8]. We repeated the meta-analysis (random model) including the new data.…”

Section: Treatment Of Inguinal Herniamentioning

confidence: 99%

Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients

Miserez

Peeters

Aufenacker

et al. 2014

Hernia

366

226

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Purpose: In 2009, the European Hernia Society published the EHS Guidelines for the Treatment of Inguinal Hernia in Adult Patients. The Guidelines contain recommendations for the treatment of inguinal hernia from diagnosis till aftercare. The guidelines expired January 1, 2012. To keep them updated, a revision of the guidelines was planned including new level 1 evidence. Methods: The original Oxford Centre for Evidence-Based Medicine ranking was used. All relevant level 1A and level 1B literature from May 2008 to June 2010 was searched (Medline and Cochrane) by the Working Group members. All chapters were attributed to the two responsible authors in the initial guidelines document. One new chapter on fixation techniques was added. The quality was assessed by the Working Group members during a 2-day meeting and the data were analysed, especially with respect to any change in the level and/or text of any of the conclusions or recommendations of the initial guidelines. In the end, all relevant references published until January 1, 2013 were included. The final text was approved by all Working Group members. Results: For the following topics, the conclusions and/or recommendations have been changed: indications for treatment, treatment of inguinal hernia, day surgery, antibiotic prophylaxis, training, postoperative pain control and chronic pain. The addendum contains all current level 1 conclusions, Grade A recommendations and new Grade B recommendations based on new level 1 evidence (with the changes in bold). Conclusions: Despite the fact that the Working Group responsible for it tried to represent most kinds of surgeons treating inguinal hernias, such general guidelines inevitably must be fitted to the daily practice of every individual surgeon treating his/her patients. There is no doubt that the future of guideline implementation will strongly depend on the development of easy to use decision support algorithms tailored to the individual patient and on evaluating the effect of guideline implementation on surgical outcome. At the 35th International Congress of the EHS in Gdansk, Poland (May 12-15, 2013), it was decided that the EHS, IEHS and EAES will collaborate from now on with the final goal to publish new joint guidelines, most likely in 2015

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“…In the early 1990s, laparoscopic techniques using a tension-free mesh were developed for groin hernia repair. The recurrence rates after laparoscopic repair are comparable to those after open tension-free mesh repair, and range between 2 and 4% [20,22,24,31].…”

Section: Morbidity and Mortality Of Elective Groin Hernia Repairmentioning

confidence: 51%

“…The short-term morbidity, the recurrence rate and the mortality rate are low. Nevertheless, over the past decade, reports have indicated high incidences of chronic pain after tension-free mesh hernia repair, ranging from 2 to 37% [17,[20][21][22][23][24]]. An inconsistency is observed, since these rates exceed the morbidity rates of 8% after elective groin hernia repair mentioned earlier (see Table 1).…”

Section: Discussionmentioning

confidence: 64%

Is surgical repair of an asymptomatic groin hernia appropriate? A review

Heuvel

Dwars

Klassen

et al. 2011

Hernia

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Purpose Groin herniorrhaphy is the most common operation performed by general surgeons. Annually, more than 20 million groin hernias are repaired worldwide. The general approach towards groin hernias is surgical repair regardless of the presence of symptoms. The rationale to recommend surgery for asymptomatic groin hernias is prevention of visceral strangulation. The goal of this review is to evaluate the appropriateness of surgery in patients with asymptomatic groin hernias. Methods The review was based on an extensive literature search of Pubmed, Medline and the Cochrane Library. Results The risk of incarceration is approximately 4 per 1,000 patients with a groin hernia per year. Risk factors for incarceration are age above 60 years, femoral hernia site and duration of signs less than 3 months. Morbidity and mortality rates of emergency groin hernia repair are higher in patients who are older than 49 years, have a delay between onset of symptoms and surgery of more than 12 h, have a femoral hernia, have nonviable bowel and have an ASA-class of 3 or 4. The recurrence rate after tension-free mesh repair in the management of emergency groin hernias is comparable to that of elective repair. There is no diVerence in pain and quality of life after elective repair compared to watchful waiting. There is no advantage in cost-eVectiveness of elective repair compared to watchful waiting. ConclusionWatchful waiting for asymptomatic groin hernias is a safe and cost-eVective modality in patients who are under 50 years old, have an ASA class of 1 or 2, an inguinal hernia, and a duration of signs of more than 3 months.

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Total Extraperitoneal Inguinal Hernia Repair Compared With Lichtenstein (the LEVEL-Trial)

Cited by 192 publications

References 24 publications

Long-Term Follow-Up of a Large Series of Patients Following ONSTEP Inguinal Hernia Repair

Long-Term Follow-Up of a Large Series of Patients Following ONSTEP Inguinal Hernia Repair

Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients

Is surgical repair of an asymptomatic groin hernia appropriate? A review

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