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Due to a lack of evidence, the use of slit meshes in laparo-endoscopic hernia repair is a topic of controversial debate. Therefore, further studies are needed on this key question.
Methods
This retrospective analysis of prospectively recorded data from the Herniamed Registry compared the perioperative and 1-year follow-up outcomes after laparo-endoscopic inguinal hernia repair with slit mesh versus non-slit mesh. Matching was performed for 1,028 pairs.
Results
A significant difference was identified in the recurrence rate on 1-year follow-up in favor of the slit mesh (0.6% vs 1.8%; p = 0.023). No such systematic difference was found for any of the other outcome variables (intraoperative complications, general complications, postoperative complications, complication-related reoperations, pain at rest, pain on exertion, and pain requiring treatment on 1-year follow-up).
Conclusion
The use of a slit mesh versus a non-slit mesh in laparo-endoscopic inguinal hernia repair is associated with a significantly lower recurrence rate. There is no relation with any other outcome criteria. Since the use of a slit mesh in laparo-endoscopic inguinal hernia repair seems to influence the outcome, this topic should be further investigated.
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Introduction
In the international guidelines for the treatment of inguinal hernias, the laparo-endoscopic techniques TEP and TAPP are recommended for primary unilateral inguinal hernia in men and women and for primary bilateral inguinal hernia in men and women if adequate resources and expertise are available [1‐5].
The laparo-endoscopic techniques have a faster recovery time, lower risk of chronic pain and are cost effective [1‐5].
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For women TEP and TAPP offer the advantage of better diagnosis and treatment of femoral hernias, which occur more often in women [1‐5]. In bilateral inguinal hernias both sides can be operated on using identical access routes [1‐5]. The mesh recommended for TEP and TAPP is a simple flat mesh measuring at least 10 × 15 cm [1‐5]. The mesh should not be fixed or only fixed with fibrin glue [1‐5].
Due to a lack of evidence, the use of slit meshes is a topic of controversial debate [6]. Some surgeons believe that a slit mesh wrapped around the cord, fashioning a new internal ring, could prevent hernia recurrence [6]. However, the slit mesh could cause circumferential scarring with subsequent postoperative pain [6]. There is no evidence in the literature linking the use of slit meshes to spermatic cord injury or to a reduction in the recurrence rate [6‐15]. Therefore, the use of slit meshes in laparo-endoscopic inguinal hernia repair is also not recommended in the guidelines [1‐5].
Two recent studies compared patients who had undergone laparo-endoscopic inguinal hernia repair with non-slit mesh vs patients treated with a slit mesh [16]. In this way it was possible to identify the influence exerted by slit meshes on the recurrence rate or the chronic pain rate. This means that there could be a relationship between the use of slit meshes vs non-slit meshes in laparo-endoscopic (TEP, TAPP) inguinal hernia repair with regard to the recurrence rate and/or the rate of chronic pain. Therefore, this retrospective analysis of prospective data from the Herniamed Registry now presented below aims to explore this key question using propensity score matching [18, 19].
Methods
Registry design
Herniamed is an internet-based hernia registry in which hospitals and office-based surgeons in Germany, Austria and Switzerland can voluntarily enter data on their routine hernia repairs [18, 19]. A cooperation contract is made with the participating hospitals and surgical centers/practices where the participating hospitals and office-based surgeons commit to entering data completely and correctly into the Herniamed Registry on all hernia operations. As a prerequisite for documentation in the Herniamed Registry, all patients must sign a separate consent form agreeing to their data being documented and processed in the Herniamed Registry. As part of the information provided to patients regarding their participation in the Herniamed Registry, they are told to inform the treating hospital or practice about all special events occurring in the early and late postoperative course. If a problem occurs the patient should present to the treating hospital or the treating surgeon. The hospital or surgeon should then conduct appropriate clinical examination.
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All perioperative complications are documented for up to 30 days after the operation. To ensure that all postoperative complications are documented, patients are asked once again about these on 1-year follow-up. On 1-year follow-up patients and the general practitioner are sent a questionnaire asking about chronic pain and/or a suspected recurrence.
If the patient reports inguinal pain or a protrusion again in the surgical area or any postoperative problems, they are requested by the treating hospital or treating surgeon to attend for clinical examination. Studies have attested to the effectiveness of follow-up based on questionnaires addressed to patients and/or the treating general practitioner as well as selective clinical examination [20]. The findings reported by the patients in the questionnaires returned to the treating hospital/practice are entered into the Herniamed Registry database where they can be used for retrospective analysis of prospectively collected data.
Aim of analysis
The analysis presented here aimed to compare the outcomes of laparo-endoscopic repair (TEP, TAPP) of primary unilateral inguinal hernias using comparable meshes with and without a slit. To that effect, matched pair analysis was performed to compare the meshes Covidien/Medtronic Parietex multifilament, folding slit mesh (slit mesh) with Covidien/Medtronic Parietex multifilament, anatomical folding mesh (non-slit mesh) (Fig. 1a, b, c). After checking plausibility and inclusion criteria, univariate analysis was then performed for the mesh group with regard to the matching parameters; this was followed by pairwise matching for the mesh groups and presentation of the analysis results of the outcome parameters for the corresponding mesh comparison based on matched pairs.
From 717,133 inguinal hernia repairs recorded from January 5, 2009 to January 4, 2023, 3,098 procedures met the inclusion criteria for this analysis (Fig. 2). The inclusion criteria were: patients with minimum valid age of 16 years who underwent primary elective unilateral inguinal laparoscopic (TEP or TAPP) hernia repair. Patients had hernia repair performed with the use of slit mesh or non-slit mesh. The surgeries had to be fully documented, and patients had to have 1-year follow-up.
All analyses were performed with the software SAS 9.4 (SAS Institute Inc.Cary, NC, USA) and intentionally calculated to a full significance level of 5%, i.e. they were not corrected in respect of multiple tests.
Operative complications included intraoperative complications, general complications, postoperative complications, and complication-related reoperations. On 1-year follow-up, recorded outcomes included recurrence, pain on exertion, pain at rest, and pain requiring treatment.
For unadjusted homogeneity tests of mesh groups, the chi-square test was used for categorical variables and the robust t test (Satterthwaite) for continuous variables. Analyses of non-normal distributed data (duration of operation and mesh size) were conducted on log-transformed values.
Pairs of slit mesh and non-slit mesh hernia repairs were matched in a 1:1 propensity score matching using the robust Greedy algorithm and a caliper of 0.2 standard deviations of the logit of the propensity score. The variables used for matching were as follows: age, American Society of Anesthesiologist classification (ASA), defect size, body mass index (BMI), EHS classification, fixation, preoperative pain, risk factors as well as fixed variable: sex, in which no variability was allowed between matched pairs.
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Balancing of matching parameters before and after matching was quantified via standardized differences.
After propensity score matching, McNemar test was performed to assess whether the mesh groups deviate significantly from another for an outcome variable.
Results
In total, 3,098 patients were included in the analysis (Fig. 2), with 1,470 patients receiving a slit mesh and 1,628 patients a non-slit mesh. Slit meshes were used only by seven hospitals/office-based surgeons with very varying frequency of use. Two hospitals performed 392 and 627 repairs, respectively, with a slit mesh, one hospital/practice three repairs, two hospitals/practices two repairs and two hospitals/practices one repair. The 1,028 repairs with a non-slit mesh were carried out in 46 hospitals/practices with a mean of 22.3 repairs performed. The 1,028 repairs with a slit mesh were conducted by 34 surgeons and the 1,028 repairs with a non-slit mesh by 176 surgeons. The average number of surgeons per hospital/practice was 3.8 for the non-slit mesh and 4.8 for the slit mesh. The level of training of the surgeons could be determined for 1,019 matched pairs with slit mesh. These operations were performed by 29 different surgeons, 10 of whom were experienced hernia surgeons and 19 of whom were residents.
Unadjusted comparison of the patient and operation characteristics before matching (Table 1 and Table 2) showed significant differences between slit mesh and non-slit mesh patients for age, BMI, duration of operation, surgical technique, defect size, ASA, preoperative pain, fixation (p < 0.001, each), and EHS classification (p = 0.005). Table 3 presents the unadjusted analysis of outcome parameters before matching. After one year of follow-up, significant differences were found between slit mesh and non-slit mesh patients in the postoperative complications (p = 0.009) and recurrence rates (p = 0.002).
Table 1
Presentation of ranges and unadjusted analysis results for homogeneity between slit and non-slit meshes for age, BMI, duration of operation and mesh size * Logarithmic transformation: Presentation of the back-transformed mean values and ranges (mean value ± SD)
Slit mesh
Non-slit mesh
p
Age [years]
N/Mean ± SD
1470/58.6 ± 16.0
1628/56.2 ± 14.6
<.001
BMI [kg/m2]
N/Mean ± SD
1465/25.3 ± 3.6
1621/25.9 ± 3.7
<.001
Duration of operation [min]*
N/Mean [Range of dispersion]
1459/39.1 [37.7; 40.5]
1603/44.8 [43.3; 46.2]
<.001
Mesh size [cm2]*
N/Mean [Range of dispersion]
1470/149.9 [148.8; 150.9]
1628/149.5 [148.4; 150.6]
0.341
Table 2
Presentation of descriptive statistics and unadjusted analysis results for homogeneity between slit and non-slit meshes for categorical matching variables # Data are available since update of Herniamed February 2022
Slit mesh
Non-slit mesh
p
n
%
n
%
Sex
Male
1305
88.8
1441
88.5
0.819
Female
165
11.2
187
11.5
Surgical technique
TEP
1431
97.3
953
58.5
<.001
TAPP
39
2.7
675
41.5
Defect size
I (< 1.5 cm)
265
18.0
441
27.1
<.001
II (1.5–3 cm)
904
61.5
936
57.5
III (> 3 cm)
301
20.5
251
15.4
EHS classification
Medial
204
13.9
300
18.4
0.005
Lateral
1040
70.7
1076
66.1
Femoral
23
1.6
28
1.7
Scrotal
13
0.9
7
0.4
Combined
190
12.9
217
13.3
ASA
I
652
44.4
593
36.4
<.001
II
722
49.1
900
55.3
III/IV
96
6.5
135
8.3
Preoperative pain
no
713
48.5
323
19.8
<.001
yes
742
50.5
1228
75.4
unknown
15
1.0
77
4.7
Fixation
No Mesh Fixation
1136
77.3
1398
85.9
<.001
Tacks
227
15.4
190
11.7
Glue
101
6.9
23
1.4
Combined
6
0.4
17
1.0
Risk factors—total
yes
436
29.7
458
28.1
0.349
no
1034
70.3
1170
71.9
- COPD
yes
84
5.7
89
5.5
0.765
no
1386
94.3
1539
94.5
- Diabetes
yes
80
5.4
71
4.4
0.163
no
1390
94.6
1557
95.6
- Aortic aneurysm
yes
9
0.6
2
0.1
0.022
no
1461
99.4
1626
99.9
- Immunosuppression
yes
11
0.7
8
0.5
0.360
no
1459
99.3
1620
99.5
- Corticoids
yes
12
0.8
16
1.0
0.625
no
1458
99.2
1612
99.0
- Smoking
yes
188
12.8
211
13.0
0.887
no
1282
87.2
1417
87.0
- Coagulopathy
yes
14
1.0
23
1.4
0.239
no
1456
99.0
1605
98.6
- Antithrombotic medication
yes
127
8.6
107
6.6
0.030
no
1343
91.4
1521
93.4
- Anticoagulant medication
yes
19
1.3
26
1.6
0.479
no
1451
98.7
1602
98.4
- Liver cirrhosis‡
yes
0
0
0
0
1.000
no
23
100
13
100
- Anticoagulants‡
yes
0
0
1
7.7
0.177
no
23
100
12
92.3
Table 3
Presentation of descriptive and unadjusted analysis results for homogeneity between slit mesh and non-slit mesh for outcome variables
Slit mesh
Non-slit mesh
p
n
%
n
%
Intraoperative complications—total
yes
18
1.2
18
1.1
0.758
no
1452
98.8
1610
98.9
General complications—total
yes
4
0.3
10
0.6
0.156
no
1466
99.7
1618
99.4
Postoperative complications—total
yes
4
0.3
17
1.0
0.009
no
1466
99.7
1611
99.0
Complication-related reoperations
yes
2
0.1
7
0.4
0.129
no
1468
99.9
1621
99.6
Recurrence on 1-year follow-up
yes
7
0.5
26
1.6
0.002
no
1463
99.5
1602
98.4
Pain on exertion on 1-year follow-up
yes
135
9.2
156
9.6
0.704
no
1335
90.8
1472
90.4
Pain at rest on 1-year follow-up
yes
73
5.0
90
5.5
0.484
no
1397
95.0
1538
94.5
Pain requiring treatment on 1-year follow-up
yes
50
3.4
55
3.4
0.972
no
1420
96.6
1573
96.6
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Propensity score matching was performed for 1,470 patients with slit mesh to 1,628 patients with non-slit mesh, resulting in 1,028 matched pairs. Figure 3 shows the standardized differences between the matching variables both before (original sample) and after (matched sample) matching. Standardized differences were well below 10% for all matching variables, attesting to a good balance for those variables between the groups for matched-pair comparison Table 4.
Fig. 3
Scatter plot of standardized differences before and after matching
Standardized differences for categorical matching variables before and after matching * for gender this characteristic was enforced within a matched pair
Slit Mesh
n
Yes
n
No
Stand. Diff
%
%
Matched sample
Original sample
Male*
912
88.7
912
88.7
0.000
0.008
Defect size I (< 1.5 cm)
229
22.3
209
20.3
0.048
0.218
Defect size II (1.5—3 cm)
603
58.7
614
59.7
0.022
0.082
Defect size III (> 3 cm)
196
19.1
205
19.9
0.022
0.132
ASA score I
438
42.6
435
42.3
0.006
0.162
ASA score II
522
50.8
527
51.3
0.010
0.124
ASA score III-IV
68
6.6
66
6.4
0.008
0.067
EHS medial
275
26.8
267
26.0
0.018
0.113
EHS lateral
845
82.2
850
82.7
0.013
0.113
EHS femoral
36
3.5
32
3.1
0.022
0.021
EHS scrotal
11
1.1
14
1.4
0.027
0.023
No Mesh Fixation
846
82.3
847
82.4
0.003
0.223
Tacks
149
14.5
152
14.8
0.008
0.110
Glue
27
2.6
23
2.2
0.025
0.277
Combined
6
0.6
6
0.6
0.000
0.075
Preoperative pain
691
67.2
687
66.8
0.008
0.535
Unknown preoperative pain
15
1.5
22
2.1
0.051
0.223
No preoperative pain
322
31.3
319
31.0
0.006
0.634
Risk factors
299
29.1
296
28.8
0.006
0.034
The standardized differences between the matching variables both before (original sample) and after (matched sample) matching are shown below. Table 5 presents the standardized differences for the continuous matching variables and Table 4 for the categorical matching variables. For all matching variables this difference was less than 10%, attesting to a good balance for the variables included in the model.
Table 5
Standardized differences for continuous matching parameters before and after matching
Slit Mesh
Stand. Diff
Yes
No
Matched sample
Original sample
Age [years]
Mean ± SD
57.1 ± 16.0
56.9 ± 14.8
0.010
0.157
BMI [kg/m2]
Mean ± SD
25.4 ± 3.8
25.4 ± 3.4
0.026
0.153
Table 6 demonstrates differences between slit mesh and non-slit mesh patients after matching. For recurrence, there is a significant disadvantage for non-slit mesh patients. Here, 0.6% of slit mesh patients and 1.8% of non-slit mesh patients reported recurrence, whereas their matched patient reported no recurrence (no concordant cases). This corresponds to a systematic deviation (p = 0.023). No significant difference was found between slit mesh and non-slit mesh patients for any of the other outcome parameters (Fig. 4).
Table 6
Analysis of systematic differences in the perioperative and 1-year follow-up outcomes between slit mesh and non-slit mesh (matched pair analysis including odds ratios and corresponding 95% confidence intervals)
Concordant cases [%]
Disadvantageous cases [%]
p-Value
OR for matched samples
Slit mesh
Non-slit mesh
OR
Lower limit
Upper limit
Intraoperative complications
0.00
1.26
1.36
1.000
0.929
0.402
2.130
General complications
0.00
0.29
0.68
0.344
0.429
0.072
1.877
Postoperative complications
0.00
0.39
0.97
0.180
0.400
0.092
1.387
Complication-related reoperations
0.00
0.19
0.39
0.687
0.500
0.045
3.489
Recurrence on 1-year follow-up
0.00
0.58
1.75
0.023
0.333
0.108
0.877
Pain on exertion on 1-year follow-up
1.65
9.24
7.98
0.367
1.159
0.853
1.576
Pain at rest on 1-year follow-up
0.49
5.25
4.47
0.484
1.174
0.777
1.779
Pain requiring treatment on 1-year follow-up
0.10
4.18
3.02
0.201
1.387
0.854
2.277
Fig. 4
Forest plot of adjusted odds ratio (OR) including confidence intervals for perioperative and 1-year follow-up outcomes comparing slit mesh versus non-slit mesh
Figure 5 shows the results of the standardized differences for patients with (n = 3,098) and without (n = 1,287) follow-up information. Standardized differences above a value of 10% were found for age, TEP and TAPP as well as ASA I and ASA II. The patients in the analysis population were on average 5.2 years older and had been operated on more often with the TEP technique. As regards the ASA scores, the proportion of group I scores was lower in the analysis population but the proportion of group II scores was somewhat higher. Standardized differences of less than 0.1 were found for all other variables, including the perioperative complication rates, and are thus not suggestive of any bias in patient selection due to available follow-up information.
Fig. 5
Scatter plot of standardized differences between patients with and without follow-up information
The double mesh technique represents a preliminary stage in the development of the surgical technique with slit meshes investigated in this study.
In 1993, Felix et al. [21] reported on a series with 85 laparoscopic hernia operations in which a double mesh technique was used for the first time. A medially slit mesh was placed and fixed laterally around the spermatic cord before a second, non-slit, mesh was placed on top of it. Variations of the slit configuration and mesh sizes were used in further studies [8, 22, 23].
B. Detruit [24] was the first to implant the mesh used in this present study in 322 patients between December 1997 and December 2001. The recurrence rate after one year was 0.44%, and the chronic pain rate was 0.89%.
Witzig et al. [25] also implanted the same mesh in 247 patients between 2000 and 2003. With a follow-up rate of 94%, they did not detect any recurrence during the first year.
In addition to higher recurrence rates, it was feared that the additionally needed dissection of the spermatic cord would increase the testicular atrophy rate, even causing necrosis and chronic pain.
Celik et al. [7] demonstrated in 40 patients, who had been treated in two similarly sized groups with slit or non-slit mesh, that there was no statistically significant difference in terms of the preoperative, 5-day postoperative or 6-month follow-up testicular volume.
Skawran et al. [26] also demonstrated in their case series with 59 patients that bilateral repair of an inguinal hernia in slit double mesh technique and requisite mobilization of the spermatic cord did not impact testicular function.
The use of a slit mesh in laparo-endoscopic inguinal hernia repair continues to trigger controversial debate. No evidence was found in the guidelines or literature reviews [3, 6] of an advantage for the use of slit meshes in laparo-endoscopic inguinal hernia repair.
In 2018, a comparative retrospective study was then published in which 149 TEP repairs with a slit mesh were compared with 154 repairs with a non-slit mesh [17]. This study did not find any difference in the recurrence rate or the complications, but did identify better postoperative and chronic pain results for the repairs with non-slit meshes [17].
The last study published involving propensity score matching of 353 laparoscopic inguinal hernia repairs without slit mesh and 258 repairs with a slit mesh [16] pointed to a lower probability of recurrence for the use of a slit mesh [16]. There was no evidence of an influence on chronic pain or complications [16].
This analysis of prospective data from the Herniamed Registry reported on here presents a retrospective comparison of laparo-endoscopic inguinal hernia repair performed with a slit mesh versus non-slit mesh. Only patients with primary unilateral inguinal hernia were included in analysis. Propensity score matching was chosen as a statistical model. To assure the greatest possible degree of mesh comparability, the Parietex multifilament, folding slit mesh (slit mesh) or the Parietex multifilament, anatomical folding mesh (non-slit mesh) was used.
Based on 1,028 matched pairs of laparo-endoscopic inguinal hernia repairs performed with a slit mesh versus non-slit mesh, it can be demonstrated that the recurrence rate on 1-year follow-up was significantly lower when using slit meshes. No significant differences were found for any of the other outcome variables (perioperative complications, complication-related reoperations, pain at rest, pain on exertion, or chronic pain requiring treatment on 1-year follow-up).
The most recently published data on this key question and our own findings suggest there is reason to critically rethink the hitherto recommendations and conduct further studies. In particular, it must be clarified whether the use of slit meshes does indeed lead to more chronic pain, as noted in one study [17], or tends to influence the recurrence rate, and in a positive sense at that, as seen in the study by Chue et al. [16] and in our own analysis. Noteworthy is that the two studies that used propensity score matching as a statistical model drew similar conclusions. The current data situation should act as an incentive to conduct further comparative studies (RCTs, studies with propensity score matching) with a longer follow-up.
Registry analyses have limitations. Missing or incorrect data can negatively impact the findings. All responsible surgeons participating in Herniamed sign a cooperation contract in which they commit to ensuring that all the necessary data are completely and correctly entered. The registry software will indicate any missing data. In the follow-up questionnaire sent after one year, patients and their general practitioner are asked once again about any perioperative complications. At the time of certification as a hernia center, the auditor can again check data entries for completeness and correctness. No 1-year follow-up data are available for a relevant proportion of patients. However, calculation of the standardized differences between patients with and without follow-up does not point to any selection bias.
The fact that far fewer hospitals/practices and surgeons used a slit mesh compared with a non-slit mesh in laparo-endoscopic inguinal hernia repair may represent a certain bias in the results. The average number of surgeons per institution in the slit mesh group (4.8) was higher than in the non-slit mesh group (3.8). Furthermore, in 1019 matched pairs in the slit mesh group, the operations were performed by 29 different surgeons, the majority of whom were still in training. The experience of the surgeon does not appear to have any demonstrable influence on the results.
In summary, this present analysis of the use of a slit mesh versus a non-slit mesh in laparo-endoscopic inguinal hernia repair demonstrates a significantly lower recurrence rate and no negative association between the slit meshes and the chronic pain rate. This has been confirmed by one other recent study.
One possible explanation for the significantly lower rate is that surgeon-related mesh placement variation is marked less for the slit mesh than the flat mesh, because mesh positioning is specified due to the configuration of the slit. Another possible explanation is that, taking into account the possible pathways for recurrence, the slit mesh technique reduces the probability of caudal recurrence (Fig. 1c).
Due to the existing limitations of the studies, the key question should be investigated in further comparative studies. An ideal approach would be a prospective study with bilateral hernias, with one side repaired using a slit mesh and the other side with a flat mesh. Data analysis of 5-year follow-up is already in the planning stage.
Declarations
Ethical approval
Only cases of routine hernia surgery were documented in the Herniamed Registry and all patients have signed a special informed consent declaration agreeing to participate.
The Herniamed Registry has ethical approval (BASEC No. 2016—00.123, 287/2017BO2).
Human and animal rights
This article does not contain any Study with animals performed by any of the authors.
Conflict of interest
Ferdinand Köckerling reports grants to fund Herniamed from Johnson&Johnson, Norderstedt, Karl Storz, Tuttlingen, MenkeMed, Munich, DB Karlsruhe and personal fees from BD Karlsruhe.
Konstantinos Zarras, Joseph Kankam, Jens Plambeck, Martin Hukauf have nothing to disclose.
Informed consent
All patients with routine hernia surgery documented in Herniamed Registry have signed an informed consent declaration agreeing to participate.
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
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Stabilini C, van Veenendaal N, Aasvang E, Agresta F, Aufenacker T, Berrevoet F, Burgmans I, Chen D, de Beaux A, East B, Garcia-Alamino J, Henriksen N, Köckerling F, Kukleta J, Loos M, Lopez-Cano M, Lorenz R, Miserez M, Montgomery A, Morales-Conde S, Oppong C, Pawlak M, Podda M, Reinpold W, Sanders D, Sartori A, Tran HM, Verdaguer M, Wiessner R, Yeboah M, Zwaans W, Simons M (2023) Update of the international hernia surge guidelines for groin hernia management. BJS Open 7:zrad080. https://doi.org/10.1093/bjsopen/zrad080CrossRefPubMedPubMedCentral
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Bittner R, Arregui ME, Bisgaard T, Dudai M, Ferzli GS, Fitzgibbons RJ, Fortelny RH, Klinge U, Köckerling F, Kuhry E, Kukleta J, Lomanto D, Misra MC, Montgomery A, Morales-Conde S, Reinpold W, Rosenberg J, Sauerland S, Schug-Pass C, Singh K, Timoney M, Weyhe D, Chowbey P (2011) Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)]. Surg Endosc 25(9):2773–843. https://doi.org/10.1007/s00464-011-1799-6CrossRefPubMedPubMedCentral
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Bittner R, Montgomery MA, Arregui E, Bansal V, Bingener J, Bisgaard T, Buhck H, Dudai M, Ferzli GS, Fitzgibbons RJ, Fortelny RH, Grimes KL, Klinge U, Köckerling F, Kumar S, Kukleta J, Lomanto D, Misra MC, Morales-Conde S, Reinpold W, Rosenberg J, Singh K, Timoney M, Weyhe D, Chowbey P (2015) Update of guidelines on laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia (International Endohernia Society). Surg Endosc 29(2):289–321. https://doi.org/10.1007/s00464-014-3917-8CrossRefPubMed
Bracale U, Andreuccetti J, Sodo M, Merola G, Pignata G (2018) Lack of advantages of slit mesh placement during laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP): a single centre, case matched study. BMC 18(1):75. https://doi.org/10.1186/s12893-018-0409-0CrossRef
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Celik AS, Memmi N, Celebi F, Guzey D, Celik A, Kaplan R, Oncu M (2009) Impact of slit and nonslit mesh technique on testicular perfusion and volume in the early and late postoperative period of the totally extraperitoneal preperitoneal technique in patients with inguinal hernia. Am J Surg 198(2):287–91. https://doi.org/10.1016/j.amjsurg.2008.11.038CrossRefPubMed
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Domniz N, Howard Perry Z, Lantsberg L, Avinoach E, Mizrahi S, Kirshtein B (2011) Slit versus non-slit mesh placement in total extraperitoneal inguinal hernia repair. World J Surg 35(11):2382–2386. https://doi.org/10.1007/s00268-011-1251-zCrossRefPubMed
9.
Chia CL, Su J, Hoe Y, Shelat VG, Junnarkar SP, Low J, Woon WW (2015) Outcomes of slit mesh in laparoscopic totally extraperitoneal inguinal hernia repair: Does it affect recurrence? Asian J Endosc Surg 8(4):434–8. https://doi.org/10.1111/ases.12224CrossRefPubMed
10.
Leibl BJ, Schmedt CG, Schwarz J, Däubler P, Kraft K, Schlossnickel B, Bittner R (1998) A single institution’s experience with transperitoneal laparoscopic hernia repair. Am J Surg 175(6):446–51. https://doi.org/10.1016/s0002-9610(98)00074-9. (discussion 452)CrossRefPubMed
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Leibl BJ, Kraft B, Redecke JD, Schmedt CG, Ulrich M, Kraft K, Bittner R (2002) Are postoperative complaints and complications influenced by different techniques in fashioning and fixing the mesh in transperitoneal laparoscopic hernioplasty? Results of a prospective randomized trial. World J Surg 26(12):1481–4. https://doi.org/10.1007/s00268-002-6204-0CrossRefPubMed
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Cristaudo A, Nayak A, Martin S, Adib R, Martin I (2015) A prospective randomised trial comparing mesh types and fixation in totally extraperitoneal inguinal hernia repairs. Int J Surg 17:79–82. https://doi.org/10.1016/j.ijsu.2015.03.018CrossRefPubMed
13.
Velasco JM, Gelman C, Vallina VL (1996) Preperitoneal bilateral inguinal herniorrhaphy evolution of a technique from conventional to laparoscopic. Surg Endosc 10(2):122–7. https://doi.org/10.1007/s004649910029CrossRefPubMed
14.
McKernan JB, Laws HL (1993) Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach. Surg Endosc 7(1):26–8. https://doi.org/10.1007/BF00591232CrossRefPubMed
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Phillips EH, Rosenthal R, Fallas M, Carrol B, Arregui M, Corbitt J, Fitzgibbons R, Seid A, Schultz L, Toy F (1995) Reasons for early recurrence following laparoscopic hernioplasty. Surg Endosc 9(2):140–4. https://doi.org/10.1007/BF00191954CrossRefPubMed
16.
Chue KM, Kabir T, Wong WK, Kam JH, Tan JTH, Tan CC, Ong LWL, Chua H, Tan AYH, Leong FQH, Koh FHX, Foo FJ, Ngaserin S, Yeung BPM (2024) Impact of slit compared with nonslit mesh in laparoscopic groin hernia repairs-A comprehensive propensity score analysis of a cohort of 611 hernias. Surgery 176(5):1424–1432. https://doi.org/10.1016/j.surg.2024.07.043CrossRefPubMed
17.
Yildirim D, Donmez T, Ozcevik H, Cakir M, Demiryas S, Akturk OM (2018) Comparison of slit mesh versus nonslit mesh in laparoscopic extraperitoneal hernia repair. Wideochir Inne Tech Maloinwazyjne 13(4):469–476. https://doi.org/10.5114/wiitm.2018.77258CrossRefPubMedPubMedCentral
Korman J, Hiatt J, Feldmar D et al (1997) Mesh configurations in laparoscopic extraperitoneal herniorrhaphy. A comparison of techniques. Surg Endosc 11:1102–1105. https://doi.org/10.1007/s004649900540CrossRefPubMed
23.
Posta CG (1997) Laparoscopic inguinal hernia repair with extraperitoneal double mesh technique. J Laparoendosc Adv Surg Tech 7(1):19–27. https://doi.org/10.1089/lap.1997.7.19CrossRef
24.
Détruit B (2005) Cure laparoscopique prépéritonéale des hernies del’aine par prothése fendue non fixée. Le J de coelio-chirurgie 56(12):47–51
25.
Witzig JA, Depierre PH, Francis K, Zurbuchen PH (2004) Totally extraperitoneal inguinal hernioplasty using a non fixed anatomical slit polyester mesh: PARIETEX ADP2 Br. J Surg 91:911–912
26.
Skawran S, Weyhe D, Schmitz B, Belyaev O, Bauer KH (2011) Bilateral endoscopic total extraperitoneal (TEP) inguinal hernia repair does not induce obstructive azoospermia: data of a retrospective and prospective trial. World J Surg 35(7):1643–1648. https://doi.org/10.1007/s00268-011-1072-0CrossRefPubMed
Ist eine Speichelgangsblockade und die damit verbundene Sialadenitis nicht durch Steine bedingt, wird oftmals versucht, die Symptomatik zu lindern, indem man den Gang mechanisch weitet. Ein aktuelles Review kann den Eingriff als chancenreiches Verfahren bestätigen und deckt gleichzeitig Schwächen auf.
Mehr als eine Million Menschen in Deutschland leiden unter Hallux valgus – eine Fehlstellung des Großzehs, die je nach Schweregrad und Symptomen behandelt wird. Welche neuen Empfehlungen die aktualisierte S2e-Leitlinie bietet, erklärt der Orthopäde Prof. Sebastian Baumbach im MedTalk Leitlinie KOMPAKT der Zeitschrift Orthopädie und Unfallchirurgie.
Ein chirurgischer Eingriff kann für Patienten mit primärem Hyperparathyreoidismus gegenüber dem konservativen Management metabolisch von Vorteil sein. Denn wie eine Studie zeigt, senkt die Operation das Diabetesrisiko.
