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03.02.2017 | Ausgabe 10/2017 Open Access

Surgical Endoscopy 10/2017

TEP or TAPP for recurrent inguinal hernia repair—register-based comparison of the outcome

Zeitschrift:
Surgical Endoscopy > Ausgabe 10/2017
Autoren:
F. Köckerling, R. Bittner, A. Kuthe, M. Hukauf, F. Mayer, R. Fortelny, C. Schug-Pass
 

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In the updated guidelines on laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia, the International Endohernia Society states as grade A recommendation for primary inguinal hernias, following comparison of the two laparo-endoscopic techniques, that both techniques are acceptable treatment options for inguinal hernia repair and there are sufficient data to conclude that both TAPP and TEP are effective methods of laparo-endoscopic primary inguinal hernia repair (1). A comparative Swiss registry study with a large proportion of TEP operations identified for primary inguinal hernias higher perioperative complication rates for TEP (2), whereas a German registry study with a large proportion of TAPP operations detected a higher perioperative complication rate for TAPP (3). Comparison of the outcome of laparo-endoscopic inguinal hernia repair for primary inguinal hernias with that of recurrent inguinal hernias revealed that recurrent procedures are associated with significantly higher postoperative complication rates, complication-related reoperation rates, and higher pain and recurrence rates (4).
There are six meta-analyses available for comparison of laparo-endoscopic with open repair of recurrent inguinal hernias (5, 6, 7, 8, 9, 10). The meta-analysis by Pisanu (8) contained the largest number of exclusively prospective randomized trials (RCTs) (11, 12, 13, 14, 15, 16, 17). All the RCTs included in that meta-analysis compared the laparo-endoscopic procedures with the open Lichtenstein technique. Three RCTs compared the Lichtenstein operation with TAPP (13, 15, 17), two RCTs compared it with TEP (11, 16), and two RCTs compared it with both TEP and TAPP (12, 14).
In the meta-analysis, only joint comparison of the two laparo-endoscopic techniques (TEP, TAPP) with the open Lichtenstein technique was performed. There was no high risk of bias in any of the included trials (8). The meta-analysis by Pisanu et al. (8) detected for laparo-endoscopic repair of recurrent hernias a significantly lower chronic pain rate and significantly earlier resumption of normal everyday activities. Compared with the Lichtenstein operation, the operative time for laparo-endoscopic procedures was significantly longer (8). On the basis of the meta-analyses, the European Hernia Society recommends laparo-endoscopic inguinal hernia repair for recurrent hernias after conventional open repair (10, 18). No distinction is made here between the laparo-endoscopic TEP and TAPP techniques.
To date, no randomized trials have been conducted to compare the TEP vs TAPP outcome for recurrent inguinal hernia repair following previous open repair. A Swiss registry study (19) compared the outcome of a total of 1309 laparo-endoscopic recurrent operations, of which 1022 used the TEP technique and 287 the TAPP technique. A significantly higher intraoperative complication rate and longer operative time was identified for the TEP group. The postoperative length of hospital stay was longer for patients undergoing TAPP (19). Surgical postoperative complications, general postoperative complications, and conversion rates were not significantly different (19). The authors concluded that the absolute outcome differences are small and that both techniques appear to be safe and effective for patients undergoing laparo-endoscopic repair for unilateral recurrent inguinal hernia (19).
Based on data from the Herniamed Registry (20), the present analysis now compares the outcome of elective laparo-endoscopic recurrent unilateral inguinal hernia repair in men following previous open operation.

Patients and methods

The Herniamed Registry is a multicenter, internet-based hernia registry (20) into which 427 participating hospitals and surgeons engaged in private practice (Herniamed Study Group) have entered data prospectively on their patients who had undergone hernia surgery. All postoperative complications occurring up to 30 days after surgery are recorded. On one-year follow-up, postoperative complications are once again reviewed when the general practitioner and patient complete a questionnaire. They are also asked about any re-recurrence, pain at rest, and on exertion as well as pain requiring treatment. This present analysis compares the prospective data collected for all male patients with a minimum age of 16 years who had undergone elective recurrent unilateral inguinal hernia repair using either transabdominal preperitoneal patch plasty (TAPP) or total extraperitoneal patch plasty (TEP).
In total, 2,246 patients were enrolled between September 1, 2009, and August 31, 2013 (Fig. 1). Of these patients, 782 (34.8%) had TEP and 1,464 (65.2%) TAPP repair. All the patients had to have one-year follow-up data available (follow-up-rate: 100%).
The majority of primary unilateral repairs in the Herniamed Registry have been performed as open mesh repair (Lichtenstein) with 32.5% and laparo-endoscopic mesh repair (TAPP, TEP) with 49.9%. Non-mesh repairs (Shouldice, Bassini) in primary unilateral inguinal hernia repair in the Herniamed Registry make only a contribution of 4.7% of all cases.
The demographic and surgery-related parameters included age (years), BMI (kg/m2), ASA-score (I, II, III, IV) as well as EHS classification (hernia type: medial, lateral, femoral, scrotal) and defect size: grade I = < 1.5 cm, grade II: 1.5–3 cm, grade III: > 3 cm) (21) and general risk factors (nicotine, COPD, diabetes, cortisone, immunosuppression, etc.). Risk factors were dichotomized, i.e., ‘yes’ if at least one risk factor is positive and ‘no’ otherwise.
The dependent variables were intra- and postoperative complication rates, number of reoperations due to complications as well as the one-year results (re-recurrence rate, pain at rest, pain on exertion, and pain requiring treatment).
All analyses were performed with the software SAS 9.2 (SAS institute Inc. Cary, NY, USA) and intentionally calculated to a full significance level of 5%, i.e., they were not corrected in respect of multiple tests, and each p value ≤ 0.05 represents a significant result. To discern differences between the groups in unadjusted analyses, Fisher’s exact test was used for categorical outcome variables, and the robust t test (Satterthwaite) for continuous variables.
To rule out any confounding of data caused by different patient characteristics, the results of unadjusted analyses were verified via multivariable analyses in which, in addition to TEP or TAPP operation, other influence parameters were simultaneously reviewed.
To identify influence factors in multivariable analyses, the binary logistic regression model for dichotomous outcome variables was used. Estimates for odds ratio (OR) and the corresponding 95% confidence interval based on the Wald test were given. For influence variables with more than two categories, one of the latter forms was used in each case as reference category. For age (years) the 10-year OR estimate and for BMI (kg/m2) the 5-point OR estimate were given. Results were presented in tabular form, sorted by descending impact.

Results

Univariable analysis

In the TEP group, recurrent repair was performed for n = 554/782 (70.8%) patients following previous suture repair and for n = 228/782 (29.2%) after mesh repair. In the TAPP group, recurrent repair was performed for n = 974/1,464 (66.5%) patients after suture and n = 490/1,464 (33.5%) after mesh repair (Table 1).
Table 1
Laparo-endoscopic recurrent unilateral inguinal hernia repair in men and previous operation
 
Previous operation
Total
Suture
Open mesh
N
%
N
%
N
%
Procedure
554
36.3
228
31.8
782
34.8
TEP
TAPP
974
63.7
490
68.2
1464
65.2
Total
1528
100.0
718
100.0
2246
100.0
No significant difference in mean age and BMI was found between the recurrent operations in TEP and TAPP technique (Table 2). That was also true for the ASA-score, defect size, and risk factors (Table 3). With regard to EHS localization, there were significantly more medial recurrent inguinal hernia defects (52.2% vs. 44.8%; p < 0.001) and significantly fewer lateral defects (55.4% vs. 68.8%; p < 0.001) in the TAPP group (Table 3).
Table 2
Age and BMI of patients with laparo-endoscopic recurrent unilateral inguinal hernia repair in men
 
TEP
TAPP
p
Age [years]
Mean ± STD
58.3 ± 15.8
59.2 ± 15.4
0.186
BMI
Mean ± STD
26.1 ± 3.5
25.9 ± 3.3
0.152
Table 3
Demographic- and surgery-related parameters and risk factors of patients with laparo-endoscopic recurrent unilateral inguinal hernia repair in men
 
TEP
TAPP
p
n
%
n
%
ASA-score
I
186
23.79
376
25.63
0.467
II
454
58.06
849
57.87
III/IV
142
18.16
242
16.50
Defect size
I (< 1,5 cm)
137
17.52
282
19.22
0.524
II (1,5–3 cm)
510
65.22
950
64.76
III (>3 cm)
135
17.26
235
16.02
Risk factors
Total
yes
249
31.84
438
29.86
0.330
no
533
68.16
1029
70.14
COPD
yes
63
8.06
88
6.00
0.063
no
719
91.94
1379
94.00
Diabetes
yes
45
5.75
84
5.73
0.978
no
737
94.25
1383
94.27
Aortic aneurysm
yes
6
0.77
10
0.68
0.818
no
776
99.23
1457
99.32
Immunosuppression
yes
5
0.64
9
0.61
0.941
no
777
99.36
1458
99.39
Corticoid
yes
9
1.15
11
0.75
0.335
no
773
98.85
1456
99.25
Smoking
yes
88
11.25
174
11.86
0.669
no
694
88.75
1293
88.14
Coagulopathy
yes
11
1.41
22
1.50
0.861
no
771
98.59
1445
98.50
Antiplatelet medication
yes
73
9.34
129
8.79
0.669
no
709
90.66
1338
91.21
Anticoagulation therapy
yes
16
2.05
28
1.91
0.823
no
766
97.95
1439
98.09
EHS-classification medial
yes
350
44.76
765
52.15
<0.001
no
432
55.24
702
47.85
EHS-classification lateral
yes
538
68.80
813
55.42
<0.001
no
244
31.20
654
44.58
EHS-classification femoral
yes
22
2.81
55
3.75
0.245
no
760
97.19
1412
96.25
EHS-classification scrotal
yes
6
0.77
21
1.43
0.168
no
776
99.23
1446
98.57
As regards the target parameters, no differences were found between TEP and TAPP recurrent inguinal hernia repair in the intraoperative complications (Table 4). For the postoperative complications, significantly lower values (1.7% vs. 4.6%; p < 0.001) were identified for TEP, but that was mainly due to the difference in the seroma rate (0.5% vs. 3.2%; p < 0.001) (Table 4).
Table 4
Univariable analysis of intra- and postoperative complications, complication-related reoperations, and 1-year follow-up results of patients with laparo-endoscopic recurrent unilateral inguinal hernia repair in men
 
TEP
TAPP
p
n
%
n
%
Intraoperative complication
Total
yes
13
1.66
13
0.89
0.101
no
769
98.34
1454
99.11
Bleeding
yes
7
0.90
8
0.55
0.332
no
775
99.10
1459
99.45
Injury
Total
yes
8
1.02
9
0.61
0.286
no
774
98.98
1458
99.39
Vascular
yes
4
0.51
4
0.27
0.365
no
778
99.49
1463
99.73
Bowel
yes
0
0.00
5
0.34
0.102
no
782
100.0
1462
99.66
Bladder
yes
2
0.26
0
0.00
0.053
no
780
99.74
1467
100.0
Postoperative complication
Total
yes
13
1.66
67
4.57
<0.001
no
769
98.34
1400
95.43
Bleeding
yes
10
1.28
19
1.30
0.974
no
772
98.72
1448
98.70
Seroma
yes
4
0.51
47
3.20
<0.001
no
778
99.49
1420
96.80
Infection
yes
0
0.00
1
0.07
0.465
no
782
100.0
1466
99.93
Bowel injury
yes
0
0.00
1
0.07
0.465
no
782
100.0
1466
99.93
Wound healing disorders
yes
0
0.00
1
0.07
0.465
no
782
100.0
1466
99.93
Reoperation
yes
11
1.41
16
1.09
0.512
no
771
98.59
1451
98.91
Recurrence on follow-up
yes
7
0.90
21
1.43
0.275
no
775
99.10
1446
98.57
Pain in rest on follow-up
yes
54
6.91
79
5.39
0.146
no
728
93.09
1388
94.61
Pain on exertion on follow-up
yes
92
11.76
158
10.77
0.475
no
690
88.24
1309
89.23
Pain requiring treatment on follow-up
yes
35
4.48
50
3.41
0.206
no
747
95.52
1417
96.59
However, since this did not result in any difference in the complication-related reoperation rate, it only meant that TAPP was associated with a higher seroma rate, which responded to conservative treatment.
On one-year follow-up no differences were detected in the re-recurrence rate after recurrent inguinal hernia repair following TAPP and TEP, or in the rates of pain at rest, pain on exertion, or chronic pain requiring treatment (Table 4).

Multivariable analyses

For the intraoperative complications, complication-related re-reoperations, and recurrences on follow-up it was not possible to calculate a valid model since the number of positive cases was too small.

Postoperative complications

The results of the model that explored how the variables related to patient and operation characteristics (surgical technique, previous open primary operation, age, BMI, ASA-score, defect size, and defect localization as well as the presence of risk factors) impacted onset of postoperative complications are illustrated in Table 5 (model matching: p < 0.001).
Table 5
Multivariable analysis of postoperative complications
Parameter
p value
Category
OR estimate
95% CI
Procedure
<0.001
TAPP vs TEP
3.010
1.636
5.538
Previous operation
0.044
Suture vs open mesh
1.753
1.016
3.025
EHS-classification medial
0.049
yes vs no
0.457
0.209
0.997
Defect size
0.055
II (1,5–3 cm) vs I (<1,5 cm)
1.052
0.539
2.055
III (>3 cm) vs I (<1,5 cm)
2.012
0.935
4.329
Risk factors
0.165
yes vs no
1.428
0.864
2.360
Age [10-years-OR]
0.270
 
1.107
0.924
1.326
EHS-classification femoral
0.297
yes vs no
1.717
0.621
4.746
BMI [5-points-OR]
0.394
 
0.857
0.601
1.223
ASA-score
0.414
II vs I
0.896
0.473
1.695
III/IV vs I
1.340
0.592
3.034
EHS-classification scrotal
0.552
yes vs no
1.500
0.394
5.715
EHS-classification lateral
0.646
yes vs no
0.827
0.368
1.860
The postoperative complications, primarily seromas, were affected by the surgical technique. Conduct of TAPP operation (OR = 3.010 [1.636; 5.538]; p < 0.001) increased the risk of postoperative complications. With a prevalence of 3.6%, this would amount to 53 postoperative complications for every 1000 patients undergoing TAPP operation compared with 18 complications for patients operated on in TEP technique. The risk for development of postoperative complications was also increased in patients with previous open suture repair (OR = 1,753 [1.016; 3.025]; p = 0.044) and decreased in EHS medial classification (OR = 0.457. [0.209; 0.997].

Pain at rest

The results of multivariable analysis of pain at rest are presented in Table 6 (model matching: p = 0.009). Here BMI was the only influence factor identified (p < 0.001). A five-point higher BMI increased pain at rest (5-point OR = 1.483 [1.176; 1.170], but there was no evidence of the surgical technique or previous open primary repair having impacted pain at rest.
Table 6
Multivariable analysis of pain at rest in 1-year follow-up
Parameter
p value
Category
OR estimate
95%-CI
BMI [5-points-OR]
<0.001
 
1.483
1.176
1.870
Defect size
0.065
II (1,5–3 cm) vs I (<1,5 cm)
0.786
0.511
1.210
III (>3 cm) vs I (<1,5 cm)
0.444
0.225
0.877
Procedure
0.124
TAPP vs TEP
0.751
0.521
1.082
Previous operation
0.232
Suture vs open mesh
0.798
0.551
1.155
EHS-classification lateral
0.248
yes vs no
0.692
0.370
1.292
Risk factors
0.328
yes vs no
1.222
0.818
1.827
EHS-classification medial
0.372
yes vs no
0.758
0.412
1.394
Age [10-years-OR]
0.513
 
0.957
0.837
1.093
EHS-classification femoral
0.869
yes vs no
1.081
0.431
2.709
ASA-score
0.899
II vs I
0.941
0.595
1.490
III/IV vs I
0.851
0.427
1.694
EHS-classification scrotal
0.980
yes vs no
0.000
0.000
I

Pain on exertion

The results of multivariable analysis of pain on exertion are shown in Table 7 (model matching: p < 0.001). These were significantly influenced by age, BMI, and defect size. A higher age (10-year OR = 0.846 [0.767; 0.933]; p < 0.001) as well as larger hernias (II vs I: OR = 0.699 [0.508; 0.964]; III vs I: OR = 0.517 [0.318; 0.840]; p = 0.018) reduced the risk of pain on exertion. Conversely, a five-point higher BMI (5-point OR = 1.289 [1.073; 1.549]; p = 0.007) increased the pain risk, but there was no evidence of the surgical technique or previous open primary repair having impacted the postoperative complication rate.
Table 7
Multivariable analysis of pain on exertion in 1-year follow-up
Parameter
p value
Category
OR estimate
95%-CI
Age [10-years-OR]
<0.001
 
0.846
0.767
0.933
BMI [5-points-OR]
0.007
 
1.289
1.073
1.549
Defect size
0.018
II (1,5–3 cm) vs I (<1,5 cm)
0.699
0.508
0.964
III (>3 cm) vs I (<1,5 cm)
0.517
0.318
0.840
EHS-classification lateral
0.066
yes vs no
0.646
0.406
1.029
EHS-classification scrotal
0.295
yes vs no
0.338
0.044
2.577
Procedure
0.365
TAPP vs TEP
0.878
0.664
1.163
EHS-classification medial
0.405
yes vs no
0.823
0.520
1.302
ASA-score
0.471
II vs I
0.870
0.623
1.217
III/IV vs I
1.075
0.646
1.787
Risk factors
0.632
yes vs no
0.925
0.674
1.270
EHS-classification femoral
0.797
yes vs no
1.096
0.543
2.214
Previous operation
0.826
Suture vs open with mesh
0.968
0.727
1.290

Chronic pain requiring treatment

The results of multivariable analysis of chronic pain requiring treatment are presented in Table 8 (model matching: p = 0.020). Here BMI was the only significant influence factor identified (p = 0.006). Accordingly, a five-point higher BMI increased the rate of chronic pain requiring treatment (5-point OR = 1.477 [1.121; 1.948]), but there was no evidence of the surgical technique or previous open primary repair having impacted the rate of chronic pain requiring treatment.
Table 8
Multivariable analysis of chronic pain requiring treatment in 1-year follow-up
Parameter
p-value
Category
OR estimate
95%-CI
BMI [5-points-OR]
0.006
 
1.477
1.121
1.948
Previous operation
0.076
Suture vs open mesh
0.666
0.425
1.043
EHS-classification medial
0.088
yes vs no
0.501
0.227
1.108
Procedure
0.195
TAPP vs TEP
0.742
0.473
1.165
EHS-classification lateral
0.246
yes vs no
0.615
0.270
1.399
Defect size
0.287
II (1,5–3 cm) vs I (<1,5 cm)
0.836
0.486
1.438
III (>3 cm) vs I (<1,5 cm)
0.515
0.225
1.179
EHS-classification femoral
0.382
yes vs no
1.556
0.578
4.190
Age [10-years-OR]
0.446
 
0.937
0.793
1.107
Risk factors
0.544
yes vs no
1.166
0.710
1.915
ASA-score
0.842
II vs I
1.048
0.584
1.881
III/IV vs I
1.252
0.547
2.865
EHS-classification scrotal
0.983
yes vs no
0.000
0.000
I

Discussion

In the Guidelines of the European Hernia Society (EHS) and the International Endohernia Society (IEHS), TEP and TAPP are recommended as equivalent procedures for recurrent hernia repair following the previous open mesh and suture repair of primary inguinal hernias (1, 10, 18). To date, no prospective randomized trials have been conducted to compare TEP and TAPP for recurrent inguinal hernia repair following previous open primary repair. A Swiss registry study that compared laparo-endoscopic recurrent hernia operations identified a significantly higher intraoperative complication rate and longer operative time for TEP operations, which were much more common than TAPP procedures in the patient group analyzed (19). The postoperative length of hospital stay was longer for patients undergoing TAPP (19). Surgical postoperative complications, general postoperative complications, and conversion rates were not significantly different (19). The authors concluded that the absolute outcome differences are small and that both techniques appear to be safe and effective for patients undergoing laparo-endoscopic repair for unilateral recurrent inguinal hernia (19).
Likewise, the present analysis of data from the Herniamed Registry, in which the proportion of TAPP operations was higher than that of the TEP operations, revealed similar outcomes for the laparo-endoscopic recurrent operations following previous open primary operation. Based on the Herniamed Registry data, no significant differences were found between the recurrent operations in TEP vs TAPP technique with regard to the intraoperative complications, complication-related reoperations, re-recurrence rates, rates of pain at rest, pain on exertion, or chronic pain requiring treatment. Unfavorable results were identified only with regard to the higher seroma rates associated with TAPP; these responded to conservative treatment. The influence variables identified here on multivariable analysis were, in addition to the surgical technique, the previous open primary operation and the EHS-classification medial. A previous open primary suture repair has a higher risk for development of a postoperative complication as a previous open primary mesh repair and the EHS-classification medial a lower risk. The results of multivariable analysis of the other parameters did not find any evidence of any impact exerted by the surgical technique.
Accordingly, this analysis of data from the Herniamed Registry corroborates the findings of the Swiss registry study. Similarly, the Herniamed Registry did not detect any significant differences between TEP and TAPP for recurrent unilateral inguinal hernia repair in men following previous open suture or mesh primary operation. That was true for the intraoperative complications, complication-related reoperations, re-recurrence, pain at rest, pain on exertion, and chronic pain requiring treatment on one-year follow-up. The only difference was that TAPP was associated with a higher seroma rate, which responded to conservative treatment. There was no difference in the other postoperative complications between TEP and TAPP for recurrent repair.
In summary, both TEP and TAPP can be recommended as effective techniques for treatment of recurrent inguinal hernia following previous open primary operation. The decision to use one or the other technique should be based solely on the surgeon’s expertise. The registry study presented here thus confirms the recommendations in the guidelines on laparo-endoscopic treatment of recurrent inguinal hernia following previous open primary operation.

Acknowledgements

Ferdinand Köckerling – Grants to fund the Herniamed Register from Johnson & Johnson, Norderstedt, Karl Storz, Tuttlingen, pfm medical, Cologne, Dahlhausen, Cologne, B Braun, Tuttlingen, MenkeMed, Munich and Bard, Karlsruhe.

Compliance with ethical standards

Disclosures

R. Bittner, A, Kuthe, M. Hukauf, F. Mayer, R. Fortelny, C. Schug-Pass have no conflicts of interest or financial ties to disclose.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://​creativecommons.​org/​licenses/​by/​4.​0/​), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Herniamed Study Group

Scientific Board

Köckerling, Ferdinand (Chairman) (Berlin); Bittner, Reinhard (Rottenburg); Fortelny, René (Wien); Jacob, Dietmar (Berlin); Koch, Andreas (Cottbus); Kraft, Barbara (Stuttgart); Kuthe, Andreas (Hannover); Lippert, Hans (Magdeburg):Lorenz, Ralph (Berlin); Mayer, Franz (Salzburg); Moesta, Kurt Thomas (Hannover); Niebuhr, Henning (Hamburg); Peiper, Christian (Hamm); Pross, Matthias (Berlin); Reinpold, Wolfgang (Hamburg); Simon, Thomas (Weinheim); Stechemesser, Bernd (Köln); Unger, Solveig (Chemnitz).

Participants

Ahmetov, Azat (Saint-Petersburg); Alapatt, Terence Francis (Frankfurt/Main); Albayrak, Nurettin (Herne); Amann, Stefan (Neuendettelsau); Anders, Stefan (Berlin); Anderson, Jürina (Würzburg); Antoine, Dirk (Leverkusen); Arndt, Anatoli (Elmshorn); Asperger, Walter (Halle); Avram, Iulian (Saarbrücken); Baikoglu-Endres, Corc (Weißenburg i. Bay.); Bandowsky, Boris (Damme); Barkus; Jörg (Velbert); Becker, Matthias (Freital); Behrend, Matthias (Deggendorf); Beuleke, Andrea (Burgwedel); Berger, Dieter (Baden–Baden); Birk, Dieter (Bietigheim-Bissingen); Bittner, Reinhard (Rottenburg); Blaha, Pavel (Zwiesel); Blumberg, Claus (Lübeck); Böckmann, Ulrich (Papenburg); Böhle, Arnd Steffen (Bremen); Bolle, Ludger (Berlin); Borchert, Erika (Grevenbroich); Born, Henry (Leipzig); Brabender, Jan (Köln); Breitenbuch von, Philipp (Radebeul); Brož, Miroslav (Ebersbach); Brütting, Alfred (Erlangen); Buchert, Annette (Mallersdorf-Pfaffenberg); Budzier, Eckhard (Meldorf); Burchett, Bert (Waren); Burghardt, Jens (Rüdersdorf); Cejnar, Stephan-Alexander (München); Chirikov, Ruslan (Dorsten); Claußnitzer, Christian (Ulm); Comman, Andreas (Bogen); Crescenti, Fabio (Verden/Aller); Daniels, Thies (Hamburg); Dapunt, Emanuela (Bruneck); Decker, Georg (Berlin); Demmel, Michael (Arnsberg); Descloux, Alexandre (Baden); Deusch, Klaus-Peter (Wiesbaden); Dick, Marcus (Neumünster); Dieterich, Klaus (Ditzingen); Dietz, Harald (Landshut); Dittmann, Michael (Northeim); Drummer, Bernhard (Forchheim); Eckermann, Oliver (Luckenwalde); Eckhoff, Jörn /Hamburg); Ehmann, Frank (Grünstadt); Eisenkrein, Alexander (Düren); Elger, Karlheinz (Germersheim); Engelhardt, Thomas (Erfurt); Erichsen, Axel (Friedrichshafen); Eucker, Dietmar (Bruderholz); Fackeldey, Volker (Kitzingen); Farke, Stefan (Delmenhorst); Faust, Hendrik (Emden); Federmann, Georg (Seehausen); Feichter, Albert (Wien); Fiedler, Michael (Eisenberg); Fikatas, Panagiotis (Berlin); Firl, Michaela (Perleberg); Fischer, Ines (Wiener Neustadt); Fleischer, Sabine (Dinslaken); Fortelny, René H. (Wien); Franczak, Andreas (Wien); Franke, Claus (Düsseldorf); Frankenberg von, Moritz (Salem); Frehner, Wolfgang (Ottobeuren); Friedhoff, Klaus (Andernach); Friedrich, Jürgen (Essen); Frings, Wolfram (Bonn); Fritsche, Ralf (Darmstadt); Frommhold, Klaus (Coesfeld); Frunder, Albrecht (Tübingen); Fuhrer, Günther (Reutlingen); Gassler, Harald (Villach); Gawad, Karim A. Frankfurt/Main); Gehrig, Tobias (Sinsheim); Gerdes, Martin (Ostercappeln); Germanov, German (Halberstadt; Gilg, Kai-Uwe (Hartmannsdorf); Glaubitz, Martin (Neumünster); Glauner-Goldschmidt, Kerstin (Werne); Glutig, Holger (Meissen); Gmeiner, Dietmar (Bad Dürrnberg); Göring, Herbert (München); Grebe, Werner (Rheda-Wiedenbrück); Grothe, Dirk (Melle); Gürtler, Thomas (Zürich); Hache, Helmer (Löbau); Hämmerle, Alexander (Bad Pyrmont); Haffner, Eugen (Hamm); Hain, Hans-Jürgen (Gross-Umstadt); Hammans, Sebastian (Lingen); Hampe, Carsten (Garbsen); Hanke, Stefan (Halle); Harrer, Petra (Starnberg); Hartung, Peter (Werne); Heinzmann, Bernd (Magdeburg); Heise, Joachim Wilfried (Stolberg); Heitland, Tim (München); Helbling, Christian (Rapperswil); Hempen, Hans-Günther (Cloppenburg); Henneking, Klaus-Wilhelm (Bayreuth); Hennes, Norbert (Duisburg); Hermes, Wolfgang (Weyhe); Herrgesell, Holger (Berlin); Herzing, Holger Höchstadt); Hessler, Christian (Bingen); Heuer, Matthias (Herten); Hildebrand, Christiaan (Langenfeld); Höferlin, Andreas (Mainz); Hoffmann, Henry (Basel); Hoffmann, Michael (Kassel); Hofmann, Eva M. (Frankfurt/Main); Hornung, Frederic (Wolfratshausen); Hügel, Omar (Hannover); Hüttemann, Martin (Oberhausen); Hunkeler, Rolf (Zürich); Imdahl, Andreas (Heidenheim); Isemer, Friedrich-Eckart (Wiesbaden); Jablonski, Herbert Gustav (Sögel); Jacob, Dietmar (Berlin); Jansen-Winkeln, Boris (Leipzig); Jantschulev, Methodi (Waren); Jenert, Burghard (Lichtenstein); Jugenheimer, Michael (Herrenberg); Junger, Marc (München); Kaaden, Stephan (Neustadt am Rübenberge); Käs, Stephan (Weiden); Kahraman, Orhan (Hamburg); Kaiser, Christian (Westerstede); Kaiser, Gernot Maximilian (Kamp-Lintfort); Kaiser, Stefan (Kleinmachnow); Kapischke, Matthias (Hamburg); Karch, Matthias (Eichstätt); Kasparek, Michael S. (München); Keck, Heinrich (Wolfenbüttel); Keller, Hans W. (Bonn); Kienzle, Ulrich (Karlsruhe); Kipfmüller, Brigitte (Köthen); Kirsch, Ulrike (Oranienburg); Klammer, Frank (Ahlen); Klatt, Richard (Hagen); Klein, Karl-Hermann (Burbach); Kleist, Sven (Berlin); Klobusicky, Pavol (Bad Kissingen); Kneifel, Thomas (Datteln); Knoop, Michael (Frankfurt/Oder); Knotter, Bianca (Mannheim); Koch, Andreas (Cottbus); Koch, Andreas (Münster); Köckerling, Ferdinand (Berlin); Köhler, Gernot (Linz); König, Oliver (Buchholz); Kornblum, Hans (Tübingen); Krämer, Dirk (Bad Zwischenahn); Kraft, Barbara (Stuttgart); Kratsch, Barthel (Dierdorf/Selters); Kreissl, Peter (Ebersberg); Krones, Carsten Johannes (Aachen); Kronhardt, Heinrich (Neustadt am Rübenberge); Kruse, Christinan (Aschaffenburg); Kube, Rainer (Cottbus); Kühlberg, Thomas (Berlin); Kühn, Gert (Freiberg); Kuhn, Roger (Gifhorn); Kusch, Eduard (Gütersloh); Kuthe, Andreas (Hannover); Ladberg, Ralf (Bremen); Ladra, Jürgen (Düren); Lahr-Eigen, Rolf (Potsdam); Lainka, Martin (Wattenscheid); Lammers, Bernhard J. (Neuss); Lancee, Steffen (Alsfeld); Lange, Claas (Berlin); Langer, Claus (Göttingen); Laps, Rainer (Ehringshausen); Larusson, Hannes Jon (Pinneberg); Lauschke, Holger (Duisburg); Leher, Markus (Schärding); Leidl, Stefan (Waidhofen/Ybbs); Lenz, Stefan (Berlin); Liedke, Marc Olaf (Heide); Lienert, Mark (Duisburg); Limberger, Andreas (Schrobenhausen); Limmer, Stefan (Würzburg); Locher, Martin (Kiel); Loghmanieh, Siawasch (Viersen); Lorenz, Ralph (Berlin); Luther, Stefan (Wipperfürth); Luyken, Walter (Sulzbach-Rosenberg); Mallmann, Bernhard (Krefeld); Manger, Regina (Schwabmünchen); Maurer, Stephan (Münster); May, Jens Peter (Schönebeck); Mayer, Franz (Salzburg); Mayer, Jens (Schwäbisch Gmünd); Mellert, Joachim (Höxter); Menzel, Ingo (Weimar); Meurer, Kirsten (Bochum); Meyer, Moritz (Ahaus); Mirow, Lutz (Kirchberg); Mittag-Bonsch, Martina (Crailsheim); Mittenzwey, Hans-Joachim (Berlin); Möbius, Ekkehard (Braunschweig); Mörder-Köttgen, Anja (Freiburg); Moesta, Kurt Thomas (Hannover); Moldenhauer, Ingolf (Braunschweig); Morkramer, Rolf (Xanten); Mosa, Tawfik (Merseburg); Müller, Hannes (Schlanders); Münzberg, Gregor (Berlin); Murr, Alfons (Vilshofen); Mussack, Thomas (St. Gallen); Nartschik, Peter (Quedlinburg); Nasifoglu, Bernd (Ehingen); Neumann, Jürgen (Haan); Neumeuer, Kai (Paderborn); Niebuhr, Henning (Hamburg); Nix, Carsten (Walsrode); Nölling, Anke (Burbach); Nostitz, Friedrich Zoltán (Mühlhausen); Obermaier, Straubing); Öz-Schmidt, Meryem (Hanau); Oldorf, Peter (Usingen); Olivieri, Manuel (Pforzheim); Passon, Marius (Freudenberg); Pawelzik, Marek (Hamburg); Pein, Tobias (Hameln); Peiper, Christian (Hamm); Peiper, Matthias (Essen); Peitgen, Klaus (Bottrop); Pertl, Alexander (Spittal/Drau); Philipp, Mark (Rostock); Pickart, Lutz (Bad Langensalza); Pizzera, Christian (Graz); Pöllath, Martin (Sulzbach-Rosenberg); Possin, Ulrich (Laatzen); Prenzel, Klaus (Bad Neuenahr-Ahrweiler); Pröve, Florian (Goslar); Pronnet, Thomas (Fürstenfeldbruck); Pross, Matthias (Berlin); Puff, Johannes (Dinkelsbühl); Rabl, Anton (Passau); Raggi, Matthias Claudius (Stuttgart); Rapp, Martin (Neunkirchen); Reck, Thomas (Püttlingen); Reinpold, Wolfgang (Hamburg); Reuter, Christoph (Quakenbrück); Richter, Jörg (Winnenden); Riemann, Kerstin (Alzenau-Wasserlos); Riesener, Klaus-Peter (Marl); Rodehorst, Anette (Otterndorf); Roehr, Thomas (Rödental); Rössler, Michael (Rüdesheim am Rhein); Roncossek, Bremerhaven); Rosniatowski, Rolland (Marburg); Roth Hartmut (Nürnberg); Sardoschau, Nihad (Saarbrücken); Sauer, Gottfried (Rüsselsheim); Sauer, Jörg (Arnsberg); Seekamp, Axel (Freiburg); Seelig, Matthias (Bad Soden); Seidel, Hanka (Eschweiler); Seiler, Christoph Michael (Warendorf); Seltmann, Cornelia (Hachenburg); Senkal, Metin (Witten); Shamiyeh, Andreas (Linz); Shang, Edward (München); Siemssen, Björn (Berlin); Sievers, Dörte (Hamburg); Silbernik, Daniel (Bonn); Simon, Thomas (Weinheim); Sinn, Daniel (Olpe); Sinner, Guy (Merzig); Sinning, Frank (Nürnberg); Smaxwil, Constatin Aurel (Stuttgart); Sörensen, Björn (Lauf an der Pegnitz); Syga, Günter (Bayreuth); Schabel, Volker (Kirchheim/Teck); Schadd, Peter (Euskirchen); Schassen von, Christian (Hamburg); Scheidbach, Hubert (Neustadt/Saale); Schelp, Lothar (Wuppertal); Scherf, Alexander (Pforzheim); Scheuerlein, Hubert (Paderborn); Scheyer, Mathias (Bludenz); Schilling, André (Kamen); Schimmelpenning, Hendrik (Neustadt in Holstein); Schinkel, Svenja (Kempten); Schmid, Michael (Gera); Schmid, Thomas (Innsbruck); Schmidt, Ulf (Mechernich); Schmitz, Heiner (Jena); Schmitz, Ronald (Altenburg); Schöche, Jan (Borna); Schoenen, Detlef (Schwandorf); Schrittwieser, Rudolf /Bruck an der Mur); Schroll, Andreas (München); Schubert, Daniel (Saarbrücken); Schüder, Gerhard (Wertheim); Schultz, Christian (Bremen-Lesum); Schultz, Harald (Landstuhl); Schulze, Frank P. Mülheim an der Ruhr); Schulze, Thomas (Dessau-Roßlau); Schumacher, Franz-Josef (Oberhausen); Schwab, Robert (Koblenz); Schwandner, Thilo (Lich); Schwarz, Jochen Günter (Rottenburg); Schymatzek, Ulrich (Eitorf); Spangenberger, Wolfgang (Bergisch-Gladbach); Sperling, Peter (Montabaur); Staade, Katja (Düsseldorf); Staib, Ludger (Esslingen); Staikov, Plamen (Frankfurt am Main); Stamm, Ingrid (Heppenheim); Stark, Wolfgang (Roth); Stechemesser, Bernd (Köln); Steinhilper, Uz (München); Stengl, Wolfgang (Nürnberg); Stern, Oliver (Hamburg); Stöltzing, Oliver (Meißen); Stolte, Thomas (Mannheim); Stopinski, Jürgen (Schwalmstadt); Stratmann, Gerald (Goch); Stubbe, Hendrik (Güstrow/); Stülzebach, Carsten (Friedrichroda); Tepel, Jürgen (Osnabrück); Terzić, Alexander (Wildeshausen); Teske, Ulrich (Essen); Tichomirow, Alexej (Brühl); Tillenburg, Wolfgang (Marktheidenfeld); Timmermann, Wolfgang (Hagen); Tomov, Tsvetomir (Koblenz; Train, Stefan H. (Gronau); Trauzettel, Uwe (Plettenberg); Triechelt, Uwe (Langenhagen); Ulbricht, Wolfgang (Breitenbrunn); Ulcar, Heimo (Schwarzach im Pongau); Unger, Solveig (Chemnitz); Verweel, Rainer (Hürth); Vogel, Ulrike (Berlin); Voigt, Rigo (Altenburg); Voit, Gerhard (Fürth); Volkers, Hans-Uwe (Norden); Volmer, Ulla (Berlin); Vossough, Alexander (Neuss); Wallasch, Andreas (Menden); Wallner, Axel (Lüdinghausen); Warscher, Manfred (Lienz); Warwas, Markus (Bonn); Weber, Jörg (Köln); Weber, Uwe (Eggenfelden); Weihrauch, Thomas (Ilmenau); Weiß, Johannes (Schwetzingen); Weißenbach, Peter (Neunkirchen); Werner, Uwe (Lübbecke-Rahden); Wessel, Ina (Duisburg); Weyhe, Dirk (Oldenburg); Wieber, Isabell (Köln); Wiesmann, Aloys (Rheine); Wiesner, Ingo (Halle); Withöft, Detlef (Neutraubling); Woehe, Fritz (Sanderhausen); Wolf, Claudio (Neuwied); Wolkersdörfer, Toralf (Pößneck); Yaksan, Arif (Wermeskirchen); Yildirim, Can (Lilienthal); Yildirim, Selcuk (Berlin); Zarras, Konstantinos (Düsseldorf); Zeller, Johannes (Waldshut-Tiengen); Zhorzel, Sven (Agatharied); Zuz, Gerhard (Leipzig);

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