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Inguinal hernia repair: where to next?
1Division of Surgery and Department of Surgical Sciences, University of Newcastle, John Hunter Hospital, New Lambton Heights, New South Wales, Australia.
ANZ Journal of Surgery
|August 23, 2002
Summary
Newer open mesh hernia repair techniques lack robust evidence. Chronic pain after hernia repair is a critical, understudied issue, necessitating further research into mesh repair outcomes.
Area of Science:
- General Surgery
- Surgical Innovation
- Evidence-Based Medicine
Background:
- Hernia repair is a common surgical procedure with significant resource implications.
- Current choices for hernia repair methods remain a subject of debate.
- Evaluating new techniques is crucial for improving patient outcomes and resource utilization.
Purpose of the Study:
- To critically assess existing evidence on recently introduced open mesh hernia repair techniques.
- To identify key areas for future research in hernia repair.
Main Methods:
- Comprehensive literature search of Medline, EMBASE, and Cochrane databases.
- Inclusion of references from review articles and textbooks.
- Contacting manufacturers for relevant clinical trial data.
Main Results:
- Eight studies on Kugel Patch, PerFix Plug, or Prolene Hernia System were identified, with no direct comparisons between them.
- Most studies (Level IV evidence) lack data on chronic posthernioplasty pain (6-12% incidence).
- Chronic pain is more frequent and clinically significant than recurrence, yet poorly understood and studied.
Conclusions:
- Limited high-level evidence (Level II) exists, primarily for the PerFix Plug, suggesting faster insertion and smaller incisions.
- Chronic significant posthernioplasty pain is a more critical research endpoint than recurrence.
- A proposal for a multicenter, randomized trial on chronic pain incidence after elective mesh repair is recommended.