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Systemic inflammatory response after endoscopic (TEP) vs Shouldice groin hernia repair
R Schwab1, S Eissele, U B Brückner
1Department of General Surgery, German Armed Forces Central Military Hospital, Rübenacher Str. 170, 56072, Koblenz, Germany. dr.robert.schwab@t-online.de
Hernia : the Journal of Hernias and Abdominal Wall Surgery
|March 26, 2004
Summary
Endoscopic hernia repair may cause more immune trauma than conventional Shouldice repair. The Shouldice procedure, especially under local anesthesia, appears least traumatic for hernia repair.
Area of Science:
- Surgical Innovation
- Minimally Invasive Surgery
- Inflammatory Response
Background:
- Endoscopic surgery is often considered less traumatic than open surgery.
- Previous studies suggest immunologic advantages for endoscopic procedures in other surgical areas.
- The inflammatory impact of endoscopic hernia repair compared to conventional methods requires investigation.
Purpose of the Study:
- To compare the postoperative inflammatory response between endoscopic and conventional hernia repair techniques.
- To evaluate the influence of anesthesia type (local vs. general) on the inflammatory response in hernia repair.
Main Methods:
- Prospective study of 101 patients undergoing hernia repair (TEP, Shouldice).
- Biochemical monitoring of cytokines (CRP, PGF1alpha, neopterin, IL-6) pre- and post-surgery.
- Comparison of inflammatory markers between endoscopic and conventional groups, and by anesthesia type.
Main Results:
- Endoscopic hernia repair showed higher immediate postoperative IL-6 and PGF1alpha levels compared to Shouldice repair.
- The TEP approach was associated with higher postoperative neopterin levels than conventional surgery under local anesthesia.
- No significant differences in inflammatory response were noted after the first postoperative day; anesthesia type did not significantly affect the response in Shouldice repair.
Conclusions:
- Contrary to other endoscopic surgeries, endoscopic hernia repair is not less traumatic than conventional approaches.
- The conventional Shouldice procedure, particularly under local anesthesia, demonstrates the lowest inflammatory response and appears to be the least traumatic hernia repair method.