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Irving L Lichtenstein - One of the best experts on this subject based on the ideXlab platform.
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simultaneous repair of bilateral Inguinal Hernias under local anesthesia
Annals of Surgery, 1996Co-Authors: Parviz K Amid, Alex G Shulman, Irving L LichtensteinAbstract:OBJECTIVE: The authors confirm the advantages of simultaneous repair of bilateral Inguinal Hernias, indicate that it is feasible to perform the procedure under local anesthesia, and suggest that when an open tension-free technique is used, the results are superior to those of laparoscopic repair of bilateral Inguinal Hernias. SUMMARY BACKGROUND DATA: Between 1971 and 1995, simultaneous repair of bilateral Inguinal Hernias were performed in 2953 men. Initially, between 1971 and 1984, patients with indirect Hernias underwent the traditional tissue approximation repair. Those with direct Hernias had the same procedure, with the repair additionally buttressed by a sheet of Marlex mesh (Davol, Inc., Cronston, RI). Between 1984 and 1995, both direct and indirect Hernias were repaired using the open tension-free hernioplasty procedure. METHOD: The 2953 patients underwent simultaneous repair of bilateral Inguinal Hernias under local anesthesia in a private practice setting in general hospitals. RESULTS: In those cases in which the "tension free" technique was used, patients experienced minimal to mild postoperative pain and had a short recovery period, with a recurrence rate of 0.1%. CONCLUSIONS: Uncomplicated bilateral Inguinal Hernias in adults are best treated simultaneously. It is feasible to perform the operation under local anesthesia, and when an open tension-free repair is used, postoperative pain and recovery periods are equally comparable with those of laparoscopic repair, although the complication and the recurrence rates are significantly less.
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the lichtenstein open tension free mesh repair of Inguinal Hernias
Surgery Today, 1995Co-Authors: Parviz K Amid, Alex G Shulman, Irving L LichtensteinAbstract:All standard methods of hernia repair involve suturing together tissues which are not normally in apposition. This violates the basic surgical principle that tissue must never be approximated under tension and thus accounts for an unacceptable number of failures. A total reinforcement of the Inguinal floor with a sheet of suitable biomaterial and the employment of a “tension-free” technique is a more effective approach. Since June 1984, 4,000 primary Inguinal Hernias have been repaired on an outpatient basis and under local anesthesia at the Lichtenstein Hernia Institute by the open “tension-free” technique using Marlex mesh. The patients were followed from 1 to 11 years by physician examination. The follow-up rate was 87%. There were four recurrences. The causes of recurrence and how to avoid them are herein discussed. Three of the recurrences occurred at the public tubercle and were caused by placing the mesh in juxtaposition to the tubercle. This error has since been corrected by overlapping the mesh at the public bone. One recurrence was caused by a disruption of the lower edge of the mesh from the shelving margin of Poupart's ligament. The error here was the utilization of a patch that was too narrow and therefore under tension. It became apparent that a wider patch, fixed in place with an appropriate degree of laxity, was required.
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a survey of non expert surgeons using the open tension free mesh patch repair for primary Inguinal Hernias
International Surgery, 1995Co-Authors: Alex G Shulman, Parviz K Amid, Irving L LichtensteinAbstract:UNLABELLED The aim of this study was to learn if general surgeons with no special interest in hernia repairs, using the open tension free repair, could achieve a degree of success comparable to that of the experts. MATERIALS AND METHODS A survey was undertaken of 72 surgeons who were known to be performing an open tension-free onlay mesh patch repair for primary Inguinal Hernias with no attempt to suture together the edges of the hernia defect. While several European surgeons were included, most were from the United States. RESULTS There was a minimal amount of wound infection, an absence of mesh rejection when Marlex mesh was used, and a recurrence rate under 0.5% in 16,068 operations. CONCLUSIONS The experience of the non-experts demonstrated that excellent results were attained by surgeons who had no special interest in hernia surgery and testifies to the simplicity and reliability of the method.
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the safety of mesh repair for primary Inguinal Hernias results of 3 019 operations from five diverse surgical sources
American Surgeon, 1992Co-Authors: Alex G Shulman, Parviz K Amid, Irving L LichtensteinAbstract:Initial attempts by surgical pioneers to repair Hernias with prosthetic mesh met with failure because of faulty materials. As a result, surgeons experienced anxiety about performing this procedure. This anxiety persists, despite the present availability of new, safe patches and sutures. It was the unacceptably high failure rate of standard methods of repair for recurrent Hernias that led to the use of plastic screens to bolster such repairs. However, persistent reluctance to use mesh for primary hernioplasty continued. Within the past two decades, true, tension-free patch repair of primary Inguinal Hernias without suture closure of hernial margins has been examined and clarified, and the technique has been perfected. In 3,019 reported primary Inguinal Hernias so treated by five different groups, there have been no mesh rejections, a 0.2 per cent recurrence rate, and insignificant incidence of infection. A new era of hernia repair appears to be at hand; therefore, such results warrant a new look at Inguinal hernia repair.
Domenic J Reda - One of the best experts on this subject based on the ideXlab platform.
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tension free repair versus watchful waiting for men with asymptomatic or minimally symptomatic Inguinal Hernias a cost effectiveness analysis
Journal of The American College of Surgeons, 2006Co-Authors: Kevin T Stroupe, Larry M Manheim, Ping Luo, Anita Giobbiehurder, Denise M Hynes, Olga Jonasson, Domenic J RedaAbstract:Background Watchful waiting (WW) has been shown to be an acceptable option in men with asymptomatic or minimally symptomatic Inguinal Hernias when clinical and patient-reported outcomes are considered. Although WW is likely to be less costly initially when compared with tension-free repair (TFR) because of the cost of the operation, it is not clear whether WW remains the least costly option when longer-term costs are considered. Study design We conducted a cost-effectiveness analysis of a randomized controlled trial at six community and academic centers. We examined costs, quality-adjusted life-years (QALY), and cost-effectiveness at 2 years of followup. Costs were assessed by applying Medicare reimbursement rates to patients' health-care use, which was obtained by contacting patients' health-care providers. Quality of life was assessed using the Short Form-36 version 2 health-related quality-of-life survey. Of the 724 men randomized, 641 were available for the economic analysis: 317 were randomized to TFR and 324 were randomized to watchful waiting. Results At 2 years, TFR patients had $1,831 higher mean costs than WW patients (95% CI, $409−$3,044), with 0.031 higher QALY (95% CI, 0.001−0.058). The cost per additional QALY for TFR patients was $59,065 (95% CI, $1,358−$322,765). The probability that TFR was cost-effective at the $50,000 per QALY level was 40%. Conclusion At 2 years, WW was a cost-effective treatment option for men with minimal or no hernia symptoms.
Christine Schugpass - One of the best experts on this subject based on the ideXlab platform.
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tep versus lichtenstein which technique is better for the repair of primary unilateral Inguinal Hernias in men
Surgical Endoscopy and Other Interventional Techniques, 2016Co-Authors: F Kockerling, Martin Hukauf, A Kuthe, B Stechemesser, Christine SchugpassAbstract:Introduction In the update of the guidelines of the European Hernia Society, open Lichtenstein and endoscopic techniques continue to be recommended as the surgical technique of choice for repair of unilateral primary Inguinal Hernias in men despite the fact that a meta-analysis had identified a higher recurrence rate for TEP compared with Lichtenstein operation. The Guidelines Group had taken that decision because one surgeon in one of the randomized controlled trials included in the meta-analysis had had a very high recurrence rate. Therefore, this study based on registry data now compares the outcome of TEP versus Lichtenstein repair.
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open repair of primary versus recurrent male unilateral Inguinal Hernias perioperative complications and 1 year follow up
World Journal of Surgery, 2016Co-Authors: F Kockerling, A Koch, R Lorenz, W Reinpold, Martin Hukauf, Christine SchugpassAbstract:Introduction The recommendation in the European Hernia Society Guidelines for the treatment of recurrent Inguinal Hernias is to modify the technique in relation to the previous technique, and use a new plane of dissection for mesh implantation. However, the registry data show that even following previous open suture and mesh repair to treat a primary Inguinal hernia, open suture and mesh repair can be used once again for a recurrent hernia. It is therefore important to know what the outcome of open repair of recurrent Inguinal Hernias is compared with open repair of primary Inguinal Hernias, while taking the previous operation into account.
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endoscopic repair of primary versus recurrent male unilateral Inguinal Hernias are there differences in the outcome
Surgical Endoscopy and Other Interventional Techniques, 2016Co-Authors: F Kockerling, Martin Hukauf, Christine Schugpass, Dietmar Jacob, W Wiegank, A Kuthe, R BittnerAbstract:Introduction To date, there are no prospective randomized studies that compare the outcome of endoscopic repair of primary versus recurrent Inguinal Hernias. It is therefore now attempted to answer that key question on the basis of registry data.
F Kockerling - One of the best experts on this subject based on the ideXlab platform.
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smaller Inguinal Hernias are independent risk factors for developing chronic postoperative Inguinal pain cpip a registry based multivariable analysis of 57 999 patients
Annals of Surgery, 2020Co-Authors: Henry Hoffmann, R Bittner, Daniela Walther, F Kockerling, Daniela Adolf, Philipp KirchhoffAbstract:OBJECTIVE Impact of Inguinal hernia defect size as stratified by the European Hernia Society (EHS) classification I to III on the rate of chronic postoperative Inguinal pain (CPIP). BACKGROUND CPIP is the most important complication after Inguinal hernia repair. The impact of hernia defect size according to the EHS classification on CPIP is unknown. METHODS In total, 57,999 male patients from the Herniamed registry undergoing primary unilateral Inguinal hernia repair including a 1-year follow-up were selected between September 1, 2009 and November 30, 2016. Using multivariable analysis, the impact of EHS Inguinal hernia classification (EHS I vs EHS II vs EHS III and/or scrotal) on developing CPIP was investigated. RESULTS Multivariable analysis revealed for smaller Inguinal Hernias a significant higher rate of pain at rest [EHS I vs EHS II: odds ratio, OR = 1.350 (1.180-1.543), P < 0.001; EHS I vs EHS III and/or scrotal: OR = 1.839 (1.504-2.249), P < 0.001; EHS II vs EHS III and/or scrotal: OR = 1.363 (1.125-1.650), P = 0.002], pain on exertion [EHS I vs EHS II: OR = 1.342 (1.223-1.473), P < 0.001; EHS I vs EHS III and/or scrotal: OR = 2.002 (1.727-2.321), P < 0.001; EHS II vs EHS III and/or scrotal: OR = 1.492 (1.296; 1.717), P < 0.001], and pain requiring treatment [EHS I vs EHS II: OR = 1.594 (1.357-1.874), P < 0.001; EHS I vs EHS III and/or scrotal: OR = 2.254 (1.774-2.865), P < 0.001; EHS II vs EHS III and/or scrotal: OR = 1.414 (1.121-1.783), P = 0.003] at 1-year follow-up. Younger patients (<55 y) revealed higher rates of pain at rest, pain on exertion, and pain requiring treatment (each P < 0.001) with a significantly trend toward higher rates of pain in smaller Hernias. CONCLUSIONS Smaller Inguinal Hernias have been identified as an independent patient-related risk factor for developing CPIP.
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tep versus lichtenstein which technique is better for the repair of primary unilateral Inguinal Hernias in men
Surgical Endoscopy and Other Interventional Techniques, 2016Co-Authors: F Kockerling, Martin Hukauf, A Kuthe, B Stechemesser, Christine SchugpassAbstract:Introduction In the update of the guidelines of the European Hernia Society, open Lichtenstein and endoscopic techniques continue to be recommended as the surgical technique of choice for repair of unilateral primary Inguinal Hernias in men despite the fact that a meta-analysis had identified a higher recurrence rate for TEP compared with Lichtenstein operation. The Guidelines Group had taken that decision because one surgeon in one of the randomized controlled trials included in the meta-analysis had had a very high recurrence rate. Therefore, this study based on registry data now compares the outcome of TEP versus Lichtenstein repair.
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open repair of primary versus recurrent male unilateral Inguinal Hernias perioperative complications and 1 year follow up
World Journal of Surgery, 2016Co-Authors: F Kockerling, A Koch, R Lorenz, W Reinpold, Martin Hukauf, Christine SchugpassAbstract:Introduction The recommendation in the European Hernia Society Guidelines for the treatment of recurrent Inguinal Hernias is to modify the technique in relation to the previous technique, and use a new plane of dissection for mesh implantation. However, the registry data show that even following previous open suture and mesh repair to treat a primary Inguinal hernia, open suture and mesh repair can be used once again for a recurrent hernia. It is therefore important to know what the outcome of open repair of recurrent Inguinal Hernias is compared with open repair of primary Inguinal Hernias, while taking the previous operation into account.
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endoscopic repair of primary versus recurrent male unilateral Inguinal Hernias are there differences in the outcome
Surgical Endoscopy and Other Interventional Techniques, 2016Co-Authors: F Kockerling, Martin Hukauf, Christine Schugpass, Dietmar Jacob, W Wiegank, A Kuthe, R BittnerAbstract:Introduction To date, there are no prospective randomized studies that compare the outcome of endoscopic repair of primary versus recurrent Inguinal Hernias. It is therefore now attempted to answer that key question on the basis of registry data.
Parviz K Amid - One of the best experts on this subject based on the ideXlab platform.
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simultaneous repair of bilateral Inguinal Hernias under local anesthesia
Annals of Surgery, 1996Co-Authors: Parviz K Amid, Alex G Shulman, Irving L LichtensteinAbstract:OBJECTIVE: The authors confirm the advantages of simultaneous repair of bilateral Inguinal Hernias, indicate that it is feasible to perform the procedure under local anesthesia, and suggest that when an open tension-free technique is used, the results are superior to those of laparoscopic repair of bilateral Inguinal Hernias. SUMMARY BACKGROUND DATA: Between 1971 and 1995, simultaneous repair of bilateral Inguinal Hernias were performed in 2953 men. Initially, between 1971 and 1984, patients with indirect Hernias underwent the traditional tissue approximation repair. Those with direct Hernias had the same procedure, with the repair additionally buttressed by a sheet of Marlex mesh (Davol, Inc., Cronston, RI). Between 1984 and 1995, both direct and indirect Hernias were repaired using the open tension-free hernioplasty procedure. METHOD: The 2953 patients underwent simultaneous repair of bilateral Inguinal Hernias under local anesthesia in a private practice setting in general hospitals. RESULTS: In those cases in which the "tension free" technique was used, patients experienced minimal to mild postoperative pain and had a short recovery period, with a recurrence rate of 0.1%. CONCLUSIONS: Uncomplicated bilateral Inguinal Hernias in adults are best treated simultaneously. It is feasible to perform the operation under local anesthesia, and when an open tension-free repair is used, postoperative pain and recovery periods are equally comparable with those of laparoscopic repair, although the complication and the recurrence rates are significantly less.
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the lichtenstein open tension free mesh repair of Inguinal Hernias
Surgery Today, 1995Co-Authors: Parviz K Amid, Alex G Shulman, Irving L LichtensteinAbstract:All standard methods of hernia repair involve suturing together tissues which are not normally in apposition. This violates the basic surgical principle that tissue must never be approximated under tension and thus accounts for an unacceptable number of failures. A total reinforcement of the Inguinal floor with a sheet of suitable biomaterial and the employment of a “tension-free” technique is a more effective approach. Since June 1984, 4,000 primary Inguinal Hernias have been repaired on an outpatient basis and under local anesthesia at the Lichtenstein Hernia Institute by the open “tension-free” technique using Marlex mesh. The patients were followed from 1 to 11 years by physician examination. The follow-up rate was 87%. There were four recurrences. The causes of recurrence and how to avoid them are herein discussed. Three of the recurrences occurred at the public tubercle and were caused by placing the mesh in juxtaposition to the tubercle. This error has since been corrected by overlapping the mesh at the public bone. One recurrence was caused by a disruption of the lower edge of the mesh from the shelving margin of Poupart's ligament. The error here was the utilization of a patch that was too narrow and therefore under tension. It became apparent that a wider patch, fixed in place with an appropriate degree of laxity, was required.
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a survey of non expert surgeons using the open tension free mesh patch repair for primary Inguinal Hernias
International Surgery, 1995Co-Authors: Alex G Shulman, Parviz K Amid, Irving L LichtensteinAbstract:UNLABELLED The aim of this study was to learn if general surgeons with no special interest in hernia repairs, using the open tension free repair, could achieve a degree of success comparable to that of the experts. MATERIALS AND METHODS A survey was undertaken of 72 surgeons who were known to be performing an open tension-free onlay mesh patch repair for primary Inguinal Hernias with no attempt to suture together the edges of the hernia defect. While several European surgeons were included, most were from the United States. RESULTS There was a minimal amount of wound infection, an absence of mesh rejection when Marlex mesh was used, and a recurrence rate under 0.5% in 16,068 operations. CONCLUSIONS The experience of the non-experts demonstrated that excellent results were attained by surgeons who had no special interest in hernia surgery and testifies to the simplicity and reliability of the method.
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the safety of mesh repair for primary Inguinal Hernias results of 3 019 operations from five diverse surgical sources
American Surgeon, 1992Co-Authors: Alex G Shulman, Parviz K Amid, Irving L LichtensteinAbstract:Initial attempts by surgical pioneers to repair Hernias with prosthetic mesh met with failure because of faulty materials. As a result, surgeons experienced anxiety about performing this procedure. This anxiety persists, despite the present availability of new, safe patches and sutures. It was the unacceptably high failure rate of standard methods of repair for recurrent Hernias that led to the use of plastic screens to bolster such repairs. However, persistent reluctance to use mesh for primary hernioplasty continued. Within the past two decades, true, tension-free patch repair of primary Inguinal Hernias without suture closure of hernial margins has been examined and clarified, and the technique has been perfected. In 3,019 reported primary Inguinal Hernias so treated by five different groups, there have been no mesh rejections, a 0.2 per cent recurrence rate, and insignificant incidence of infection. A new era of hernia repair appears to be at hand; therefore, such results warrant a new look at Inguinal hernia repair.