the role of pure tissue repairs in a tailored concept … · the role of pure tissue repairs in a...
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The Role of Pure Tissue Repairs in a tailored Concept for Inguinal Hernia Repair
Dr. Andreas Koch FACS • Day Surgery and Hernia Center • Gerhart-Hauptmann-Str. 15 • D-03044 Cottbus • [email protected] Lorenz MD • 3CHIRURGEN • Klosterstrasse 34/35 • D-13581 Berlin • [email protected]
ResultsOwn results: 1.1.2006 - 31.07.2013 • Follow up 6 month to 7 years Median Age: 48 ys. • N = 1.572 • Suture n= 597 (38%) • Recurrence 0,5% Mesh n= 975 (62%) • Recurrence 0,7% • Total Recurrence Rate 0,7%Pure Tissue Repairs: Shouldice: 373 • Recurrence n= 2 (0,5%)Desarda: 142 • No Recurrence until 1.1.2014 Minimal Repair: 86 • Recurrence n= 1 (1,2%)
MethodsEHS-Classifacation:M,C,L,F = medial, combined, lateral, femoral • R* 0-x = RecurrenceI = up to 1,5 cm • II = 1,5 to 3 cm • III = more than 3 cm
Background Robert Bendavid 2013: „After 120 years of Pure Tissue repairs, 50 years of Mesh repairs and 20 years of laparoscopic repairs, we are finally reaching some intere-sting conclusions .... All three techniques, in terms of recurrence, are E Q U I V A L E N T ! ! !“With or without mesh? • *Amato B, Moja L, Panico S, Persico G, Rispoli C, Rocco N, Moschetti I. • Cochrane Database Syst Rev. 2012 Apr 18;4:CD001543.Shouldice technique versus other open techniques for inguinal hernia repair.Sixteen trials contributed to this review. A total of 2566 hernias: Shouldice herniorrhaphy is the best non-mesh technique in terms of recurrence, though it is more time consuming and needs a slightly longer post-operative hospital stay. • The use of mesh is associated with a lower rate of recurrence. The quality of included studies, assessed with jadad scale, were low. • Patients have similar characteristic in the treatment and control group but seems more healthy than in general population, this features may affect the dimension of effect in par-ticularly recurrence rate could be higher in general population. • The length of follow-up vary broadly among the studies from 1 year to 13.7 year.
Desarda Repair Desarda Repair
ConclusionThe EHS Guidelines consider only the hernia itself • There is no real evidence for Mesh techniques in every case yet! • No differentia-tion based on the own classification! • EHS I – II in young males the Suture Techniques are the best option with low recurrence rates •
Future studies need to consider the classification!Individualized Concept! Risk factors! EHS Classification!
Mesh in case of EHS III M or more than 2 Risk factors • Minimal Repair EHS I M without Risk factors • Shouldice EHS I and IIL and I M with Risk factors • Desarda EHS II M and EHS II C also EHS III L
"The Role of Pure Tissue Repairs in a tailored Concept for Inguinal
Hernia Repair" Dr.Andreas Koch FACS
Day Surgery and Hernia Center Gerhart-Hauptmann-Str. 15
03044 Cottbus www.chirurgie-cottbus.de
Desarda Repair
Own Results
Shouldice Repair
Preoperative Type III L 1 year postoperative
Desarda Repair
Preoperative Type III L 1 year postoperative
Shouldice Repair
Shouldice Repair
Own Results EHS Mesh Suture
I L 0,1 % 27,8%
I M 0,5% 46,0%
I C 1,8 % 10,8 %
II L 10,7 % 3,1 %
II M 24,1 % 8,8 %
IIC 11,6 % 2,0 %
III L 9,1 % 0,6 %
III M 25,7 % 0,9 %
III C 16,2 % 0
Total 820 (70%) 352 (30%)
86,7%
96,5%
Suture vs. Mesh depending on EHS Classification
0%
20%
40%
60%
80%
100%
EHS IEHS II
EHS III
MeshSuture
Suture vs. Mesh depending on EHS Classification
0%
20%
40%
60%
80%
100%
EHS IEHS II
EHS III
MeshSuture
Suture vs. Mesh depending on Localisation
0%10%20%30%40%50%60%70%80%90%
100%
direct (M) indirect (L) Combined ( C)
MeshSuture
Suture vs. Mesh depending on Localisation
0%10%20%30%40%50%60%70%80%90%
100%
direct (M) indirect (L) Combined ( C)
MeshSuture
Suture vs. Mesh depending on Localisation
0%10%20%30%40%50%60%70%80%90%
100%
direct (M) indirect (L) Combined ( C)
MeshSuture
Junge et al. Risk factors related to recurrence in inguinal hernia repair: a retrospective analysis, Hernia, 2006
0 2 4 6 8 100,00
0,05
0,10
0,15
0,20
0,25
0,30nonsmoker
smoker
years
recu
rrenc
e ra
te 16.9 %
4.8 %
0 2 4 6 8 100,00
0,05
0,10
0,15
0,20
0,25
0,30nonsmoker
smoker
nonsmoker
smoker
years
recu
rrenc
e ra
te 16.9 %
4.8 %
Junge et al. Risk factors related to recurrence in inguinal hernia repair: a retrospective analysis, Hernia, 2006
0 2 4 6 8 100,00
0,05
0,10
0,15
0,20
0,25
0,30 family not affected
family affected
years
recu
rrenc
e ra
te
30.0 %
9.9 %
0 2 4 6 8 100,00
0,05
0,10
0,15
0,20
0,25
0,30 family not affected
family affected
family not affected
family affected
years
recu
rrenc
e ra
te
30.0 %
9.9 %
Junge et al. Risk factors related to recurrence in inguinal hernia repair: a retrospective analysis, Hernia, 2006
0 2 4 6 8 100,00
0,05
0,10
0,15
0,20
0,25
0,30recurrent
primary
years
recu
rrenc
e ra
te
22.0 %
7.7 %
0 2 4 6 8 100,00
0,05
0,10
0,15
0,20
0,25
0,30recurrent
primary
recurrent
primary
years
recu
rrenc
e ra
te
22.0 %
7.7 %
Junge et al. Risk factors related to recurrence in inguinal hernia repair: a retrospective analysis, Hernia, 2006
0 2 4 6 8 100,00
0,05
0,10
0,15
0,20
0,25
0,30 > 50 years
< 50 years
years
recu
rrenc
e ra
te
15.5 %
1.8 %
0 2 4 6 8 100,00
0,05
0,10
0,15
0,20
0,25
0,30 > 50 years
< 50 years
> 50 years
< 50 years
years
recu
rrenc
e ra
te
15.5 %
1.8 %
If 2 ore more Risk factors the mesh repair should be the first choice!
Hernia. 2006 Aug;10(4):309-15. Epub 2006 May 23.Risk factors related to recurrence in inguinal hernia repair: a retrospective analysis.
Junge K, Rosch R, Klinge U, Schwab R, Peiper Ch, Binnebösel M, Schenten F, Schumpelick V.
Quality managementin day case surgery
in Germany
Ralph Lorenz ‐ 3CHIRURGEN Berlin , [email protected] Koch ‐ Chirurgische Praxis Cottbus, [email protected] collaboration with the Quality institute for operative medicineUniversity of Magdeburg
3CHIRURGEN