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(TAPP) and Endoscopic (TEP) Treatment of Inguinal Hernia [International Endohernia Society (IEHS)]

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(TAPP) and Endoscopic (TEP) Treatment of Inguinal Hernia [International Endohernia Society (IEHS)] Surg Endosc DOI 10.1007/s00464-011-1799-6 GUIDELINES Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal Hernia [International Endohernia Society (IEHS)] R. Bittner • M. E. Arregui • T. Bisgaard • M. Dudai • G. S. Ferzli • R. J. Fitzgibbons • R. H. Fortelny • U. Klinge • F. Kockerling • E. Kuhry • J. Kukleta • D. Lomanto • M. C. Misra • A. Montgomery • S. Morales-Conde • W. Reinpold • J. Rosenberg • S. Sauerland • C. Schug-Paß • K. Singh • M. Timoney • D. Weyhe • P. Chowbey Received: 4 January 2011 / Accepted: 12 May 2011 Ó The Author(s) 2011. This article is published with open access at Springerlink.com Table of contents prophylaxis in laparoscopic inguinal hernia surgery? Introduction Chapter 2 Technical key points in transabdominal preperitoneal patch plasty (TAPP) Chapter 1 Perioperative management: what is the Chapter 3 Technical key points: total extraperitoneal evidence for antibiotic and thromboembolic patch plasty (TEP) repair R. Bittner (&) F. Kockerling Hernia Center, Department of General,-Visceral, and Vascular Department of Surgery and Center for Minimally Invasive Surgery, EuromedClinic, Europaallee 1, 90763 Fu¨rth, Germany Surgery, Vivantes Hospital, Neue Bergstr. 6, 13585 Berlin, e-mail: [email protected] Germany M. E. Arregui E. Kuhry Advanced GI surgery, Laparoscopy, Endoscopy and Ultrasound, Department of Surgery, St Olavs Hospital, Trondheim, Norway St. Vincent Hospital and Health Care Center, 8402 Harcourt Rd. Suite 815, Indianapolis, IN 46260, USA J. Kukleta General, Visceral, Abdominal Wall Surgery, Klinik Im Park, T. Bisgaard Grossmuensterplatz 9, 8001 Zu¨rich, Switzerland Department of Surgery, Køge Hospital, University of Copenhagen, Køge, Denmark D. Lomanto Minimally Invasive Surgical Center, KTP Advanced Surgical M. Dudai Training Center, YYL School of Medicine, National University Department of Surgery, Elisha Medical Center, Haifa, Israel Hospital, Kent Ridge Wing 2, 5 Lower Kent Ridge Road, Singapore 119074, Singapore G. S. Ferzli Á M. Timoney Department of Surgery, Lutheran Medical Center, SUNY Health M. C. Misra Science Center, Brooklyn, 65 Cromwell Avenue, Staten Island, Division of Minimally Invasive Surgery, J P N Apex Trauma NY, USA Centre, All India Institute of Medical Sciences, Angari Nagar, New Delhi 110029, India R. J. Fitzgibbons Department of Surgery, Creighton University, 601 North 30th A. Montgomery Street, Suite 3700, Omaha, NE, USA Section of Laparoscopy and Abdominal Wall Reconstruction, Department of Surgery, University Hospital of Malmo¨, Malmo¨ R. H. Fortelny 20502, Sweden Department of General, Visceral and Oncological Surgery, Wilhelminenspital, 1171 Vienna, Austria S. Morales-Conde Advanced Laparoscopic Unit of the University Hospital ‘‘Virgen U. Klinge del Rocı´o’’, General, Digestive and Laparoscopic Surgery Unit Surgical Department, University of Aachen, and Institut for of the USP-‘‘Sagrado Corazo´n’’ Clinic, University of Sevilla, Applied Medical Engineering AME Helmholtz, Pauwelstrasse, Sevilla, Spain 52074 Aachen, Germany 123 Surg Endosc Chapter 4 TEP versus TAPP: which is better for the Louis postulated: ‘‘Thus, a therapeutic agent cannot be employed patient? with any discrimination or probability of success in a given case, Chapter 5 Laparoscopic surgery in complicated hernia: unless its general efficacy, in analogous cases, has been previ- feasibility, risks, and benefits ously ascertained; therefore I conceive that without the aid of Chapter 6 Mesh size and recurrence: what is the statistics nothing like real medicine is possible.’’ Opponents of optimal size? EBM argue that, in view of the uniqueness of the patient, clinical Chapter 7 Selection of mesh material studies are of little value. However, despite these criticisms, it is Chapter 8 Cutting or not cutting of mesh: does it generally accepted today that classifications, rules, laws, and influence the recurrence rate? scientific theories cannot be developed without identifying the Chapter 9 Mesh fixation modalities: is there an common features of large patient populations or diseases; variety association with acute or chronic pain? in itself warrants statistical methods. To answer specific ques- Chapter 10 Risk factors and prevention of acute and tions in a particular case, the surgeon should be able to draw from chronic pain pertinent, high-quality, well-documented biometric studies to Chapter 11 Urogenital complications associated with choose the most appropriate therapy for his patient. However, laparoscopic/endoscopic hernia repair because the studies often suffer from methodical flaws, espe- Chapter 12 Intraperitoneal onlay mesh (IPOM) for cially from the heterogeneity of data, it needs caution and deep inguinal hernia repair—still a therapeutic clinical experience when applying results of EBM to an indi- option? vidual case, even if elaborate meta-analytic techniques have been Chapter 13 Role for open preperitoneal mesh repair in developed to allow for a differential evaluation of the study the era of laparoscopic inguinal hernia repair results. Chapter 14 Sportsman hernia—diagnosis and treatment The authors of the following guidelines are aware of these problems and are conscious of the responsibility that they undertake when describing the scientific state-of-the- Introduction art in laparoscopic/endoscopic inguinal hernia repair according to the best external evidence available and when Governments and health insurers increasingly demand making recommendations for the individual case. transparent quality-control mechanisms. A new type of Inguinal hernia repair is the most frequent operation in reimbursement, ‘‘pay for performance,’’ is being discussed. general and visceral surgery worldwide. In the western Therefore, the development and implementation of guide- countries, including the United States, more than 1.5 millions lines constitutes an important step toward the introduction of procedures are performed every year. Thus, hernia repair not optimal diagnostic and therapeutic concepts with the goal of only affects the individual patient but also has a significant improving the quality of treatment. Guidelines should define socioeconomic relevance and an important impact on the standards to help the surgeon in his or her daily work by costs for the health care system. During the third meeting of finding the best surgical strategy for his patient. the network International Endohernia Society (IEHS) held in The Guidelines are essentially evidence-based (Evidence- Stuttgart, January 2008, live demonstrations of hernia repair Based Medicine, EBM) but also allow use of ‘‘eminence’’-based performed by ten surgeons from four continents showed that statements in a critical way. Already 200 years ago, P.Ch.A. guidelines for standardization of operative technique, W. Reinpold K. Singh Department of Surgery, Gross-Sand Hospital Hamburg, Department of General Surgery, St. Vincent Hospital and Health Gross-Sand 3, 21107 Hamburg, Germany Care Center, 8402 Harcourt Rd. Suite 815, Indianapolis, IN 46260, USA J. Rosenberg Department of Surgery D, Herlev Hospital, University D. Weyhe of Copenhagen, Copenhagen, Denmark Department of Surgery, Pius Hospital, Georgstrasse 12, 26121 Oldenburg, Germany S. Sauerland Institute for Research in Operative Medicine, University P. Chowbey of Witten/Herdecke, Cologne, Germany Minimal Access, Metabolic, and Bariatric Surgery, Max Healthcare Institute Ltd., 2 Press Enclave Road, Saket, C. Schug-Paß New Delhi, India Department of Surgery and Center for Minimally Invasive Surgery, Vivantes Hospital, Neue Bergstr. 6, 13585 Berlin, Germany 123 Surg Endosc especially regarding teaching, are urgently needed. This (3) For the recommendations, use the following grading prompted a discussion about this challenge, which was scale: pursued during the meeting of AHS in Scottsdale/Arizona, A Consistent level 1 studies =[ strict recommendations 2008, with the attendance of R. Fitzgibbons, M. Arregui, F. (‘‘standard’’; ‘‘surgeons must do it’’). Ko¨ckerling, and P. Chowbey. The need for guidelines was B Consistent level 2 or 3 studies or extrapolations from unanimously acknowledged but with a focus on technique level 1 studies =[ less strict wording (‘‘recommenda- and special problems in transabdominal preperitoneal patch tion’’; ‘‘surgeons should do it’’). plasty (TAPP) and total extraperitoneal patch plasty (TEP). C Level 4 studies or extrapolations from level 2 or 3 studies =[ The authors were aware that some overlapping or interfer- vague wording (‘‘option’’; ‘‘surgeons can do it’’). ence with the EHS Guidelines was not completely avoidable D Level 5 evidence or troublingly inconsistent or incon- but should be limited as far as possible. Regarding this clusive studies at any level =[ no recommendation at problem, the authors appreciate the valuable contributions all, describe options. that M. Miserez gave during the past year. We started the guideline development process in June However, there often is a need to upgrade or downgrade 2008 by collecting the most important questions and a recommendation, because the outcome is so important or assembling the most qualified experts in laparoscopic hernia the clinical preference is so strong. This is possible but repair. An inviting letter was sent to all well-known laparo- needs to be explained in the commentary text, and scopic hernia specialists who have made outstanding con- (4) Prepare a paper to present at the Consensus Con- tributions to hernia surgery published in peer-review ference in Delhi. journals to participate
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