Inguinal hernia surgery: Difference between revisions
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There is no definitive consensus as to the comparative risk of complications, or comparative rate of recurrence compared to the open tension-free repairs.{{Citation needed|date=April 2009}} However, most non-emergent abdominal surgeries are moving to laproscopic methodologies, as the smaller incisions used result in less bleeding, less infection, faster recovery, reduced hospitalization and reduced pain.<ref name=Mayo>http://www.mayoclinic.org/minimally-invasive-surgery</ref> |
There is no definitive consensus as to the comparative risk of complications, or comparative rate of recurrence compared to the open tension-free repairs.{{Citation needed|date=April 2009}} However, most non-emergent abdominal surgeries are moving to laproscopic methodologies, as the smaller incisions used result in less bleeding, less infection, faster recovery, reduced hospitalization and reduced pain.<ref name=Mayo>http://www.mayoclinic.org/minimally-invasive-surgery</ref> |
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One specific method of laparoscopic repair is ''totally extraperitoneal'' (''TEP'') repair. TEp repair has been associated with fewer complications and a significantly shorter duration of post-operative analgesia than Lichtenstein repair for recurrent inguinal hernia.<ref name=Kumar1999>{{cite journal|author=Kumar S, Nixon SJ, MacIntyre IM|title=Laparoscopic or Lichtenstein repair for recurrent inguinal hernia: one unit's experience|journal=J R Coll Surg Edinb|volume=44|issue=5|pages=301–2 |year=1999|pmid=10550952 |
One specific method of laparoscopic repair is ''totally extraperitoneal'' (''TEP'') repair. TEp repair has been associated with fewer complications and a significantly shorter duration of post-operative analgesia than Lichtenstein repair for recurrent inguinal hernia.<ref name=Kumar1999>{{cite journal|author=Kumar S, Nixon SJ, MacIntyre IM|title=Laparoscopic or Lichtenstein repair for recurrent inguinal hernia: one unit's experience|journal=J R Coll Surg Edinb|volume=44|issue=5|pages=301–2 |year=1999|pmid=10550952}}</ref> |
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{{Main|Comparison of meshes used in inguinal hernia repair}} |
{{Main|Comparison of meshes used in inguinal hernia repair}} |
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Commercial meshes are typically made of [[prolene]] ([[polypropylene]]) or [[polyester]]. [[Marlex]], [[Gore-Tex]] or [[Polytetrafluoroethylene|Teflon]] meshes are sold by some companies. Partially absorbable meshes are used sometimes, but they are not advised because increase the risk of recurrence. Light-weight meshes seem to cause less discomfort than heavy-weight meshes.<ref> |
Commercial meshes are typically made of [[prolene]] ([[polypropylene]]) or [[polyester]]. [[Marlex]], [[Gore-Tex]] or [[Polytetrafluoroethylene|Teflon]] meshes are sold by some companies. Partially absorbable meshes are used sometimes, but they are not advised because increase the risk of recurrence. Light-weight meshes seem to cause less discomfort than heavy-weight meshes.<ref>{{cite journal |author=Agarwal BB, Agarwal KA, Sahu T, Mahajan KC |title=Traditional polypropylene and lightweight meshes in totally extraperitoneal inguinal herniorrhaphy |journal=Int J Surg |volume=8 |issue=1 |pages=44–7 |year=2010 |pmid=19853672 |doi=10.1016/j.ijsu.2009.08.014 |url=http://www.sciencedirect.com/science/article/pii/S1743919109001496}}</ref> |
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Cases of obstructive [[azoospermia]] have been related with the use of polypropylene mesh. However, this risk seems to be less than 1% <ref> |
Cases of obstructive [[azoospermia]] have been related with the use of polypropylene mesh. However, this risk seems to be less than 1% <ref>{{cite journal |author=Hallén M, Westerdahl J, Nordin P, Gunnarsson U, Sandblom G |title=Mesh hernia repair and male infertility: A retrospective register study |journal=Surgery |volume=151 |issue=1 |pages=94–8 |year=2012 |month=January |pmid=21943643 |doi=10.1016/j.surg.2011.06.028 |url=http://linkinghub.elsevier.com/retrieve/pii/S0039-6060(11)00311-4}}</ref> and therefore, it does not need to be notified in an [[informed consent]].<ref>{{cite journal |author=Fitzgibbons RJ |title=Can we be sure polypropylene mesh causes infertility? |journal=Ann. Surg. |volume=241 |issue=4 |pages=559–61 |year=2005 |month=April |pmid=15798456 |pmc=1357058 |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0003-4932&volume=241&issue=4&spage=559}}</ref> |
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Meshes made of [[mosquito net]] clothes, in [[copolymer]] of [[polyethylene]] and [[polypropylene]] have been used for low-income patients in rural [[India]] and [[Ghana]].<ref> |
Meshes made of [[mosquito net]] clothes, in [[copolymer]] of [[polyethylene]] and [[polypropylene]] have been used for low-income patients in rural [[India]] and [[Ghana]].<ref>{{cite journal |author=Clarke MG, Oppong C, Simmermacher R, ''et al.'' |title=The use of sterilised polyester mosquito net mesh for inguinal hernia repair in Ghana |journal=Hernia |volume=13 |issue=2 |pages=155–9 |year=2009 |month=April |pmid=19089526 |doi=10.1007/s10029-008-0460-3 |url=http://www.springerlink.com/index/U147UM764L3J4227.pdf |format=PDF}}</ref> They are 3700 times cheaper than commercial meshes.<ref name=Tongaonkar03>{{cite journal |author=Tongaonkar RR, Reddy BV,. Mehta VK, Singh NS, Shivade S |title=Preliminary Multicentric Trial of Cheap Indigenous Mosquito-Net Cloth for Tension-free Hernia Repair |journal=Indian Journal of Surgery |volume=65 |issue=1 |pages=89–95 |date=January–February 2003 |url=http://www.bioline.org.br/request?is03018}}</ref> They are thinner and lighter, but weaker than commercial meshes.<ref>{{cite journal |author=Wilhelm TJ, Freudenberg S, Jonas E, Grobholz R, Post S, Kyamanywa P |title=Sterilized mosquito net versus commercial mesh for hernia repair. an experimental study in goats in Mbarara/Uganda |journal=Eur Surg Res |volume=39 |issue=5 |pages=312–7 |year=2007 |pmid=17595545 |doi=10.1159/000104402 |url=http://content.karger.com/produktedb/produkte.asp?DOI=000104402&typ=pdf}}</ref> However, they give results identical to commercial meshes in terms of infection and recurrence rate at 5 years. <ref name=Tongaonkar03/> |
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Synthetic totally bioabsorbable meshes are being experimented, giving encouraging results.<ref> |
Synthetic totally bioabsorbable meshes are being experimented, giving encouraging results.<ref>{{cite journal |author=Negro P, Gossetti F, Dassatti MR, Andreuccetti J, D'Amore L |title=Bioabsorbable Gore BIO-A plug and patch hernia repair in young adults |journal=Hernia |year=2011 |month=October |pmid=22042382 |doi=10.1007/s10029-011-0886-x |url=http://www.springerlink.com/content/x072m7276nk26417/fulltext.pdf |format=PDF}}</ref> |
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''Bioabsorbable Gore BIO-A plug and patch hernia repair in young adult ''],Hernia. 2011 Oct 25</ref> |
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[[Biologic meshes]] are increasingly popular since their introduction in 2003. Contrary to synthetic meshes, they can be used for repair in infected environment, like for an incarcerated hernia. Moreover, they seem to improve comfort and presumably, they reduce the risk of [[inguinodynia]].<ref> |
[[Biologic meshes]] are increasingly popular since their introduction in 2003. Contrary to synthetic meshes, they can be used for repair in infected environment, like for an incarcerated hernia. Moreover, they seem to improve comfort and presumably, they reduce the risk of [[inguinodynia]].<ref>{{cite journal |author=Ansaloni L, Catena F, Coccolini F, Gazzotti F, D'Alessandro L, Pinna AD |title=Inguinal hernia repair with porcine small intestine submucosa: 3-year follow-up results of a randomized controlled trial of Lichtenstein's repair with polypropylene mesh versus Surgisis Inguinal Hernia Matrix |journal=Am. J. Surg. |volume=198 |issue=3 |pages=303–12 |year=2009 |month=September |pmid=19285658 |doi=10.1016/j.amjsurg.2008.09.021 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9610(08)00893-3}}</ref> |
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They have been tested successfully after mesh-related inguinodynia.<ref>{{cite journal |author=Koopmann MC, Yamane BH, Starling JR |title=Long-term follow-up after meshectomy with acellular human dermis repair for postherniorrhaphy inguinodynia |journal=Arch Surg |volume=146 |issue=4 |pages=427–31 |year=2011 |month=April |pmid=21502450 |doi=10.1001/archsurg.2011.49 |url=http://archsurg.ama-assn.org/cgi/pmidlookup?view=long&pmid=21502450}}</ref> Moreover, [[polypropylene]] meshes can face [[Polypropylene#Degradation|degradation]] in the long term,<ref>{{cite journal |author=Costello CR, Bachman SL, Grant SA, Cleveland DS, Loy TS, Ramshaw BJ |title=Characterization of heavyweight and lightweight polypropylene prosthetic mesh explants from a single patient |journal=Surg Innov |volume=14 |issue=3 |pages=168–76 |year=2007 |month=September |pmid=17928615 |doi=10.1177/1553350607306356 |url=http://sri.sagepub.com/cgi/pmidlookup?view=long&pmid=17928615}}</ref> |
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<ref>{{cite journal |author=Ostergard DR |title=Degradation, infection and heat effects on polypropylene mesh for pelvic implantation: what was known and when it was known |journal=Int Urogynecol J |volume=22 |issue=7 |pages=771–4 |year=2011 |month=July |pmid=21512830 |pmc=3112322 |doi=10.1007/s00192-011-1399-y }}</ref> which increases the risk of stiffness and [[inguinodynia]]. Some meshes can be relatively cheap (prices start at 500$), such as Surgisis-Biodesign, manufactured by [[Cook Group]], made from [[Small intestinal submucosa]]. <ref>Inguinal Hernia Repair with Biodesign® (Surgisis®) -- David Edelman, MD [http://www.youtube.com/watch?v=zieBX96y0rQ]</ref> Though their benefit is not fully established yet, the market is exploding, and if the current trend is confirmed, they may replace synthetic meshes in the US by 2016<ref>[http://mrg.net/Products-and-Services/Syndicated-Report.aspx?r=RPUS43ST11 ''US Markets for Soft Tissue Repair Devices 2012''],</ref> |
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===Suture-based repair=== |
===Suture-based repair=== |
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|<!--advantages--> |
|<!--advantages--> |
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*Quicker recovery<ref name=WashingtonSurgery2008>{{cite book |author=Trudie A Goers; Washington University School of Medicine Department of Surgery; Klingensmith, Mary E; Li Ern Chen; Sean C Glasgow |title=The Washington manual of surgery|publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins|location=Philadelphia|year=2008 |
*Quicker recovery<ref name=WashingtonSurgery2008>{{cite book |author=Trudie A Goers; Washington University School of Medicine Department of Surgery; Klingensmith, Mary E; Li Ern Chen; Sean C Glasgow |title=The Washington manual of surgery|publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins|location=Philadelphia|year=2008 |isbn=0-7817-7447-0}}</ref><ref name=nice/> |
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*Less pain during first days<ref name=nice/> |
*Less pain during first days<ref name=nice/> |
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*Fewer postoperative complications<ref name=WashingtonSurgery2008/> |
*Fewer postoperative complications<ref name=WashingtonSurgery2008/> |
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Revision as of 21:29, 19 December 2011
| Inguinal hernia repair | |
|---|---|
| ICD-9-CM | 53.0-53.1 |
Inguinal hernia repair refers to a surgical operation for the correction of an inguinal hernia.
Techniques
Almost 700,000 herniorrhaphies are performed each year in the United States.[citation needed]
Mesh-based repair
Open repair (Lichtenstein)
The mostly performed inguinal hernia repair today is the Lichtenstein repair (90%). A flat mesh is placed on top of the defect,[1] Most are "tension-free" repairs that involve the placement of a synthetic mesh to strengthen the inguinal region; . Other techniques include Plug and Patch (mesh plug placed in the defect and covered by a Lichtenstein-type patch), Kugel (mesh device placed behind the defect), and Prolene Hernia System (2-layer mesh device placed over and behind the defect). Patients typically go home within a few hours of surgery, often requiring no medication beyond acetaminophen. Patients are encouraged to walk as soon as possible postoperatively, and they can usually resume most normal activities within a week or two of the operation. Recurrence rates are around 2% or less, compared with 5% for a Shouldice (tension) repair.[citation needed]. complications include chronic pain (>10%), foreign-body sensation, stiffness, ischemic orchitis, and testicular atrophy.[2][3]
Laparoscopic repair
In recent years, as in other areas of surgery, laparoscopic repair of inguinal hernia has emerged as an option. Laparoscopic repairs (sometimes referred to as minimally invasive surgery or "keyhole surgery") are also tension-free, although the mesh is placed within the pre-peritoneal space behind the defect as opposed to in or over it. Advantages of lap over the open method include a faster recovery time and a lower post-operative pain score.
Like the open method, laparoscopic surgery may involve local or general anesthesia, depending on the size and related factors of the hernia. Lap is usually more expensive as it requires more Operating Room time than open repair, but a shorter hospitalization period.
There is no definitive consensus as to the comparative risk of complications, or comparative rate of recurrence compared to the open tension-free repairs.[citation needed] However, most non-emergent abdominal surgeries are moving to laproscopic methodologies, as the smaller incisions used result in less bleeding, less infection, faster recovery, reduced hospitalization and reduced pain.[4]
One specific method of laparoscopic repair is totally extraperitoneal (TEP) repair. TEp repair has been associated with fewer complications and a significantly shorter duration of post-operative analgesia than Lichtenstein repair for recurrent inguinal hernia.[5]
Meshes
Commercial meshes are typically made of prolene (polypropylene) or polyester. Marlex, Gore-Tex or Teflon meshes are sold by some companies. Partially absorbable meshes are used sometimes, but they are not advised because increase the risk of recurrence. Light-weight meshes seem to cause less discomfort than heavy-weight meshes.[6]
Cases of obstructive azoospermia have been related with the use of polypropylene mesh. However, this risk seems to be less than 1% [7] and therefore, it does not need to be notified in an informed consent.[8]
Meshes made of mosquito net clothes, in copolymer of polyethylene and polypropylene have been used for low-income patients in rural India and Ghana.[9] They are 3700 times cheaper than commercial meshes.[10] They are thinner and lighter, but weaker than commercial meshes.[11] However, they give results identical to commercial meshes in terms of infection and recurrence rate at 5 years. [10]
Synthetic totally bioabsorbable meshes are being experimented, giving encouraging results.[12]
Biologic meshes are increasingly popular since their introduction in 2003. Contrary to synthetic meshes, they can be used for repair in infected environment, like for an incarcerated hernia. Moreover, they seem to improve comfort and presumably, they reduce the risk of inguinodynia.[13]
They have been tested successfully after mesh-related inguinodynia.[14] Moreover, polypropylene meshes can face degradation in the long term,[15]
[16] which increases the risk of stiffness and inguinodynia. Some meshes can be relatively cheap (prices start at 500$), such as Surgisis-Biodesign, manufactured by Cook Group, made from Small intestinal submucosa. [17] Though their benefit is not fully established yet, the market is exploding, and if the current trend is confirmed, they may replace synthetic meshes in the US by 2016[18]
Suture-based repair
A commonly performed herniorrhaphy technique was first described by Bassini in the 1880s.[19][20] The Bassini technique is a "tension" repair, in which the edges of the defect are sewn back together without any reinforcement or prosthesis. In the Bassini technique, the conjoint tendon (formed by the distal ends of the transversus abdominis and internal oblique muscles) is approximated to the inguinal ligament and closed.[21]
Tension repairs are less commonly used today than in previous years. This is mostly due to the fact that tension-free Lichtenstein method is easier to perform than Shouldice. Another drawback of thisDue to the slightly higher rate of hernia recurrence, recovery period and postoperative pain of few weeks,. However, a few tension repairs are still in use today; these include the Shouldice and the Cooper's ligament/McVay repair.[22][23]
The Shouldice technique is a complicated four layer reconstruction of fascia transversalis; however, it has relatively low reported recurrence rates.[24]
Comparisons
| Advantages | Disadvantages |
|---|---|
|
In the UK a government committee called NICE[26] re-examined the data on laparoscopic and open repair (2004). They concluded that there is no difference in cost, as the increased costs of operation are offset by the decreased recovery period. They concluded that recurrence rates are identical, but newer studies have questioned this. They found that laparoscopic repair results in a more rapid recovery and less pain in the first few days. They found that laparoscopic repair has less risk of wound infection, less bleeding, and less swelling after surgery. They also reported less chronic pain, which can last for years and in one in 30 patients can be severe. A recent, large American study[27] found that recurrence within two years of operation after lap repair was 10% compared with 4% after open surgery. Both of these results, however, are considered poor by international standards and suggest that the surgeons were inexperienced, particularly in lap repair.
Mesh repairs have shown reduced recurrences or early recovery compared to tension repairs. Mesh repair complications include infection, mesh migration, adhesion formation, erosion into intraperitoneal organs, and chronic pain - due probably to entrapment of nerves, vessels, or the vas deferens.[28] Such complications usually become apparent weeks to years after the initial repair, presenting as abscess, fistula, or bowel obstruction.[29][30] More recently, concerns have been raised about the possibility of obstruction of the vas deferens as a result of the fibroblastic reaction to the mesh.[31][32]
References
- ^ Lichtenstein I, Shulman A (1986). "Ambulatory outpatient hernia surgery. Including a new concept, introducing tension-free repair". Int Surg. 71 (1): 1–4. PMID 3721754.
- ^ Wantz GE (1993). "Testicular atrophy and chronic residual neuralgia as risks of inguinal hernioplasty". Surg Clin North Am. 73 (3): 571–81. PMID 8497804.
- ^ Ridgway PF, Shah J, Darzi AW (2002). "Male genital tract injuries after contemporary inguinal hernia repair". BJU Int. 90 (3): 272–6. doi:10.1046/j.1464-410X.2002.02844.x. PMID 12133064.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ http://www.mayoclinic.org/minimally-invasive-surgery
- ^ Kumar S, Nixon SJ, MacIntyre IM (1999). "Laparoscopic or Lichtenstein repair for recurrent inguinal hernia: one unit's experience". J R Coll Surg Edinb. 44 (5): 301–2. PMID 10550952.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Agarwal BB, Agarwal KA, Sahu T, Mahajan KC (2010). "Traditional polypropylene and lightweight meshes in totally extraperitoneal inguinal herniorrhaphy". Int J Surg. 8 (1): 44–7. doi:10.1016/j.ijsu.2009.08.014. PMID 19853672.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Hallén M, Westerdahl J, Nordin P, Gunnarsson U, Sandblom G (2012). "Mesh hernia repair and male infertility: A retrospective register study". Surgery. 151 (1): 94–8. doi:10.1016/j.surg.2011.06.028. PMID 21943643.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ Fitzgibbons RJ (2005). "Can we be sure polypropylene mesh causes infertility?". Ann. Surg. 241 (4): 559–61. PMC 1357058. PMID 15798456.
{{cite journal}}: Unknown parameter|month=ignored (help) - ^ Clarke MG, Oppong C, Simmermacher R; et al. (2009). "The use of sterilised polyester mosquito net mesh for inguinal hernia repair in Ghana" (PDF). Hernia. 13 (2): 155–9. doi:10.1007/s10029-008-0460-3. PMID 19089526.
{{cite journal}}: Explicit use of et al. in:|author=(help); Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ a b Tongaonkar RR, Reddy BV,. Mehta VK, Singh NS, Shivade S (January–February 2003). "Preliminary Multicentric Trial of Cheap Indigenous Mosquito-Net Cloth for Tension-free Hernia Repair". Indian Journal of Surgery. 65 (1): 89–95.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Wilhelm TJ, Freudenberg S, Jonas E, Grobholz R, Post S, Kyamanywa P (2007). "Sterilized mosquito net versus commercial mesh for hernia repair. an experimental study in goats in Mbarara/Uganda". Eur Surg Res. 39 (5): 312–7. doi:10.1159/000104402. PMID 17595545.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Negro P, Gossetti F, Dassatti MR, Andreuccetti J, D'Amore L (2011). "Bioabsorbable Gore BIO-A plug and patch hernia repair in young adults" (PDF). Hernia. doi:10.1007/s10029-011-0886-x. PMID 22042382.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ Ansaloni L, Catena F, Coccolini F, Gazzotti F, D'Alessandro L, Pinna AD (2009). "Inguinal hernia repair with porcine small intestine submucosa: 3-year follow-up results of a randomized controlled trial of Lichtenstein's repair with polypropylene mesh versus Surgisis Inguinal Hernia Matrix". Am. J. Surg. 198 (3): 303–12. doi:10.1016/j.amjsurg.2008.09.021. PMID 19285658.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ Koopmann MC, Yamane BH, Starling JR (2011). "Long-term follow-up after meshectomy with acellular human dermis repair for postherniorrhaphy inguinodynia". Arch Surg. 146 (4): 427–31. doi:10.1001/archsurg.2011.49. PMID 21502450.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ Costello CR, Bachman SL, Grant SA, Cleveland DS, Loy TS, Ramshaw BJ (2007). "Characterization of heavyweight and lightweight polypropylene prosthetic mesh explants from a single patient". Surg Innov. 14 (3): 168–76. doi:10.1177/1553350607306356. PMID 17928615.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ Ostergard DR (2011). "Degradation, infection and heat effects on polypropylene mesh for pelvic implantation: what was known and when it was known". Int Urogynecol J. 22 (7): 771–4. doi:10.1007/s00192-011-1399-y. PMC 3112322. PMID 21512830.
{{cite journal}}: Unknown parameter|month=ignored (help) - ^ Inguinal Hernia Repair with Biodesign® (Surgisis®) -- David Edelman, MD [1]
- ^ US Markets for Soft Tissue Repair Devices 2012,
- ^ doctor/3213 at Who Named It?
- ^ Bassini E, Nuovo metodo operativo per la cura dell'ernia inguinale. Padua, 1889.
- ^ Gordon TL (1945). "Bassini's Operation for Inguinal Hernia". Br Med J. 2 (4414): 181–2. doi:10.1136/bmj.2.4414.181. PMC 2059571. PMID 20786215.
- ^ Mittelstaedt WE, Rodrigues Júnior AJ, Duprat J, Bevilaqua RG, Birolini D (1999). "Treatment of inguinal hernias. Is the Bassini's technique current yet? A prospective, randomized trial comparing three operative techniques: Bassini, Shouldice and McVay". Revista da Associação Médica Brasileira (1992) (in Portuguese). 45 (2): 105–14. PMID 10413912.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Mulholland MW and Doherty GM, ed. (2005). Complications in Surgery. Hagerstown, Maryland: Lippincott Williams & Wilkins. p. 533. ISBN 0781753163.
- ^ Arlt G, Schumpelick V (2002). "The Shouldice repair for inguinal hernia—technique and results". Zentralblatt für Chirurgie (in German). 127 (7): 565–9. doi:10.1055/s-2002-32844. PMID 12122581.
- ^ a b c d Trudie A Goers; Washington University School of Medicine Department of Surgery; Klingensmith, Mary E; Li Ern Chen; Sean C Glasgow (2008). The Washington manual of surgery. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 0-7817-7447-0.
{{cite book}}: CS1 maint: multiple names: authors list (link) - ^ a b c d e "Hernia - laparoscopic surgery (review)". National Institute for Health and Clinical Excellence. 2004. Retrieved 2007-03-26.
- ^ Neumayer L, Giobbie-Hurder A, Jonasson O; et al. (2004). "Open mesh versus laparoscopic mesh repair of inguinal hernia". N Engl J Med. 350 (18): 1819–27. doi:10.1056/NEJMoa040093. PMID 15107485.
{{cite journal}}: Explicit use of et al. in:|author=(help)CS1 maint: multiple names: authors list (link) - ^ Crespi G, Giannetta E, Mariani F, Floris F, Pretolesi F, Marino P (2004). "Imaging of early postoperative complications after polypropylene mesh repair of inguinal hernia". Radiol Med. 108 (1–2): 107–15. PMID 15269694.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Parra JA, Revuelta S, Gallego T, Bueno J, Berrio JI, Fariñas MC (2004). "Prosthetic mesh used for inguinal and ventral hernia repair: normal appearance and complications in ultrasound and CT". Br J Radiol. 77 (915): 261–5. doi:10.1259/bjr/63333975. PMID 15020373.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Aguirre DA, Santosa AC, Casola G, Sirlin CB (2005). "Abdominal wall hernias: imaging features, complications, and diagnostic pitfalls at multi-detector row CT". Radiographics. 25 (6): 1501–20. doi:10.1148/rg.256055018. PMID 16284131.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Shin D, Lipshultz LI, Goldstein M; et al. (2005). "Herniorrhaphy with polypropylene mesh causing inguinal vasal obstruction: a preventable cause of obstructive azoospermia". Ann Surg. 241 (4): 553–8. doi:10.1097/01.sla.0000157318.13975.2a. PMC 1357057. PMID 15798455.
{{cite journal}}: Explicit use of et al. in:|author=(help)CS1 maint: multiple names: authors list (link) - ^ Weyhe D, Belyaev O, Müller C; et al. (2007). "Improving outcomes in hernia repair by the use of light meshes—a comparison of different implant constructions based on a critical appraisal of the literature". World J Surg. 31 (1): 234–44. doi:10.1007/s00268-006-0123-4. PMID 17180568.
{{cite journal}}: Explicit use of et al. in:|author=(help)CS1 maint: multiple names: authors list (link)