Surgical management of inguinal hernia: retrospective cohort study in southeastern Scotland, 1985-2001
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《英国医生杂志》
1 Charing Cross Hospital, London W6 8RF Department of Orthopaedic and Trauma Surgery, 2 Department of Trauma and Orthopaedic Surgery, Bristol Royal Infirmary, 3 Department of General Surgery, St Mary's Hospital, London, 4 Department of Surgery, Royal Infirmary of Edinburgh
Correspondence to: H D E Atkinson duscha@hotmail.com
Introduction
The annual ratio of recurrent to primary repairs has significantly decreased in southeastern Scotland, during a period in which surgical technique has changed while selection criteria have remained the same. This ratio started falling before the introduction of mesh repair, indicating that other variables may be involved. Although changes in recurrence rates may lag up to 10 years behind changes in surgical technique, 40% occur within one year of surgery,4 and therefore it is likely that new techniques have influenced the recurrence rates in the 17 years of this study.
What is already known on this topic
Using mesh in inguinal hernia repair has increased rapidly worldwide since 1989 and is associated with low recurrence rates
What this study adds
Use of mesh in the past decade in southeastern Scotland mirrors the global trend. The annual ratio of recurrent to primary repairs has significantly decreased perhaps partly because of newer techniques but also other factors, such as better supervision and training
This article was posted on bmj.com on 16 November 2004: http://bmj.com/cgi/doi/10.1136/bmj.38282.675556.F7
We thank Stephanie C Lewis for her help and advice with the statistics.
Contributors: HDEA and SP-B designed the study. HDEA collected the data. HDEA, SGN, and SP analysed the data and wrote the initial draft. SGN and HDEA revised the draft and prepared the final manuscript. HDEA is guarantor.
Funding: None.
Competing interests: None declared.
Ethical approval: Not needed.
References
Lichtenstein IL, Shulman AG, Amid PK, Montlor HM. The tension-free hernioplasty. Am J Surg 1989;157: 188-93.
McCormack K, Scott NW, Go PM, Ross S, Grant AM, Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev 2003(1): CD001785.
Schumpelick V, Treutner KH, Arlt G. Inguinal hernia repair in adults. Lancet 1994;344: 375-9.
EU Hernia Trialists Collaboration. Mesh compared with non-mesh methods of open groin hernia repair: systematic review of randomized controlled trials. Br J Surg 2000;87: 854-9.
Bay-Nielsen M, Kehlet H, Strand L, Malmstrom J, Andersen FH, Wara P, et al. Quality assessment of 26304 herniorrhaphies in Denmark; a prospective nationwide study. Lancet 2001;358: 1124-8.(H D E Atkinson, specialis)
Correspondence to: H D E Atkinson duscha@hotmail.com
Introduction
The annual ratio of recurrent to primary repairs has significantly decreased in southeastern Scotland, during a period in which surgical technique has changed while selection criteria have remained the same. This ratio started falling before the introduction of mesh repair, indicating that other variables may be involved. Although changes in recurrence rates may lag up to 10 years behind changes in surgical technique, 40% occur within one year of surgery,4 and therefore it is likely that new techniques have influenced the recurrence rates in the 17 years of this study.
What is already known on this topic
Using mesh in inguinal hernia repair has increased rapidly worldwide since 1989 and is associated with low recurrence rates
What this study adds
Use of mesh in the past decade in southeastern Scotland mirrors the global trend. The annual ratio of recurrent to primary repairs has significantly decreased perhaps partly because of newer techniques but also other factors, such as better supervision and training
This article was posted on bmj.com on 16 November 2004: http://bmj.com/cgi/doi/10.1136/bmj.38282.675556.F7
We thank Stephanie C Lewis for her help and advice with the statistics.
Contributors: HDEA and SP-B designed the study. HDEA collected the data. HDEA, SGN, and SP analysed the data and wrote the initial draft. SGN and HDEA revised the draft and prepared the final manuscript. HDEA is guarantor.
Funding: None.
Competing interests: None declared.
Ethical approval: Not needed.
References
Lichtenstein IL, Shulman AG, Amid PK, Montlor HM. The tension-free hernioplasty. Am J Surg 1989;157: 188-93.
McCormack K, Scott NW, Go PM, Ross S, Grant AM, Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev 2003(1): CD001785.
Schumpelick V, Treutner KH, Arlt G. Inguinal hernia repair in adults. Lancet 1994;344: 375-9.
EU Hernia Trialists Collaboration. Mesh compared with non-mesh methods of open groin hernia repair: systematic review of randomized controlled trials. Br J Surg 2000;87: 854-9.
Bay-Nielsen M, Kehlet H, Strand L, Malmstrom J, Andersen FH, Wara P, et al. Quality assessment of 26304 herniorrhaphies in Denmark; a prospective nationwide study. Lancet 2001;358: 1124-8.(H D E Atkinson, specialis)