Search

Purpose: In meta-analyses and systematic reviews comparing laparoscopic with open repair of ventral hernias, data on umbilical, epigastric, and incisional hernias are pooled. Based on data from the Herniamed Hernia Registry, we aimed to investigate whether the differences in the therapy and treatment results justified such an approach., Methods: Between 1st September 2009 and 31st August 2013, 31,664 patients with a ventral hernia were enrolled in the Herniamed Hernia Registry. The implicated hernias included 16,206 umbilical hernias, 3,757 epigastric hernias, and 11,701 incisional hernias. Data on the surgical techniques, postoperative complication rates, and 1-year follow-up results were subjected to statistical analysis to identify any significant differences between the various hernia types., Results: The laparoscopic IPOM technique was used significantly more often for incisional hernia than for epigastric hernia, 31.3 vs. 24.0%, respectively, and was used for 12.9% of umbilical hernias (p < 0.0001). Likewise, the open technique with suturing of defect was used significantly more often for umbilical hernia than for epigastric hernia, 56.1 vs. 35.4%, respectively, and was used for 12.5% of incisional hernias (p < 0.0001). The postoperative complication rates of 3.2% for umbilical hernia and 3.5% for epigastric hernia were significantly lower than for incisional hernia, at 9.2% (p < 0.0001). That was also true for the reoperation rates due to postoperative complications, of 1.0 vs. 1.2 vs. 4.2% (p < 0.0001). The 1-year follow-up revealed significantly higher recurrence rates as well as rates of chronic pain needing treatment of 6.3 and 7.9%, respectively, for incisional hernia, compared with 4.1 and 4.3%, respectively, for epigastric hernia, and 2 and 1.9%, respectively, for umbilical hernia (p < 0.0001)., Conclusion: Since significant differences were identified in the therapy and treatment results between umbilical hernia, epigastric hernia, and incisional hernia, scientific studies should be conducted comparing the various surgical techniques only for a single hernia type.

The endoscopic procedures TEP and TAPP and the open techniques Lichtenstein, Plug and Patch, and PHS currently represent the gold standard in inguinal hernia repair recommended in the guidelines of the European Hernia Society, the International Endohernia Society, and the European Association of Endoscopic Surgery. Eighty-two percent of experienced hernia surgeons use the "tailored approach," the differentiated use of the several inguinal hernia repair techniques depending on the findings of the patient, trying to minimize the risks. The following differential therapeutic situations must be distinguished in inguinal hernia repair: unilateral in men, unilateral in women, bilateral, scrotal, after previous pelvic and lower abdominal surgery, no general anesthesia possible, recurrence, and emergency surgery. Evidence-based guidelines and consensus conferences of experts give recommendations for the best approach in the individual situation of a patient. This review tries to summarize the recommendations of the various guidelines and to transfer them into a practical decision tree for the daily work of surgeons performing inguinal hernia repair.