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Niebuhr H, Reinpold W, Morgenroth F, Berger C, Dag H, Wehrenberg U, Trzewik J, Köckerling F. Assessment of myofascial medialization following intraoperative fascial traction (IFT) in a cadaveric model. Hernia 2024:10.1007/s10029-024-03003-1. [PMID: 38615297 DOI: 10.1007/s10029-024-03003-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/20/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE Intraoperative fascial traction (IFT) for the treatment of large ventral hernias and loss of domain (LOD) hernias is a promising tool in abdominal wall surgery. However, little is known about the extent of gain in myofascial advancement especially for the anterior rectus sheath. We, therefore, used a cadaveric model to determine the medialization during IFT. METHODS 4 fresh frozen specimens were used. Retromuscular preparation was carried out followed by IFT with diagonal vertical traction for 30 min. Medial advancement of the anterior rectus sheath was measured after 15 and 30 min as well as traction forces. RESULTS Total medialization for anterior rectus sheath after 30 min of IFT was 10.5 cm (mean). The mean traction force was 16.28 kg. Total medialization was significantly higher during the first 15 min of vertical fascial traction (p < 0.05). CONCLUSIONS IFT provides significant medialization for the anterior rectus sheath in the cadaveric model. The findings align with results from a retrospective case study. Therefore, we see IFT as a beneficial tool in abdominal wall surgery.
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Affiliation(s)
- H Niebuhr
- Hamburg Hernia Centre, Hamburg, Germany.
| | | | - F Morgenroth
- Hamm-Lippstadt University of Applied Sciences, Hamm, Germany
| | - C Berger
- Hamburg Hernia Centre, Hamburg, Germany
| | - H Dag
- Hamburg Hernia Centre, Hamburg, Germany
| | - U Wehrenberg
- Anatomical Institute University of Hamburg, Hamburg, Germany
| | - J Trzewik
- Hamm-Lippstadt University of Applied Sciences, Hamm, Germany
| | - F Köckerling
- Hernia Centre Vivantes Humboldt-Klinikum Berlin, Berlin, Germany
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Lorenz R, Paasch C, Stechemesser B, Reinpold W, Niebuhr H, Fortelny RH, Mayer F, Köckerling F, Mantke R. Long-term evaluation of the Hernia Compact course of the German Hernia School. Hernia 2024; 28:621-628. [PMID: 38393496 DOI: 10.1007/s10029-024-02966-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/11/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Since 2011, the German Hernia Society has developed the German Hernia School (GHS) as a standardized hernia surgery training program for younger surgeons, consisting of the Hernia Compact basic module. It is a standardized three day training program (cadaver workshop, ultrasound simulation training, and hands-on training). After 12 years of experience, a survey was conducted to evaluate the long term effect of this training. METHOD Using an anonymous online-questionnaire, we contacted from September 2023 to October 2023 the Hernia Compact course participants via the congress organizer "Weitmeer" and the German Hernia Society. This online questionnaire contains 18 multiple choice questions regarding participants' age, gender, professional experience, participation in other modules of the German Hernia School, the effect of the course on their daily practice and their specific interest in hernia and abdominal wall surgery. RESULTS A total of 146 participants responded to the anonymous online questionnaire. A majority of 132 of 146 participants (90.42%) responded that this course improved the quality of surgical and hernia training (n = 146, no missing data). 141 of 146 individuals (96.58%) recommended the course to surgical colleagues (n = 146, no missing data). There were 89.73% of participants, (n = 146, no missing data) that developed a specific interest in hernia and abdominal wall surgery after the course. For 78.08% (n = 146, no missing data) of participants hernia and abdominal wall surgery was one of the most important activities in their daily surgical practice. CONCLUSION The standardized Hernia Compact basic course of the German Hernia School appears to have a huge impact on the quality of hernia surgery training in Germany and Austria. It might also help generate a specific interest in hernia surgery among participants.
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Affiliation(s)
- R Lorenz
- 3+CHIRURGEN Hernia Center, Klosterstrasse 34/35, 13581, Berlin, Germany.
- Department of General and Abdominal Surgery, Clinic for General and Abdominal Surgery, University Hospital Brandenburg an der Havel, Hochstrasse 29, 14770, Brandenburg an der Havel, Germany.
| | - C Paasch
- Department of General and Abdominal Surgery, Clinic for General and Abdominal Surgery, University Hospital Brandenburg an der Havel, Hochstrasse 29, 14770, Brandenburg an der Havel, Germany
| | - B Stechemesser
- Hernia Center Cologne, PAN-Klinik, Zeppelinstrasse 1, 50667, Cologne, Germany
| | - W Reinpold
- Hamburger Hernien Centrum, Harburg (an der Helios Mariahilf Klinik), Stader Str. 203c, 21075, Hamburg, Germany
| | - H Niebuhr
- Hamburger Hernien Centrum, Eppendorf, Eppendorfer Baum 8, 20249, Hamburg, Germany
| | - R H Fortelny
- Department of General Surgery, Klinik Ottakring, Montleartstraße 37, 1160, Vienna, Austria
- Medical Faculty, Sigmund Freud University, Freudplatz 3, 1020, Vienna, Austria
| | - F Mayer
- Department of Surgery, Paracelsus Medical University, University Hospital, Müllner Hauptstrasse 48, 5020, Salzburg, Austria
| | - F Köckerling
- Vivantes Humboldt Hospital Berlin, Academic Teaching Hospital of Charite' University Medicine, Am Nordgraben 2, 13509, Berlin, Germany
| | - R Mantke
- Department of General and Abdominal Surgery, Clinic for General and Abdominal Surgery, University Hospital Brandenburg an der Havel, Hochstrasse 29, 14770, Brandenburg an der Havel, Germany
- Faculty of Medicine, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
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Niebuhr H, Köckerling F, Fortelny R, Hoffmann H, Conze J, Holzheimer RG, Koch A, Köhler G, Krones C, Kukleta J, Kuthe A, Lammers B, Lorenz R, Mayer F, Pöllath M, Reinpold W, Schwab R, Stechemesser B, Weyhe D, Wiese M, Zarras K, Meyer HJ. [Inguinal hernia operations-Always outpatient?]. Chirurgie (Heidelb) 2023; 94:230-236. [PMID: 36786812 PMCID: PMC9950173 DOI: 10.1007/s00104-023-01818-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 06/17/2023]
Abstract
Inguinal hernia operations represent the most frequent operations overall with 300,000 interventions annually in Germany, Austria and Switzerland (DACH region). Despite the announced political willingness and the increasing pressure from the legislator to avoid costly inpatient treatment by carrying out as many outpatient operations as possible, outpatient treatment has so far played a subordinate role in the DACH region. The Boards of the specialist societies the German Hernia Society (DHG), the Surgical Working Group Hernia (CAH of the DHG), the Austrian Hernia Society (ÖHG) and the Swiss Working Group Hernia Surgery (SAHC) make inroads into this problem, describe the initial position and assess the current situation.
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Affiliation(s)
- H Niebuhr
- Hamburger Hernien Centrum, Eppendorfer Baum 8, 20249, Hamburg, Deutschland.
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Köckerling F, Lorenz R, Stechemesser B, Conze J, Kuthe A, Reinpold W, Niebuhr H, Lammers B, Zarras K, Fortelny R, Mayer F, Hoffmann H, Kukleta JF, Weyhe D. Comparison of outcomes in rectus abdominis diastasis repair-which data do we need in a hernia registry? Hernia 2021; 25:891-903. [PMID: 34319466 DOI: 10.1007/s10029-021-02466-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/16/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Rectus abdominis diastasis (RAD) ± concomitant hernia is a complex hernia entity of growing significance in everyday clinical practice. Due to a multitude of described surgical techniques, a so far missing universally accepted classification and hardly existing comparative studies, there are no clear recommendations in guidelines. Therefore, "RAD ± concomitant hernia" will be documented as a separate hernia entity in the Herniamed Registry in the future. For this purpose, an appropriate case report form will be developed on the basis of the existing literature. METHODS A systematic search of the available literature was performed in March 2021 using Medline, PubMed, Google Scholar, Scopus, Embase, Springer Link, and the Cochrane Library. 93 publications were identified as relevant for this topic. RESULTS In total 45 different surgical techniques for the repair of RAD ± concomitant hernia were identified in the surgical literature. RAD ± concomitant hernia is predominantly repaired by plastic but also by general surgeons. Classification of RAD ± concomitant hernia is based on a proposal of the German Hernia Society and the International Endohernia Society. Surgical techniques are summarized as groups subject to certain aspects: Techniques with abdominoplasty, open techniques, mini-less-open and endoscopic sublay techniques, mini-less-open and endoscopic subcutaneous/preaponeurotic techniques and laparoscopic techniques. Additional data impacting the outcome are also recorded as is the case for other hernia entities. Despite the complexity of this topic, documentation of RAD ± concomitant hernia has not proved to be any more cumbersome than for any of the other hernia entities when using this classification. CONCLUSION Using the case report form described here, the complex hernia entity RAD ± concomitant hernia can be recorded in a registry for proper analysis of comparative treatment options.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - R Lorenz
- Hernia Center 3+CHIRURGEN, Klosterstrasse 34/35, 13581, Berlin, Germany
| | - B Stechemesser
- Pan Hospital, Hernia Center, Zeppelinstraße 1, 50667, Köln, Germany
| | - J Conze
- UM Hernia Center, Arabellastr. 17, 81925, München, Germany
| | - A Kuthe
- DRK-Krankenhaus Clementinenhaus, Lützerodestr. 1, 30161, Hannover, Germany
| | - W Reinpold
- Hernia Center Hamburg, Helios Mariahilf Klinik, Stader Str. 203C, 21075, Hamburg, Germany
| | - H Niebuhr
- Hanse Hernia Center, Alte Holstenstr. 16, 21031, Hamburg, Germany
| | - B Lammers
- Department of Surgery I-Section Coloproctology and Hernia Surgery, Lukas Hospital, Preussenstr. 84, 41464, Neuss, Germany
| | - K Zarras
- Marien Hospital Düsseldorf, Rochusstraße 2, 40479, Düsseldorf, Germany
| | - R Fortelny
- Medical Faculty Austria, Private Hospital Confraternitaet, Sigmund Freud Private University Vienna, 1080, Vienna, Austria
| | - F Mayer
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - H Hoffmann
- ZweiChirurgen GmbH-Center for Hernia Surgery and Proctology, St. Johanns-Vorstadt 44, 4056, Basel, Switzerland
- University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - J F Kukleta
- Klinik Im Park Zurich (Hirslanden Group), Grossmuensterplatz 9, 8001, Zurich, Switzerland
| | - D Weyhe
- Department of General and Visceral Surgery, Pius Hospital, University Hospital of Visceral Surgery, Georgstrasse 12, 26121, Oldenburg, Germany
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Köckerling F, Brunner W, Fortelny R, Mayer F, Adolf D, Niebuhr H, Lorenz R, Reinpold W, Zarras K, Weyhe D. Treatment of small (< 2 cm) umbilical hernias: guidelines and current trends from the Herniamed Registry. Hernia 2020; 25:605-617. [PMID: 33237505 DOI: 10.1007/s10029-020-02345-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 11/13/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Based on meta-analyses and registry data, the European Hernia Society and the Americas Hernia Society have published guidelines for the treatment of umbilical hernias. These recommend that umbilical hernia should generally be treated by placing a non-absorbable (permanent) flat mesh into the preperitoneal space with an overlap of the hernia defect of 3 cm. Suture repair should only be considered for small hernia defects of less than 1 cm. Hence, the use of a mesh in general is subject to controversial debate particularly for small (< 2 cm) umbilical hernias. This analysis of data from the Herniamed Registry now presents data on the treatment of small (< 2 cm) umbilical hernias over the past 10 years. METHODS Herniamed is an Internet-based hernia registry in which hospitals and surgical centers in Germany, Austria and Switzerland can voluntarily enter data on their routine hernia operations. Between 2010 and 2019, data were entered into the Herniamed Registry by 737 hospitals/surgery centers on a total of 111,765 patients with primary elective umbilical hernia repair. The prospective data were analyzed retrospectively for each year and statistically compared. Due to a higher number of cases, the years 2013 and 2019 were compared for the perioperative outcome and the years 2013 and 2018 for 1-year follow-up. Fisher's exact test was applied for unadjusted analyses between the years, using a significance level of alpha = 5%. For post hoc tests of single categories, a Bonferroni adjustment for multiple testing was implemented. RESULTS A mesh technique was used to treat 45.4% of all umbilical hernias. The proportion of small (< 2 cm) umbilical hernias in the total collective of umbilical hernias was 55.6%. Suture repair was used consistently over the 10-year period to treat around 75% of all small (< 2 cm) umbilical hernias. Preperitoneal mesh placement as recommended in the guidelines was used only in 1.8% of cases. Between 2013 and 2019, stable values of 2 and 0.7% were observed for the postoperative complications and complication-related reoperations, respectively, with no relevant effect identified for the surgical technique. At 1-year follow-up, significantly higher rates of pain at rest (2.6 vs. 3.3), pain on exertion (5.7 vs. 6.6), and recurrences (1.3 vs. 1.8) (all p < 0.05) were identified for 2018 compared with 2013. CONCLUSIONS A suture technique is still used to treat 75% of patients with small (< 2 cm) umbilical hernias. The pain and recurrence rates are significantly less favorable for 2018 compared with 2013.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - W Brunner
- Department of Surgery, Kantonspital St. Gallen, Rorschacher Str. 95, CH-9007, St. Gallen, Switzerland
| | - R Fortelny
- Department of General Surgery, Faculty of Medicine, Sigmund Freud University, Freudplatz 3, 1020, Vienna, Austria
| | - F Mayer
- Department of Surgery, Paracelsus Medical University Salzburg, University Hospital of Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria
| | - D Adolf
- StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany
| | - H Niebuhr
- Hansechirurgie, Niebuhr Marleschki & Partner, Alte Holstenstr. 16, 21031, Hamburg, Germany
| | - R Lorenz
- Hernia Center 3+CHIRURGEN, Klosterstrasse 34/35, 13581, Berlin, Germany
| | - W Reinpold
- Wilhelmsburger Hospital Gross-Sand, Gross-Sand 3, 21107, Hamburg, Germany
| | - K Zarras
- Marien Hospital Düsseldorf, Rochusstrasse 2, 40479, Düsseldorf, Germany
| | - D Weyhe
- University Hospital of Visceral Surgery, Pius Hospital Oldenburg, Georgstrasse 12, 26121, Oldenburg, Germany
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Köckerling F, Brunner W, Mayer F, Fortelny R, Adolf D, Niebuhr H, Lorenz R, Reinpold W, Zarras K, Weyhe D. Assessment of potential influencing factors on the outcome in small (< 2 cm) umbilical hernia repair: a registry-based multivariable analysis of 31,965 patients. Hernia 2020; 25:587-603. [PMID: 32951104 DOI: 10.1007/s10029-020-02305-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/09/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION How best to treat a small (< 2 cm) umbilical hernia continues to be the subject of controversial debate. The recently published guidelines for treatment of umbilical hernias from the European Hernia Society and Americas Hernia Society recommend open mesh repair for defects ≥ 1 cm. Since the quality of evidence is limited for hernias with defect sizes smaller than 1 cm, suture repair can be considered. To date, little is known about the potential influencing factors on the outcome in small (< 2 cm) umbilical hernia repair. This multivariable analysis of data from the Herniamed Registry now aims to assess these factors. METHODS The data of patients with primary elective umbilical hernia repair and defect size < 2 cm entered into the Herniamed Registry from September 1, 2009 to December 31, 2018 were analyzed to assess through multivariable analysis all confirmatory pre-defined potential influencing factors on the primary outcome criteria intraoperative and postoperative complications, general complications, complication-related reoperations, recurrence rate and rates of pain at rest, pain on exertion and chronic pain requiring treatment at 1-year follow-up. RESULTS 31,965 patients (60%) met the inclusion criteria. The proportion of suture repairs was 78.6% (n = 25,119), of open mesh repairs 15.2% (n = 4853), and of laparoscopic mesh repairs 6.2% (n = 1993). Compared with open mesh repair, suture repair had a highly significantly unfavorable association with the recurrence rate (OR = 1.956 [1.463; 2.614]; p < 0.001). Female gender also had an unfavorable relation to the recurrence rate (OR = 1.644 [1.385; 1.952]; p < 0.001). Compared with open mesh repair, open suture repair had a highly significantly favorable association with the rate of postoperative complications (OR = 0.583 [0.484; 0.702]; p < 0.001) and complication-related reoperations (OR = 0.567 [0.397; 0.810]; p = 0.002).While laparoscopic IPOM showed a favorable relationship with the postoperative complications and complication-related reoperations, it demonstrated an unfavorable association with the intraoperative complications, general complications, recurrence rate and pain rates. CONCLUSION Suture repair continues to be used for 78% of umbilical hernias with a defect < 2 cm. While suture repair has a favorable influence on the rates of postoperative complications and complication-related reoperations, it has a higher risk of recurrence. Female gender also has an unfavorable influence on the recurrence rate. Laparoscopic IPOM appears to be indicated only in settings of obesity (BMI ≥ 30).
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - W Brunner
- Department of General, Visceral, Endocrine and Transplant Surgery, Rorschacher Kantonsspital St. Gallen, Str. 95, 9007, St. Gallen, Switzerland
| | - F Mayer
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria
| | - R Fortelny
- Department of General Surgery, Hospital Ottakring, Montleartstrasse 37, 1160, Vienna, Austria.,Sigmund Freud University Vienna, Medical Faculty, Schnirchgasse 9a, 1030, Vienna, Austria
| | - D Adolf
- StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany
| | - H Niebuhr
- Hansechirurgie, Niebuhr Marleschki & Partner, Alte Holstenstr. 16, 21031, Hamburg, Germany
| | - R Lorenz
- Hernia Center 3 + CHIRURGEN, Klosterstrasse 34/35, 13581, Berlin, Germany
| | - W Reinpold
- Wilhelmsburger Hospital Gross-Sand, Gross-Sand 3, 21107, Hamburg, Germany
| | - K Zarras
- Marien Hospital Düsseldorf, Rochusstrasse 2, 40479, Düsseldorf, Germany
| | - D Weyhe
- Department of General and Visceral Surgery, Pius Hospital Oldenburg, University Hospital of Visceral Surgery, Georgstraße 12, 26121, Oldenburg, Germany
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Köckerling F, Hantel E, Adolf D, Kuthe A, Lorenz R, Niebuhr H, Stechemesser B, Marusch F. Differences in the outcomes of scrotal vs. lateral vs. medial inguinal hernias: a multivariable analysis of registry data. Hernia 2020; 25:1169-1181. [PMID: 32748006 DOI: 10.1007/s10029-020-02281-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/24/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION There are hardly any studies on the outcome of scrotal compared with medial and lateral inguinal hernias. Therefore, this present multivariable analysis of data from the Herniamed Registry compared the outcome of scrotal vs. lateral vs. medial inguinal hernias and explored the relationship between hernia localization and outcomes. METHODS Included in the analysis were all primary elective unilateral inguinal hernias in men with scrotal, lateral or medial defect localization whose details had been entered into the Herniamed Registry by 712 participating institutions (status February 1, 2019). The relation of the hernia localization with the outcome parameters adjusted for pre-defined confounding patient- and procedure-related variables was analyzed via multivariable binary logistic models. RESULTS Details of 98,321 patients were thus available for multivariable analysis. These related to 65,932 (67.1%) lateral, 29,697 (30.2%) medial and 2,710 (2.7%) scrotal inguinal hernias. Scrotal hernias were associated with higher patient age, higher BMI, higher ASA score, larger defect, more risk factors and more frequent use of Lichtenstein repair. On the other hand, scrotal hernias were associated less commonly with preoperative pain. Multivariable analysis revealed that scrotal hernias had a highly significantly unfavorable association with postoperative complications, complication-related reoperations and general complications. But scrotal hernias had a highly significantly favorable relation with the pain rates at 1-year follow-up. Medial hernias were the hernia type most often related with recurrence and also had an unfavorable association with the pain rates at 1-year follow-up. CONCLUSION Scrotal inguinal hernias demonstrated a very unfavorable relation with the postoperative complication rate, the rate of complication-related reoperations and the rate of general complications. But a very favorable association with chronic pain rates was identified at 1-year follow-up. Medial inguinal hernia had an unfavorable relation with the recurrence and pain rates.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching, Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - E Hantel
- Department of General, Visceral, Vascular and Thoracic Surgery, Ernst Von Bergmann Hospital, Charlottenstrasse 72, 14467, Potsdam, Germany
| | - D Adolf
- StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany
| | - A Kuthe
- Department of General and Visceral Surgery, DRK-Krankenhaus Clementinenhaus, Lützerodestr. 1, 30161, Hannover, Germany
| | - R Lorenz
- 3+Chirurgen, Klosterstrasse 34/35 Spandau, 13581, Berlin, Germany
| | - H Niebuhr
- Hansechirurgie, Niebuhr Marleschki and Partner, Alte Holstenstr. 16, 21031, Hamburg, Germany
| | - B Stechemesser
- Hernia Center, Pan Hospital, Zeppelinstrasse 1, 50667, Cologne, Germany
| | - F Marusch
- Department of General, Visceral, Vascular and Thoracic Surgery, Ernst Von Bergmann Hospital, Charlottenstrasse 72, 14467, Potsdam, Germany
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Köckerling F, Hantel E, Adolf D, Stechemesser B, Niebuhr H, Lorenz R, Zarras K, Marusch F. Do drains have an impact on the outcome after primary elective unilateral inguinal hernia repair in men? Hernia 2020; 24:1083-1091. [PMID: 32566993 DOI: 10.1007/s10029-020-02254-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/15/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The use of drains continues to be a controversial topic in surgery. In a review of that topic for incisional hernia it was not possible to find sufficient evidence of the need for a drain. Likewise, for inguinal hernia surgery the data available are insufficient. METHODS In a multivariable analysis of data from the Herniamed Registry for 98,321 patients with primary elective unilateral inguinal hernia repair in men, the role of a drain was investigated. RESULTS A drain was used in 24.7% (n = 24,287/98,321) of patients. These patients were on average older, had higher BMI, longer operating time and received a smaller mesh. Drains were also used more often for patients with higher ASA score, risk factors, larger defects and scrotal hernia localization as well as for Lichtenstein, TEP and suture repair. The use of drains was highly significantly associated with intra- and postoperative complications as well as with complication-related reoperations. Hence, drains are used selectively in inguinal hernia repair for patients at higher risk of perioperative complications. Despite the use of drains, the outcome in this risk group is less favorable. It remains unclear if drains prevent further complications in high-risk patients. CONCLUSION Drains are used selectively in high-risk men with primary elective unilateral inguinal hernia repair. Drains are associated with intra- and postoperative complications rates and complication-related reoperation rate. Drains can serve as an indicator for early detection of complications.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - E Hantel
- Department of General, Visceral, Vascular and Thoracic Surgery, Ernst Von Bergmann Hospital, Charlottenstrasse 72, 14467, Potsdam, Germany
| | - D Adolf
- StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany
| | - B Stechemesser
- Hernia Center, Pan Hospital, Zeppelinstraße 1, 50667, Köln, Germany
| | - H Niebuhr
- Hanse-Hernienzentrum, Eppendorfer Baum 8, 20249, Hamburg, Germany
| | - R Lorenz
- 3+Chirurgen, Klosterstraße 34/35, 13581, Berlin-Spandau, Germany
| | - K Zarras
- Department of Visceral, Minimally Invasive and Oncologic Surgery, Academic Teaching Hospital of University of Düsseldorf, Marien Hospital, Rochusstraße 2, 40479, Düsseldorf, Germany
| | - F Marusch
- Department of General, Visceral, Vascular and Thoracic Surgery, Ernst Von Bergmann Hospital, Charlottenstrasse 72, 14467, Potsdam, Germany
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Köckerling F, Krüger C, Gagarkin I, Kuthe A, Adolf D, Stechemesser B, Niebuhr H, Jacob D, Riediger H. What is the outcome of re-recurrent vs recurrent inguinal hernia repairs? An analysis of 16,206 patients from the Herniamed Registry. Hernia 2020; 24:811-819. [PMID: 32086633 PMCID: PMC7395905 DOI: 10.1007/s10029-020-02138-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/06/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The proportion of recurrent repairs in the total collective of inguinal hernia repairs among men is 11.3-14.3% and among women 7.0-7.4%. The rate of re-recurrences is reported to be 2.9-9.2%. To date, no case series has been published on second and ≥ third recurrences and their treatment outcomes. Only case reports are available. MATERIALS AND METHODS In an analysis of data from the Herniamed Registry the perioperative and 1-year follow-up outcomes of 16,206 distinct patients who had undergone first recurrent (n = 14,172; 87.4%), second recurrent (n = 1,583; 9.8%) or ≥ third recurrent (n = 451; 2.8%) inguinal hernia repair between September 1, 2009 and July 1, 2017 were compared. RESULTS The intraoperative complication rate for all recurrent repairs was between 1-2%. In the postoperative complications a continuous increase was observed (first recurrence: 3.97% vs second recurrence: 5.75% vs ≥ third recurrence 8.65%; p < 0.001). That applied equally to the complication-related reoperation rates (first recurrence: 1.50% vs second recurrence: 2.21% vs ≥ third recurrence 2.66; p = 0.020). Likewise, the re-recurrence rate rose significantly (first recurrence: 1.95% vs second recurrence: 2.72% vs ≥ third recurrence 3.77; p = 0.005). Similarly, the rate of pain requiring treatment rose highly significantly with an increasing number of recurrences (first recurrence: 5.21% vs second recurrence: 6.70% vs ≥ third recurrence 10.86; p = < 0.001). CONCLUSION The repair of re-recurrences in inguinal hernia is associated with increasingly more unfavorable outcomes. For the first recurrence the guidelines should definitely be noted. For a second and ≥ third recurrence diagnostic laparoscopy may help to select the best possible surgical technique.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - C Krüger
- Immanuel Hospital Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf, Germany
| | - I Gagarkin
- Spital Riggisberg, Inselgruppe,, Eyweg 2, 3132, Riggisberg, Switzerland
| | - A Kuthe
- DRK-Krankenhaus Clementinenhaus, Lützerodestr. 1, 30161, Hannover, Germany
| | - D Adolf
- StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany
| | - B Stechemesser
- Pan Hospital, Hernia Center, Zeppelinstraße 1, 50667, Köln, Germany
| | - H Niebuhr
- Hansechirurgie, Niebuhr, Marleschki & Partner, Alte Holstenstr. 16, 21031, Hamburg, Germany
| | - D Jacob
- COPV-Hernia Center, Kaiser-Wilhelm-Str. 24-26, 12247, Berlin, Germany
| | - H Riediger
- Vivantes Humboldt Hospital, Am Nordgraben 2, 13509, Berlin, Germany
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10
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Bittner R, Bain K, Bansal VK, Berrevoet F, Bingener-Casey J, Chen D, Chen J, Chowbey P, Dietz UA, de Beaux A, Ferzli G, Fortelny R, Hoffmann H, Iskander M, Ji Z, Jorgensen LN, Khullar R, Kirchhoff P, Köckerling F, Kukleta J, LeBlanc K, Li J, Lomanto D, Mayer F, Meytes V, Misra M, Morales-Conde S, Niebuhr H, Radvinsky D, Ramshaw B, Ranev D, Reinpold W, Sharma A, Schrittwieser R, Stechemesser B, Sutedja B, Tang J, Warren J, Weyhe D, Wiegering A, Woeste G, Yao Q. Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS))-Part A. Surg Endosc 2019; 33:3069-3139. [PMID: 31250243 PMCID: PMC6722153 DOI: 10.1007/s00464-019-06907-7] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 06/07/2019] [Indexed: 02/08/2023]
Abstract
Abstract In 2014, the International Endohernia Society (IEHS) published the first international “Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias.” Guidelines reflect the currently best available evidence in diagnostics and therapy and give recommendations to help surgeons to standardize their techniques and to improve their results. However, science is a dynamic field which is continuously developing. Therefore, guidelines require regular updates to keep pace with the evolving literature. Methods For the development of the original guidelines, all relevant literature published up to year 2012 was analyzed using the ranking of the Oxford Centre for Evidence-Based Medicine. For the present update, all of the previous authors were asked to evaluate the literature published during the recent years from 2012 to 2017 and revise their statements and recommendations given in the initial guidelines accordingly. In two Consensus Conferences (October 2017 Beijing, March 2018 Cologne), the updates were presented, discussed, and confirmed. To avoid redundancy, only new statements or recommendations are included in this paper. Therefore, for full understanding both of the guidelines, the original and the current, must be read. In addition, the new developments in repair of abdominal wall hernias like surgical techniques within the abdominal wall, release operations (transversus muscle release, component separation), Botox application, and robot-assisted repair methods were included. Results Due to an increase of the number of patients and further development of surgical techniques, repair of primary and secondary abdominal wall hernias attracts increasing interests of many surgeons. Whereas up to three decades ago hernia-related publications did not exceed 20 per year, currently this number is about 10-fold higher. Recent years are characterized by the advent of new techniques—minimal invasive techniques using robotics and laparoscopy, totally extraperitoneal repairs, novel myofascial release techniques for optimal closure of large defects, and Botox for relaxing the abdominal wall. Furthermore, a concomitant rectus diastasis was recognized as a significant risk factor for recurrence. Despite insufficient evidence with respect to these new techniques, it seemed to us necessary to include them in the update to stimulate surgeons to do research in these fields. Conclusion Guidelines are recommendations based on best available evidence intended to help the surgeon to improve the quality of his daily work. However, science is a continuously evolving process, and as such guidelines should be updated about every 3 years. For a comprehensive reference, however, it is suggested to read both the initial guidelines published in 2014 together with the update. Moreover, the presented update includes also techniques which were not known 3 years before.
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Affiliation(s)
- R Bittner
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Trubetskaya str., 8, b. 2, 119992, Moscow, Russia. .,Emeritus Director Marienhospital Stuttgart, Supperstr. 19, 70565, Stuttgart, Germany.
| | - K Bain
- Department of Surgery, New York University, New York, USA
| | - V K Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Room No. 5026A, 5th Floor, Teaching Block, Ansari Nagar, New Delhi, 110029, India
| | - F Berrevoet
- Universitair Ziekenhuis Gent, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - J Bingener-Casey
- Division of Breast, Endocrine, Metabolic & Gastrointestinal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - D Chen
- Lichtenstein Amid Hernia Clinic at UCLA, Section of Minimally Invasive Surgery, UCLA Division of General Surgery, Los Angeles, USA
| | - J Chen
- Department of Hernia and Abdominal Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Fengtai, China
| | - P Chowbey
- Max Super Speciality Hospital, 2 Press Enclave Road, Saket, New Delhi, 110017, India
| | - U A Dietz
- Klinik für Viszeral-, Gefäss- und Thoraxchirurgie, Kantonsspital Olten, Baslerstrasse 150, 4600, Olten, Switzerland
| | - A de Beaux
- Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - G Ferzli
- Department of Surgery, New York University, New York, USA
| | - R Fortelny
- Allgemein-, Viszeral- und Tumorchirurgie, Wilhelminenspital, 1160, Vienna, Austria
| | - H Hoffmann
- ZweiChirurgen GmbH, Zentrum für Hernienchirurgie und Proktologie, St. Johanns-Vorstadt 44, 4056, Basel, Switzerland
| | - M Iskander
- Department of Surgery, Mount Sinai Hospital, 1010 5th Avenue, New York, NY, 10028, USA
| | - Z Ji
- Department of Surgery, Southeast University School of Medicine, Main Add. 87 Ding Jia Qiao, Nanjing, 210009, Jiangsu, China
| | - L N Jorgensen
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, 2400, Copenhagen NV, Denmark
| | - R Khullar
- Max Super Speciality Hospital, 2 Press Enclave Road, Saket, New Delhi, 110017, India
| | - P Kirchhoff
- ZweiChirurgen GmbH, Zentrum für Hernienchirurgie und Proktologie, St. Johanns-Vorstadt 44, 4056, Basel, Switzerland
| | - F Köckerling
- Visceral- und Gefäßchirurgie, Zentrum für Minimal Invasive Chirurgie, Vivantes Klinikum Spandau, Neue Bergstraße 6, 13585, Berlin, Germany
| | - J Kukleta
- Klinik im Park, Grossmuensterplatz 9, 8001, Zurich, Switzerland
| | - K LeBlanc
- Our Lady of the Lake Physician Group, 7777 Hennessy Blvd., Suite 612, Baton Rouge, LA, 70808, USA
| | - J Li
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - D Lomanto
- Department of Surgery, YLL School of Medicine, National University Hospital, Level 2, Kent Ridge Wing 2, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - F Mayer
- Paracelsus Medizinische Universität Salzburg (PMU), Universitätsklinik für Chirurgie, Salzburg, Austria
| | - V Meytes
- Department of Surgery, New York University, New York, USA
| | - M Misra
- Mahatma Gandhi University of Medical Sciences & Technology, RIICO Institutional Area, Tonk Road, Sitapura, Jaipur, Rajasthan, 302 022, India
| | - S Morales-Conde
- Centro de Cirugía Mayor Ambulatoria Ave María, Avda. de la Palmera, 53, 41013, Seville, Spain
| | - H Niebuhr
- HANSECHIRURGIE, Niebuhr Marleschki & Partner, Alte Holstenstr. 16, 21031, Hamburg, Germany
| | - D Radvinsky
- SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - B Ramshaw
- Department of Surgery, University Surgeons Associates, 1930 Alcoa Highway, Bldg A, Ste 285, Knoxville, TN, 37920, USA
| | - D Ranev
- Lenox Hill Hospital-Northwell Health, New York, USA
| | - W Reinpold
- Abteilung für Chirurgie, Wilhelmsburger Krankenhaus, Groß-Sand 3, 21107, Hamburg, Germany
| | - A Sharma
- Max Super Speciality Hospital, 2 Press Enclave Road, Saket, New Delhi, 110017, India
| | - R Schrittwieser
- Abteilung für Chirurgie, LKH Hochsteiermark, Standort Bruck an der Mur Tragösser Str. 1, 8600, Bruck an der Mur, Austria
| | - B Stechemesser
- Hernienzentrum Köln, Zeppelinstraße 1, 50667, Cologne, Germany
| | - B Sutedja
- Gading Pluit Hospital, Jl. Boulevard Timur Raya Kelapa Gading, Jakarta, 14250, Indonesia
| | - J Tang
- Department of General Surgery, Huadong Hospital, Fudan University, Shanghai, China
| | - J Warren
- Minimally Invasive Surgery, Greenville Health System, Department of Surgery, University of South Carolina School of Medicine, Greenville, USA
| | - D Weyhe
- Pius-Hospital Oldenburg, Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinik für Viszeralchirurgie, Georgstraße 12, 26121, Oldenburg, Germany
| | - A Wiegering
- Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Würzburg, Germany
| | - G Woeste
- AGAPLESION ELISABETHENSTIFT gemeinnützige GmbH, Akademisches Lehrkrankenhaus, Landgraf-Georg-Strasse 100, 64287, Darmstadt, Germany
| | - Q Yao
- Department of Hernia and Abdominal Surgery, Huashan Hospital, Fudan University, Shanghai, China
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11
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Abstract
The new worldwide guidelines of all international hernia societies only recommend the mesh-based methods TEP, TAPP and Lichtenstein. The best mesh-free technique, the Shouldice operation, should only be used if the patient has declined the use of a mesh or no mesh is available. The systematic use of the Shouldice technique for smaller inguinal hernias and younger men should be confined to study settings. A tailored approach should be taken for mesh-based procedures to minimize the risk to patients. Due to lower pain rates the laparoendoscopic techniques TEP and TAPP are the methods of choice for primary male unilateral inguinal hernia. They are also preferred for female patients as they improve the diagnostics of femoral hernias as well as for bilateral inguinal hernias in female and male patients. The Lichtenstein operation tends to be recommended for scrotal hernia, following previous pelvic surgery, vascular surgery, liver cirrhosis, radiotherapy and intolerance of general anesthesia. This also applies for recurrent hernia following a previous laparoendoscopic primary operation. Similarly, recurrent hernia after a primary suture or mesh procedure should be repaired using the TEP or TAPP technique. In emergency procedures for incarceration the diagnostic superiority of laparoscopy and the ability to reposition the incarcerated organs should be utilized. The inguinal hernia can then be repaired at the same time or later depending on whether there is any local infection.
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Affiliation(s)
- H Niebuhr
- Hanse-Hernia Center, Alte Holstenstraße 16, 21031, Hamburg, Deutschland.
| | - M Pawlak
- Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, PL-210, Gdańsk, Polen
| | - F Köckerling
- Visceral- und Gefäßchirurgie, Zentrum für Minimal Invasive Chirurgie, Vivantes Klinikum Spandau, Berlin, Deutschland
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12
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Wadhawan R, Gupta M, Laharwal A, Tsai C, Tang S, Hu J, Tan WB, Clara ES, Prakash P, Shabbir A, Lomanto D, Takahashi M, Matsuya H, Nishinari N, Szura M, Pasternak A, Kibil W, Solecki R, Matyja A, Porter A, Berney C, Niebuhr H, Mayer F, Köckerling F, Lal D, Klobusicky P, Feyerherd P, Ates M, Kinaci E, Kose E, Soyer V, Sarici B, Cuglan S, Korkmaz F, Dirican A, Gómez-Menchero J, Jurado PJ, Luque JB, Moreno JG, Grau JMS, Jurado JFG, Giubileo M, Federico L, De Nigris S, Ventura P, García-Pastor P, Carbonell-Tatay F, Torregrosa-Gallud A, Forgione U, Feleshtynsky Y, Vatamanyuk VF, Svyrydovsky SA, Kokhanevych AV, Curado-Soriano A, Infantes-Ormad M, Valera-Sanchez Z, Dominguez-Amodeo A, Naranjo-Fernandez JR, Ruiz Zafra A, Navarrete-Carcer E, Oliva-Mompean F, Padillo-Ruiz J, Brochado J, Farah F, Nicastro RG, Condi GA, De Marco M, Samaan R, Radtke MC, Ji Z, Li J. Topic: Inguinal Hernia - Fixation. Hernia 2015; 19 Suppl 1:S254-60. [PMID: 26518818 DOI: 10.1007/bf03355366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R Wadhawan
- Fortis Hospital, Vasant Kunj, New Delhi, India
| | - M Gupta
- Fortis Hospital, Vasant Kunj, New Delhi, India
| | - A Laharwal
- Fortis Hospital, Vasant Kunj, New Delhi, India
| | - C Tsai
- Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - S Tang
- Minimally Invasive Surgical Centre, Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - J Hu
- Minimally Invasive Surgical Centre, Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - W B Tan
- Minimally Invasive Surgical Centre, Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - E Sta Clara
- Minimally Invasive Surgical Centre, Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - P Prakash
- Minimally Invasive Surgical Centre, Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - A Shabbir
- Minimally Invasive Surgical Centre, Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - D Lomanto
- Minimally Invasive Surgical Centre, Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | | | - H Matsuya
- Morioka Yuai Hospital, Morioka, Japan
| | | | - M Szura
- I Department of General Surgery, Jagiellonian University, Krakow, Poland
| | - A Pasternak
- I Department of General Surgery, Jagiellonian University, Krakow, Poland.,Department of Anatomy, Jagiellonian University, Krakow, Poland
| | - W Kibil
- I Department of General Surgery, Jagiellonian University, Krakow, Poland
| | - R Solecki
- I Department of General Surgery, Jagiellonian University, Krakow, Poland
| | - A Matyja
- I Department of General Surgery, Jagiellonian University, Krakow, Poland
| | - A Porter
- Bankstown-Lidcombe Hospital, University of New South Wales, Sydney, Australia
| | - C Berney
- Bankstown-Lidcombe Hospital, University of New South Wales, Sydney, Australia
| | - H Niebuhr
- Hanse-Hernienzentrum Hamburg, Hamburg, Germany
| | - F Mayer
- Landeskrankenhaus Salzburg Uniklinikum, Salzburg, Austria
| | | | - D Lal
- National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - P Klobusicky
- Helios St. Elisabeth Hospital, Bad Kissingen, Germany
| | | | - M Ates
- Faculty of Medicine, Department of General Surgery and Liver Transplantation Institute, Inonu University, Malatya, Turkey.,Faculty of Medicine, Department of Anatomy, Inonu University, Malatya, Turkey
| | - E Kinaci
- Faculty of Medicine, Department of General Surgery and Liver Transplantation Institute, Inonu University, Malatya, Turkey.,Department of General Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - E Kose
- Faculty of Medicine, Department of Anatomy, Inonu University, Malatya, Turkey
| | - V Soyer
- Faculty of Medicine, Department of General Surgery and Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - B Sarici
- Faculty of Medicine, Department of General Surgery and Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - S Cuglan
- Faculty of Medicine, Department of Anatomy, Inonu University, Malatya, Turkey
| | - F Korkmaz
- Faculty of Medicine, Department of Anatomy, Inonu University, Malatya, Turkey
| | - A Dirican
- Faculty of Medicine, Department of General Surgery and Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | | | - P J Jurado
- Hospital General Básico de Riotinto, Huelva, Spain
| | | | | | | | | | - M Giubileo
- Ospedale San Carlo Borromeo, Milano, Italy.
| | - L Federico
- Ospedale San Carlo Borromeo, Milano, Italy
| | | | - P Ventura
- Ospedale San Carlo Borromeo, Milano, Italy
| | | | | | | | | | - Y Feleshtynsky
- Optimization of Transabdominal Pre-Peritoneal Alloplasty of Inguinal Hernias, Kyiv, Ukraine
| | | | | | | | | | | | | | | | | | - A Ruiz Zafra
- Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | | | | | - J Brochado
- Hospital Servidor Publico Estadual, São Paulo, Brazil
| | - F Farah
- Hospital Servidor Publico Estadual, São Paulo, Brazil
| | - R G Nicastro
- Hospital Servidor Publico Estadual, São Paulo, Brazil
| | - G A Condi
- Hospital Servidor Publico Estadual, São Paulo, Brazil
| | - M De Marco
- Hospital Servidor Publico Estadual, São Paulo, Brazil
| | - R Samaan
- Hospital Servidor Publico Estadual, São Paulo, Brazil
| | - M C Radtke
- Hospital Servidor Publico Estadual, São Paulo, Brazil
| | - Z Ji
- Department of General Surgery, Zhongda Hospital, Southeast University, Nanjing, China
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13
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Pawlak M, Niebuhr H, Bury K. Dynamic inguinal ultrasound: a diagnostic tool for hernia surgeons. Hernia 2015; 19:1033-4. [DOI: 10.1007/s10029-015-1356-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 02/14/2015] [Indexed: 11/28/2022]
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14
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Tschechne B, Borghardt J, Wildfang I, Schroder D, Niebuhr H, Zakaria H, Fanaei S, Luft S, Jordan W. BENDAMUSTINE AND CETUXIMAB IN COMBINATION AS ALTERNATIVE THERAPEUTIC OPTION FOR RECURRENT HEAD AND NECK CANCER. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70060-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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Jordan W, Wildfang I, Welkoborsky H, Borghardt J, Zakaria H, Fanaei S, Niebuhr H, Luft S, Tschechne B. TPF induction-radioimmunochemotherapy for the treatment of advanced head and neck cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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16
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Tschechne B, Wildfang I, Niebuhr H, Borghardt J, Zakaria H, Fanaei S, Luft S, Jordan W. Bendamustine and cetuximab as an alternative therapeutic option for recurrent head and neck squamous cell carcinoma. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e16029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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17
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Abstract
The potential for improvement of the results of laparoscopic operations as well as necessity of enhanced efficiency in the health-care systems are the main reasons for development and practical use of robotic systems in the field of laparoscopic surgery. While robotic systems imitate the human camera-holder the Image Tracking System (ImagTrac, Olympus, Tokio) is based on another principle: A voice-activated zoom function allows change between overview and detailed view. In the zoom-in position it is possible to select four different fields of view. The results of a clinical trial with control group show that the system: 1. Makes it possible to dispense with the human camera-holder without compromising patient safety, sometimes at greater convenience to the surgeon. 2. Makes it possible for routine laparoscopic operations such as laparoscopic cholecystectomy and laparoscopic hernia repair to be performed (as solo surgery) by a team of a surgeon and a nurse only. 3. Is more cost-effective than robotic systems with a similar range of features.
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Affiliation(s)
- H Niebuhr
- Chirurgische Abteilung, Evangelisches Krankenhauses Alsterdorf, Hamburg
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18
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Niebuhr H, Nahrstedt U, Born O. [Routine ultrasound in diagnosis of acute appendicitis]. Zentralbl Chir 1999; 123 Suppl 4:26-8. [PMID: 9880866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
A prospective trial reveals that routine ultrasound in suspected appendicitis in the hands of experts can lead to a specificity of 94% and a sensitivity of 90% in opposite to 82% and 78% for clinical findings alone. The rate of "negative laparotomies" has decreased from 22% to 11%.
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Affiliation(s)
- H Niebuhr
- Chirurgische Abteilung, Evangelisches Krankenhaus Alsterdorf, Hamburg
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19
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Taylessani C, Muth K, Niebuhr H, Rückert K. [Does pneumoperitoneum in laparoscopic intervention induce additional stress on elderly patients?]. Langenbecks Arch Chir Suppl Kongressbd 1997; 114:1108-1110. [PMID: 9574348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Although the required pneumoperitoneum for laparoscopic cholecystectomy and laparoscopic hernial repair means stress for the elderly, it does not affect them negatively from a clinical point of view. On the contrary, the patient profits by a low complication rate, a quick recovery and a shorter stay in hospital.
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Affiliation(s)
- C Taylessani
- Chirurgische Abteilung, Allgemeines Krankenhaus Ochsenzoll, Hamburg
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20
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Niebuhr H, Nahrstedt U, Reis M, Wilhelm W, Rückert K. [Interdisciplinary short-term therapy center as organizational response to future responsibilities of a large community hospital]. Chirurg 1995; 66:suppl 151-5. [PMID: 7671749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- H Niebuhr
- Chirurgische Abteilung, Allgemeines Krankenhaus Ochsenzoll, Hamburg
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21
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Niebuhr H, Nahrstedt U, Hollmann S, Rückert K. Complications in laparoscopic surgery. Surg Technol Int 1995; IV:173-177. [PMID: 21400429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Over the last few years, laparoscopic surgery has gained widespread acceptance in surgical practice. The indications range has expanded extraordinarily in that time. Some of the practiced procedures are already considered the gold standard, while others are still on the way there. The fascinating technique and results notwithstanding, a number of risks, mistakes, and complications are possible in both the initial and the advanced states. We present our experience from 2118 laparoscopic operations performed between February 1991 to March 1995, focusing on the intraoperative complications (Tables 1, 2).
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Affiliation(s)
- H Niebuhr
- Senior Surgeon, Department of General Surgery, Ochsenzoll General Hospital, Hamburg, Germany
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22
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Abstract
Laparoscopic cholecystectomy and appendectomy are widely accepted in clinical practice. In the initial stage, when the method is introduced, there are a number of mistakes, risks, and complications possible. The surgeons, the staff, the instruments, the anesthetist, and, last but not least, the patient, are among the possible contributing causes. We try to analyze the reasons and conditions leading to possible complications. Complications we have experienced are reported. In our conclusions we try to show how it is possible to avoid severe problems.
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Affiliation(s)
- H Niebuhr
- Chirurgische Abteilung, Allgemeines Krankenhaus Ochsenzoll, Hamburg, Federal Republic of Germany
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23
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Niebuhr H, Nahrstedt U, Seide K, Rückert K. [Standardized ultrasound study with computer-assisted documentation of findings in diagnosis of polytrauma patients]. Unfallchirurg 1992; 95:319-23. [PMID: 1502569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Based on the results of a prospective trial to establish the value of routine ultrasound examination in cases of polytrauma or blunt abdominal trauma, we report on our standard ultrasound examination and computer assisted documentation of the findings. Between May 1988 and December 1990 we examined 233 patients with polytrauma or blunt abdominal trauma. The results were compared with those of abdominal lavage (n = 47) performed during the same period. We found a sensitivity of 100% and a specificity of 99.5% for the ultrasound findings and a sensitivity of 80% and a specificity of 100% for the abdominal lavage. We conclude that ultrasonography should be the first diagnostic procedure used in the emergency room in cases of polytrauma and blunt abdominal trauma.
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Affiliation(s)
- H Niebuhr
- Chirurgische Abteilung, Allgemeines Krankenhaus Heidberg
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24
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Niebuhr H, Nahrstedt U, Brüning M, Rückert K. [Variable head endoprosthesis in the treatment of femoral neck and trochanteric fractures]. Unfallchirurgie 1991; 17:146-51. [PMID: 1877095 DOI: 10.1007/bf02588198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
UNLABELLED During 1978 to 1987 361 patients (312 female, 49 male) were treated with Variokopf-prosthesis (a bipolar hip prosthesis with a variable head) after femoral neck fracture, per- or subtrochanteric fracture. The mean age was 83 years. During postoperative treatment 73 patients (20.2%) died. 288 could be discharged. 98 of these died before the follow-up examination. The follow-up was possible in 103 cases. A good to satisfactory result was found in 91 cases (88%). A poor result in twelve cases (12%) (Score by Merle d'Aubigne et al.). CONCLUSIONS 1. The Variokopf-prosthesis is a favourable alternative to a normal hip prosthesis (e.g. Moore), 2. The implantation of a Variokopf-prosthesis was found to be indicated as well in the treatment of medial femoral neck fractures as in special cases in the treatment of per- or subtrochanteric fractures. 3. The operation should be performed soon after the trauma--after a two to three days treatment. 4. The dorsal approach is superior to the lateral in the treatment of hip fractures because of short operating time and the possible early mobilisation of the patients.
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Affiliation(s)
- H Niebuhr
- Chirurgische Abteilung des Allgemeinen Krankenhauses Heidberg, Hamburg
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25
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Nahrstedt U, Rückert K, Niebuhr H. [Bile T-drain connection as a closed system]. Chirurg 1991; 62:152-3. [PMID: 2044425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- U Nahrstedt
- Chirurgische Abteilung, Allgemeinen Krankenhauses Heidberg, Hamburg
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26
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Abstract
Forty five years after being injured by a grenade splinter a now 74-year old man suddenly developed colicky pain in the right upper abdomen, accompanied by colourless stools, jaundice and fever. The white cell count was 21,000/microliters, bilirubin was raised to 10.9 mg/dl, and ultrasound examination revealed a sharply circumscribed echo in the distal choledochal duct. Retrograde endoscopic cholangiography revealed a metal-dense concrement, presumably the nidus of gallstone formation. After endoscopic emptying of the bile duct the patient quickly improved so that cholecystectomy could be performed. The long symptom-free interval was most likely due to an at first peripheral position of the splinter in liver tissue. The secretory pressure of the liver cells then probably caused a slow migration into the choledochal duct.
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Affiliation(s)
- H Niebuhr
- Chirurgische Abteilung, Allgemeines Krankenhaus Heidberg, Hamburg
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27
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Niebuhr H, Hartmann V, Dehn U, Wening V. [Vario-head endoprostheses in femoral neck and para-femoral neck fractures]. Unfallheilkunde 1984; 87:331-7. [PMID: 6485151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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28
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Göltner E, Schlunk T, Niebuhr H. [Orthostatic dizziness and venous function in post partum patients (author's transl)]. Geburtshilfe Frauenheilkd 1974; 34:1023-8. [PMID: 4457385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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29
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Blumberg L, Shipley TE, Shandler IW, Niebuhr H. The development, major goals and strategies of a skid row program: Philadelphia. Q J Stud Alcohol 1966; 27:242-58. [PMID: 5963139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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