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Administration of antibiotic prophylaxis for elective inguinal hernia repair cannot be universally recommended.

The use of antibiotic prophylaxis for elective hernia repair is currently a controversial issue. Although elective hernia repair is considered a clean procedure, the rate of postoperative wound infection in many countries exceeds the one expected for clean surgery, increasing discomfort in patients and health care expenses. In addition, antibiotics administration is not exempt of potential risks.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Laparoscopic techniques versus open techniques for repair of a hernia in the groin

Repair of a hernia in the groin (an inguinal hernia) is the most frequently performed operation in general surgery. The hernia is repaired (with suturing or placing a synthetic mesh over the hernia in one of the layers of the abdominal wall) using either open surgery or minimal access laparoscopy. The most common laparoscopic techniques for inguinal hernia repair are transabdominal preperitoneal (TAPP) repair and totally extraperitoneal (TEP) repair. In TAPP the surgeon goes into the peritoneal cavity and places a mesh through a peritoneal incision over possible hernia sites. TEP is different as the peritoneal cavity is not entered and mesh is used to seal the hernia from outside the thin membrane covering the organs in the abdomen (the peritoneum). The mesh, where used, becomes incorporated by fibrous tissue. Minor postoperative problems occur. More serious complications such as damage to the spermatic cord, a blood vessel or nerves, are occasionally reported with open surgery and nerve or major vascular injuries, bowel obstruction, and bladder injury have been reported with laparoscopic repair. Reoccurrence of a hernia is a major drawback.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Open surgery using mesh for groin hernia repair

This review examines the evidence from studies comparing different types of open surgery for people with groin hernia. We included only randomised studies comparing either 1) methods using synthetic mesh versus methods without mesh or 2) flat mesh methods versus plug and mesh methods. We divided mesh methods into flat mesh, plug and mesh or preperitoneal mesh and non‐mesh methods into Shouldice or other non‐mesh repair.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Two different laparoscopic techniques for repairing a hernia in the groin

An inguinal hernia is a weakness in the wall of the abdominal cavity that is large enough to allow escape of soft body tissue or internal organ, especially a part of the intestine. It usually appears as a lump and for some peoples can cause pain and discomfort, limit daily activities and the ability to work. If the bowel strangulates or becomes obstructed it can be life‐threatening. A hernia is repaired generally using a synthetic mesh either with open surgery or increasingly using less invasive laparoscopic procedures. The most common laparoscopic techniques for inguinal hernia repair are transabdominal preperitoneal (TAPP) repair and totally extraperitoneal (TEP) repair. In TAPP the surgeon goes into the peritoneal cavity and places a mesh through a peritoneal incision over possible hernia sites. TEP is different in that the peritoneal cavity is not entered and mesh is used to seal the hernia from outside the peritoneum (the thin membrane covering the organs in the abdomen). This approach is considered to be more difficult than TAPP but may have fewer complications. Laparoscopic repair is technically more difficult than open repair.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Regional (spinal, epidural, caudal) versus general anaesthesia in preterm infants undergoing inguinal herniorrhaphy in early infancy

Background: babies born preterm (before 37 weeks) often have serious health problems and sometimes need surgery. Inguinal hernia (IH) (where the intestine protrudes through the abdominal wall) is the commonest condition where surgery is needed. General anaesthetics for surgery can disrupt breathing and cause other complications in preterm babies. Regional anaesthetics including spinal block (injection) might avoid complications such as pauses in breathing in the first 24 hours after surgery. Whether this improves outcomes for preterm babies having surgery is unclear because no trials have looked at the effects of anaesthetics on brain function in older children.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Two different open approaches using a mesh for repairing an elective hernia in the groin.

An inguinal hernia is a protrusion of abdominal cavity contents through the inguinal canal. It is visible as a swelling in the groin, which can cause pain and discomfort. If the bowel incarcerates and subsequently strangulates a life‐threatening condition occurs. Many people develop an inguinal hernia making its repair one of the most performed procedures worldwide. Mesh repair is superior to primary suture techniques. The mesh can either be placed using an open technique or via a laparoscopic approach. As most types of mesh repair result in a low recurrence rate, reduction of postoperative chronic pain remains a major challenge. An open approach using a mesh in the preperitoneal space could reduce this major complication because, as this space lacks nervous structures, interaction between the mesh and nerves is absent.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Shouldice technique is better than other open techniques, not using mesh

Inguinal hernia is a very common disease that mainly affects men in young and middle age and it's reparation is the most frequent operation in general surgery. Hernias present as bulges in the groin area that can become more prominent when coughing, straining, standing up and in all situation where the abdominal pressure grow. If uncomplicated they are rarely painful, and the bulge commonly disappears on lying down. There are various surgical strategies which may be considered in the planning of inguinal hernia repair. These include the consideration of mesh use (mesh is a prosthesis made up by net of synthetic material that help to contrast a abdominal wall tension). A tension free repair method have been proposed to achieve better results in terms of pain and infections and to avoid the problem to present again (recurrence).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Smart Health Choices: Making Sense of Health Advice

This book aims to help consumers and practitioners develop the skills to assess health advice – and hopefully to make decisions that will improve the quality of their care. For some people, making better-informed decisions could be life saving. We hope that it will be useful if you are struggling to come to terms with an illness or injury, and the best ways of managing it. Or you may simply want to lead a healthier life, and may be wondering how to make sense of the often conflicting flood of health information that deluges us every day, through the media, and from our friends and health practitioners.

Hammersmith Press.

Version: 2008
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Cyanoacrylate microbial sealants for skin preparation prior to surgery

Surgical site infection (SSI) is a serious complication of surgery. Microbial sealant is a liquid applied to the surface of the skin immediately before surgery to seal in any bacteria living on the skin that may pose a risk of infection. Before applying the sealant, the skin at the operating site is usually prepared with an antiseptic solution of 10% povidone‐iodine. Our searches discovered three eligible randomised trials, with a total of 524 participants, that compared the impact of sealant compared with no sealant on the incidence of SSIs. Two trials concerned cardiac surgery, and the third concerned inguinal hernia repair. When the results of the trials were combined they did produce a statistically significant difference in SSI rates, however, the evidence from the trials was not of high quality, so further research is needed to find out whether this intervention works.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

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