AHRQ Publication No. 12-EHC091-EF August 2012

Risk of Infection Suture Symptomatic Inguinal Hernia Elective Surgery Recurrence Mesh Primary unilateral Primary bilateral Incarcerated Risk of Infection Suture Flowchart at Page 5 of the Guidelines !

With or without mesh? *Amato B, Moja L, Panico S, Persico G, Rispoli C, Rocco N, Moschetti I. Cochrane Database Syst Rev. 2012 Apr 18;4:CD001543. Shouldice technique versus other open techniques for inguinal hernia repair. Sixteen trials contributed to this review. A total of 2566 hernias Shouldice herniorrhaphy is the best non-mesh technique in terms of recurrence, though it is more time consuming and needs a slightly longer post-operative hospital stay. The use of mesh is associated with a lower rate of recurrence. The quality of included studies, assessed with jaded scale, were low. Patients have similar characteristic in the treatment and control group but seems more healthy than in general population, this features may affect the dimension of effect in particularly recurrence rate could be higher in general population. The length of follow-up vary broadly among the studies from 1 year to 13.7 year.

Volume 206, Issue 4 , Pages 619-623, October 2013 Fi Fischer JE: Hernia repair: why do we continue to perform mesh repair in the face of the human toll of inguinodynia?

Great Debate: Is there a successful repair for inguinal hernia possible without mesh? before: 20% yes after: 50% yes William Hope: „... Than you have to come to the US to teach us in pure tissue repairs...“

Mc Gilliguddy 1998 Invited Commentary by L.M. Nyhus Arch Surg. 1998 Sep;133(9):974-8. ... the disadvantage relates to the use of mesh in all patients ... The „one suit fits all“ approach should not be promulgated ... Let us not create a new generation of „habadashery surgeons“