Turner White CommunicationsAbout TWCSubscribeContact TWCHomeSearch
Hospital PhysicianJCOMSMPBRMsCart
Current Contents
Past Issue Archives
Self-Assessment Questions
Review of
Clinical Signs
Clinical Review
Pediatric Rounds
Resident Grand Rounds
Article Archives
Case Reports
Clinical Practice
Pediatric Rounds
Resident Grand Rounds
Review of
Clinical Signs

Guide to Reading
Hospital Physician
Editorial Board
Information for Authors

Reprints, Permissions, & Copyright
Site Map
Self-Assessment Questions

General Surgery

Answer 2
  1. Laparoscopic repair as compared with open repair is associated with a higher recurrence rate after 2 years regardless of the surgeon’s age. In clean contaminated cases, systemic antibiotic prophylaxis given prior to surgical incision has been shown to reduce the incidence of SSI.4 Trials evaluating the effectiveness of preoperative antibiotics in preventing SSI in abdominal wall hernia and inguinal hernia repairs (including laparoscopic repairs) have had mixed results. A recent meta-analysis revealed no benefit with the use of systemic antibiotics in preventing SSI after groin hernia surgery.4 In a multicenter randomized trial, Neumayer et al5 found that surgeon inexperience (< 250 procedures) was an independent risk factor for recurrence of inguinal hernia after laparoscopic repair; an ad-hoc analysis6 revealed that surgeon’s age of 45 years and older was also an independent risk factor for recurrence. The odds of recurrence for an inexperienced surgeon aged 45 years or older were 1.72 times that of a younger inexperienced surgeon.6 The surgeon’s level of frustration while performing surgery but not the surgeon’s satisfaction at completion of surgery was associated with a higher complication rate after laparoscopic inguinal hernia repair. The TAPP and TEP approaches are laparoscopic techniques used for inguinal hernia repair. Although evidence favoring one approach over the other is lacking, the TEP approach has been found to be associated with lower rates of port-site hernias and visceral injuries and higher rates of conversion than TAPP in nonrandomized studies.

    4. Aufenacker TJ, Koelemay MJ, Gouma DJ, Simons MP. Systematic review and meta-analysis of the effectiveness tion after mesh repair of abdominal wall hernia. Br J Surg 2006;93:5-10.

    5. Neumayer LA, Giobbie-Hurder A, Jonasson O, et al. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 2004;350:1819-27.

    6. Neumayer LA, Gawander AA, Wang J, et al. Proficiency of surgeons in inguinal hernia repair: effect of experience and age. Ann Surg 2005;242:344-8.

Click here to return to the questions


Hospital Physician     JCOM     Seminars in Medical Practice
Hospital Physician Board Review Manuals
About TWC    Subscribe    Contact TWC    Home    Search   Site Map

Copyright © 2009, Turner White Communications
Updated 1/04/08 • kkj