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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.

    REFERENCE
    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.

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