TY - JOUR
T1 - Onstep repair of inguinal hernias
AU - Andresen, Kristoffer
N1 - Articles published in the Danish Medical Journal are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.
PY - 2018/3
Y1 - 2018/3
N2 - Inguinal hernias are a protrusion of the peritoneum through a weakening in the groin in which abdominal content (intestines or fat) can herniate and cause a bulge. Inguinal hernias can be painful and require surgery. Worldwide, approximately 20 million patients are operated each year, with 10,000 in Denmark. The repair of inguinal hernias causes pain and 16% of patients experience chronic pain six months after the standard, open, mesh-based Lichtenstein technique. Therefore, surgeons are trying to improve the techniques by finding new ways of operating. The Onstep method was a new method for the repair of inguinal hernias, presented along with excellent results regarding pain, recurrence and complications. However, the technique had not been tested outside the department of the inventors.
The overall aim was to clarify whether the Onstep technique should be implemented on a larger scale outside the departments of the inventors.
Six papers are included in this thesis: a systematic review, a protocol article, three reports on the Onstep versus Lichtenstein trial, and finally a focus group interview.
The systematic review identified nine different methods of placing a preperitoneal mesh through and open anterior approach. In general, the techniques seem to provide good results regarding pain and discomfort, but more studies are needed.
The protocol article describes the randomized, double blinded Onstep versus Lichtenstein study, with focus on the statistical analysis and sample size calculations. Four separate sample size calculations were conducted, making several primary outcomes possible.
The three reports of the Onstep versus Lichtenstein study reported on early postoperative outcomes, on chronic pain, and lastly on sexual dysfunction. The overall findings from the trial demonstrated that there were no differences between the Onstep and the Lichtenstein technique regarding early and chronic pain (30 days, six months, and 12 months). However, for the group of patients operated with the Onstep technique, fewer patients experienced pain during sexual activity.
The focus group interview was done with experienced surgeons teaching the Onstep technique. They described their experience, thoughts, and concerns regarding teaching the technique. The results from the focus group interview can be used to guide future trainings sessions.
In this thesis the Onstep technique has been investigated in comparison with the Lichtenstein technique, but the results have not been as promising as the initial studies from the inventors. However, implementation of the Onstep technique outside the departments of the inventors is unlikely to result in increased risk of complications. Furthermore, the Onstep technique could possibly benefit patients by reducing the risk of pain during sexual activity.
AB - Inguinal hernias are a protrusion of the peritoneum through a weakening in the groin in which abdominal content (intestines or fat) can herniate and cause a bulge. Inguinal hernias can be painful and require surgery. Worldwide, approximately 20 million patients are operated each year, with 10,000 in Denmark. The repair of inguinal hernias causes pain and 16% of patients experience chronic pain six months after the standard, open, mesh-based Lichtenstein technique. Therefore, surgeons are trying to improve the techniques by finding new ways of operating. The Onstep method was a new method for the repair of inguinal hernias, presented along with excellent results regarding pain, recurrence and complications. However, the technique had not been tested outside the department of the inventors.
The overall aim was to clarify whether the Onstep technique should be implemented on a larger scale outside the departments of the inventors.
Six papers are included in this thesis: a systematic review, a protocol article, three reports on the Onstep versus Lichtenstein trial, and finally a focus group interview.
The systematic review identified nine different methods of placing a preperitoneal mesh through and open anterior approach. In general, the techniques seem to provide good results regarding pain and discomfort, but more studies are needed.
The protocol article describes the randomized, double blinded Onstep versus Lichtenstein study, with focus on the statistical analysis and sample size calculations. Four separate sample size calculations were conducted, making several primary outcomes possible.
The three reports of the Onstep versus Lichtenstein study reported on early postoperative outcomes, on chronic pain, and lastly on sexual dysfunction. The overall findings from the trial demonstrated that there were no differences between the Onstep and the Lichtenstein technique regarding early and chronic pain (30 days, six months, and 12 months). However, for the group of patients operated with the Onstep technique, fewer patients experienced pain during sexual activity.
The focus group interview was done with experienced surgeons teaching the Onstep technique. They described their experience, thoughts, and concerns regarding teaching the technique. The results from the focus group interview can be used to guide future trainings sessions.
In this thesis the Onstep technique has been investigated in comparison with the Lichtenstein technique, but the results have not been as promising as the initial studies from the inventors. However, implementation of the Onstep technique outside the departments of the inventors is unlikely to result in increased risk of complications. Furthermore, the Onstep technique could possibly benefit patients by reducing the risk of pain during sexual activity.
KW - Chronic Pain/diagnosis
KW - Hernia, Inguinal/surgery
KW - Herniorrhaphy/adverse effects
KW - Humans
KW - Pain, Postoperative/diagnosis
KW - Randomized Controlled Trials as Topic
KW - Recurrence
KW - Sexual Dysfunction, Physiological/etiology
KW - Surgical Mesh
KW - Treatment Outcome
M3 - Review
C2 - 29510815
SN - 1603-9629
VL - 65
JO - Danish Medical Journal
JF - Danish Medical Journal
IS - 3
ER -