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Annals of Surgery Journal Club
Interactive resource for surgery residents and surgeons to discuss and critically evaluate articles published in Annals of Surgery selected by a monthly guest expert who will review an article each month, offer questions and respond to reader's comments.
Monday, April 02, 2012
April Journal Club

Using data from a prospectively collected registry, Belyansky et. al., evaluated patient centered outcomes in 2086 patients who underwent inguinal hernia repair via one of three methods: TEP, TAPP or ML (modified Lichtenstein). They found that the use of >10 tacks, lack of prostate pathology, recurrent hernia repairs and bilateral hernia repairs were predictors of postoperative pain. They also found less pain at one month in patients who underwent TEP repair compared to those who underwent ML repair, although at 6 months and 1 year no differences were observed.

Overall rates of symptoms (as measured by the Carolinas Comfort Scale) at 1 year was 6-8% and recurrence rates were also low.


1.   How should you translate the data from this study into how you treat patients with inguinal hernia repair?


2.    What are the limitations of this study?


3.    How are the results of this study similar or different from prior studies regarding quality of life after inguinal hernia repair? 


Please feel free to comment on any or all of the questions above. We look forward to hearing from you, the Annals readers.


About the Author

Dr. David T Efron
Dr. Efron is an Associate Professor of Surgery, Anesthesiology & Critical Care Medicine and Emergency Medicine at the Johns Hopkins School of Medicine. He is the Director of Trauma and Chief of the Division of Acute Care Surgery (encompassing Trauma, Emergency Surgery and Surgical Critical Care) in The Johns Hopkins Hospital Department of Surgery. He is currently the Vice-Chair of the Maryland State Committee on Trauma. Dr. Efron’s current research interests are within the realm of regulation of inflammatory mediators of septic and post-injury states, particularly focusing on the role that statins play in this milieu. Dr. Efron carries additional interest in traumatic injury from interpersonal violence, measures of violence intensity, and trauma recidivism with an eye to prevention strategies.

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