Reply to Comment to "Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients" W.J. Bökkerink, C.J. van Laarhoven, G.G. Koning. DOI 10.1007/s10029-014-1266-0

Excerpt

We thank Dr Bökkerink, van Laarhoven and Koning for their very valuable comment related to the recent Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients [1]. We concur with the authors that the open approach for placing a preperitoneal mesh is a very interesting technique and possible alternative to Lichtenstein, laparoscopic repair, PHS and Plug and Patch. Willaert and colleagues published in 2012 a Cochrane review on 3 RCTs (search till April 2011) comparing open preperitoneal techniques (Kugel patch, Read-Rives repair and TIPP) versus Lichtenstein [2]. They concluded that both techniques result in similar low recurrence rates and possibly a benefit in acute and chronic pain for the preperitoneal mesh technique. The follow-up in those studies ranged between 3 months and 82 months in the study by Muldoon et al. [3]. The data of the recent study by Koning et al. [4] add important evidence with respect to this issue and we are looking forward to more studies on the TREPP technique. Since we did not intend to write completely new guidelines, but only an update, our methodology clearly stated that “data were analysed especially with respect to any change in the level and/or the text of any of the conclusions or recommendations of the initial guidelines. Only papers potentially affecting these statements are incorporated in the final text” [5]. In contrast to the data available for PHS and Plug and Patch, we felt that the outcome data of the Cochrane review and the trial by Koning were insufficiently homogenous with respect to long-term recurrence and chronic pain. We fully agree that further high level data, also comparing the open vs. the endoscopic approach for placing a preperitoneal mesh in the groin, are highly needed. A specific chapter on open preperitoneal mesh techniques will be included in the new joint guidelines of the EHS, EAES, IEHS, AHS, APHS, AMEHS and Australasian Hernia Society. …