title: Systemic inflammatory response after endoscopic (TEP) vs Shouldice groin hernia repair Tension-free hernia repair is associated with an increase in inflammatory response markers against the mesh. Long-term Follow-up of a Randomized Controlled Trial of Suture Versus Mesh Repair of Incisional Hernia Systemic inflammatory response after Kugel versus laparoscopic groin hernia repair: a prospective randomized trial Coagulation, inflammatory, and stress responses in a randomized comparison of open and laparoscopic repair of recurrent inguinal hernia Laparoendoscopic single-site versus conventional laparoscopic total extraperitoneal hernia repair: a prospective randomized clinical trial Impact of Different Texture of Polypropylene Mesh on the Inflammatory Response Impact of Heavy Polypropylene Mesh and Composite Light Polypropylene and Polyglactin 910 on the Inflammatory Response Serum VEGF and b-FGF profiles after tension-free or conventional hernioplasty Reduced acute phase response after laparoscopic total extraperitoneal bilateral hernia repair compared to open repair with the Stoppa procedure Advanced age influences the dynamic changes in circulating C-reactive protein following injury Inflammatory markers following laparoscopic and open hernia repair Early outcome after open versus extraperitoneal endoscopic tension-free hernioplasty: a randomized clinical trial. Prospective comparison of local, spinal, and general types of anaesthesia regarding oxidative stress following Lichtenstein hernia repair. Cytokine modifications after tension-free hernioplasty or open conventional inguinal hernia repair. Systemic inflammatory responses during laparoscopic and open inguinal hernia repair: a randomised prospective study. Systemic stress responses after laparoscopic or open hernia repair. Early assessment of bilateral inguinal hernia repair: A comparison between the laparoscopic total extraperitoneal and Stoppa approaches C-reactive protein as early predictor for infectious postoperative complications in rectal surgery Lipid peroxidation and inguinal hernia repair. Tension-free vs. Andrews technique.
abstract: Endoscopic techniques are commonly used for many different types of surgery . It is cl aim ed that videoendoscopic procedures have the advantage of being less traumatic and of offering higher postoperative patient comfort than conventional open techniques . The extent of tissue trauma can be evaluated on the basis of the inflammatory response observed in the wake of surgery . Available studies that have compared endoscopic and conventional techniques suggest that endoscopic cholecystectomy , laparoscopic colorectal resection , and thoracoscopic pulmonary resection have immunologic advantages over conventional approaches . The objective of this prospect i ve study was to determine whether endoscopic hernia repair techniques are also preferable to conventional procedures and to what extent the anesthetic technique ( local or general anesthesia ) influences the postoperative inflammatory response . For this purpose , biochemical monitoring of cytokine activity [ C-reactive protein ( CRP ) , prostagl and in F1α ( PGF1α ) , neopterin , interleukin-6 ( IL-6 ) ] was done prospect ively in 101 patients [ totally extraperitoneal approach ( TEP ) n=32 , unilateral n=12 , bilateral n=20 ; Shouldice n=69 , local anesthesia ( LA ) n=23 , general anesthesia ( GA ) n=46 ] before and until 3 days after surgery . The parameters IL-6 and PGF1α suggested that the immune trauma immediately after surgery was significantly higher in the group of patients with endoscopic hernia repair than in the group of patients who received a Shouldice repair . No significant differences were observed after the first postoperative day . A comparison between the TEP group and the patients who received conventional surgery under local anesthesia showed that the TEP approach was also associated with a higher postoperative neopterin level . Within the first 3 days after surgical intervention , bilateral endoscopic hernia repair induced no significantly higher inflammatory response than the surgical treatment of unilateral conditions . The anesthetic procedure that was used in the Shouldice operation had no significant effect on inflammatory response . Unlike other types of endoscopic surgery , the repair of groin hernias using an endoscopic technique can not be regarded as a minimally invasive procedure that is less traumatic than conventional approaches . Instead , the conventional Shouldice procedure appears to cause the lowest inflammatory response and to be the least traumatic approach to hernia repair , especially when it is performed under local anesthesia BACKGROUND The purpose of this study was to evaluate the involvement of inflammatory mediators in patients undergoing Lichtenstein tension-free hernioplasty ( LH ) using polypropylene prosthetic material s or conventional Bassini hernia repair ( BH ) .  METHODS Thirty patients male with unilateral inguinal hernia without complications or recurrence were included in this study . R and omly , patients underwent LH or BH .  Peripheral venous bloods sample s were collected 24 hours prior to surgery and then 6 , 24 , 48 and 168 hours postoperatively . RESULTS We present evidence s that LH patients showed a higher increased serum level of fibrinogen , C-reactive protein , alpha-1-antitrypsin , and interleukin-6 than BH patients . Postoperative visual analogue scales for pain were reduced on mobilization for patients undergoing LH compared with BH . Neutrophils were significantly increased only in LH compared with baseline . Ceruloplasmin , transferrin , and albumin levels were unmodified after BH or LH . CONCLUSIONS In conclusion our data show that although LH induces less pain and more rapid postoperative recovery , it is associated with an higher inflammatory response compared with BH , likely due to polypropylene mesh Objective : The objective of this study was to determine the best treatment of incisional hernia , taking into account recurrence , complications , discomfort , cosmetic result , and patient satisfaction . Background : Long-term results of incisional hernia repair are lacking . Retrospective studies and the midterm results of this study indicate that mesh repair is superior to suture repair . However , many surgeons are still performing suture repair . Methods : Between 1992 and 1998 , a multicenter trial was performed , in which 181 eligible patients with a primary or first-time recurrent midline incisional hernia were r and omly assigned to suture or mesh repair .  In 2003 , follow-up was up date d. Results : Median follow-up was 75 months for suture repair and 81 months for mesh repair patients . The 10-year cumulative rate of recurrence was 63 % for suture repair and 32 % for mesh repair ( P < 0.001 ) . Abdominal aneurysm ( P = 0.01 ) and wound infection ( P = 0.02 ) were identified as independent risk factors for recurrence . In patients with small incisional hernias , the recurrence rates were 67 % after suture repair and 17 % after mesh repair ( P = 0.003 ) . One hundred twenty-six patients completed long-term follow-up ( median follow-up 98 months ) . In the mesh repair group , 17 % suffered a complication , compared with 8 % in the suture repair group ( P = 0.17 ) . Abdominal pain was more frequent in suture repair patients ( P = 0.01 ) , but there was no difference in scar pain , cosmetic result , and patient satisfaction . Conclusions : Mesh repair results in a lower recurrence rate and less abdominal pain and does not result in more complications than suture repair . Suture repair of incisional hernia should be ab and oned Background Kugel repair , a minimally invasive technique , has become an alternative to laparoscopic groin hernia repair , but the technique has not been adequately evaluated by assessment of objective parameters . A prospect i ve r and omized clinical study was carried out to compare the systemic inflammatory response to surgical trauma and clinical outcomes in patients who underwent groin hernia repair by the Kugel and totally extraperitoneal ( TEP ) laparoscopic methods . Methods Forty consecutive patients admitted for unilateral groin hernia were r and omized to Kugel ( n = 20 ) or TEP ( n = 20 ) repair under general anesthesia .  Operation time , length of hospital stay , pain severity , time to return to normal activities , cost , and systemic inflammatory and hormone responses to surgical trauma were compared . Results There were no significant between-group differences in duration of operation , length of hospital stay , time to return to normal activities , or mean visual analogue scale ( VAS ) score ( p > 0.05 for each ) . Serum cortisol , high-sensitivity C-reactive protein ( hsCRP ) , and interleukin (IL)-6 concentrations before surgery , and 1 and 24 h after surgery , did not differ significantly in the two groups ( p > 0.05 ) . There were no recurrences or complications during follow-up . Cost per patient was US $ 546 lower in the Kugel group . Conclusion Kugel herniorrhaphy is a minimally invasive technique that offers all the advantages of TEP and is more cost-effective Background In previous comparisons of inflammatory and stress responses to open ( OR ) and laparoscopic ( LR ) hernia repair , all operations were performed under general anesthesia . Since local anesthesia is widely used for OR , a comparison of this approach with LR seemed relevant . Methods Patients with recurrent inguinal hernia were r and omized to OR under local anesthesia ( n = 30 ) or LR under general anesthesia ( n = 31 ) . The magnitude of the surgical trauma was assessed by measuring markers of coagulation ( prothrombin fragment 1 + 2 ) , endothelial activation ( von Willebr and factor ) , inflammation [ leukocytes , interleukin-6 , -8 and -10 , granulocyte macrophage colony-stimulating factor , and C-reactive protein ( CRP ) ] , and endocrine stress ( cortisol ) in blood collected before operation , 4 h postincision , and on postoperative day 2 . Results Leukocyte counts and interleukin-6 and CRP levels increased in both groups , with the CRP increase being significantly greater in the OR group . The other markers did not increase significantly . Conclusion The acute phase response was more pronounced after OR , even when this was done under local anesthesia . Both techniques seemed rather atraumatic Background This study aim ed to compare laparoendoscopic single-site ( LESS ) total extraperitoneal ( TEP ) repair with conventional laparoscopic TEP repair for the treatment of inguinal hernias .  To date , no other studies have compared the LESS and conventional laparoscopic TEP approaches for the treatment of  inguinal hernia  in a prospect i ve r and omized study setting . Methods For this study , 100 patients undergoing inguinal hernia repair were prospect ively r and omized into either the  LESS TEP group or the conventional laparoscopic TEP group . Pre- , intra- , and postoperative factors were recorded . The primary end point was postoperative pain . The patients were interviewed at outpatient clinics at 1 week , 3 months , and 6 months postoperatively . Results The demographic data were comparable between the two groups . The median operative time was longer in the LESS TEP group ( 63.5 min ) than in the conventional TEP group ( 50.5 min ) ( p = 0.001 ) . No conversion was performed in either group . The mean pain score 2 h postoperatively during rest was significantly higher in the conventional TEP group than in the LESS TEP group ( 3.9 vs. 2.6 ; p = 0.02 ) . The postoperative results were comparable between the groups in terms of analgesic requirements , systemic stress responses , complications , and postoperative convalescence . Conclusions The LESS TEP technique is associated with a longer operative time but offers the minor benefit of a reduction in immediate postoperative pain Over the past decade , hernia surgery has undergone a considerable transformation with the use of prosthetic material s. The most used polypropylene meshes induce a rapid acute inflammatory response followed by chronic foreign body reaction . Many factors influence this response such as density , size , physical characteristics , different texture and porosity of each bio material . The aim of this study is to assess whether the implant of monofilament or multifilament meshes , in the inguinal hernioplasty , determine a different inflammatory response .  Thirty-two male patients were included in the study and were r and omly divided into two groups . In the first group ( MO ) inguinal hernioplasty was performed using monofilament polypropylene mesh , while in the second one ( MU ) multifilament prosthesis was used . Peripheral venous blood sample s were collected 24 hours before surgery and then 6,24,48 and 168 hours posto-peratively . Modifications in leukocyte count , C-reactive protein ( CRP ) , alpha-1 antitrypsin ( α1-AT ) , interleukin (IL)-1 , IL-6 , IL-1 ra and IL-10 serum levels were recorded at all sampling times . We present evidence that serum levels of CRP , ( α1-AT ) , leukocytes and cytokines were significantly increased post-operatively in both groups , returning to basal values 168 hours afterwards . In particular , the production of all pro-inflammatory mediators was higher in the MU group , whereas the anti-inflammatory cytokine ( IL-10 , IL-1ra ) production was higher in MO patients . Our results indicate that polypropylene multifilament mesh allows a higher intense acute inflammatory response as compared to monofilament mesh implantation The aim of the study was to analyze the acute inflammatory response after implantation of a heavyweight mesh of polypropylene ( PP ) compared with a composite mesh of light PP and polyglactin 910 ( PG ) in patients undergoing inguinal hernioplasty . A total of 30 male patients with inguinal hernia were included in the study and divided into 2 groups ( PP and PP-PG ) according to the mesh used . Changes of leukocytes , cytokines , growth factors , and acute phase proteins were evaluated in the sera . Leukocytes and acute phase proteins were significantly increased postoperatively in both groups , and the values were slightly higher in the PP group . Cytokine levels were significantly increased postoperatively in both groups ; a slight increase was observed in the PP-PG group , especially for the proinflammatory cytokine . Growth factors decreased significantly in both groups immediately after surgery . The authors found that the use of the mesh is a stimulator of inflammatory response , and the 2 types of mesh induce a similar inflammatory response Background Angiogenesis is strongly influenced by vascular endothelial growth factor ( VEGF ) and basic fibroblast growth factor ( b-FGF ) , whose production is also regulated by interferon (IFN)-γ and interleukin (IL)-10 . The aim of this study was to evaluate the modifications of serum VEGF , b-FGF , IFN-γ and IL-10 levels in patients with inguinal hernia undergoing hernioplasty with the Lichtenstein technique ( LH ) using polypropylene mesh or with Bassini open conventional inguinal hernia repair ( BH ) .  Material s and methods R and omly , 16 patients underwent BH , and 16 were treated with the LH technique using polypropylene mesh .  Blood sample s were collected 24 h prior to surgery and then 6 , 24 , 48 and 168 h postoperatively . The serum concentrations of VEGF , b-FGF , IFN-γ and IL-10 were evaluated . Results In BH patients , a peak of VEGF synthesis at 6 h with a normalization of this parameter 24 h after surgery has been observed . In the same subjects , b-FGF synthesis increased after surgery reaching significant levels 48 h later . On the contrary , in LH patients , a decrease in the serum VEGF and b-FGF concentrations was detected after surgery and their increase afterwards . IL-10 was increased in both groups 6 h after operation and declined to preoperative levels 24 h afterwards . IFN-γ enhanced in LH patients 6 h after surgery , whereas no modifications were detected in BH subjects . Conclusions This preliminary study shows that VEGF and b-FGF modifications , associated with alterations of cytokine secretion , are detectable in human undergoing hernioplasty , and suggests that they could somehow influence in the wound-healing process Background : Although  laparoscopic hernia repair  has been shown to be associated with less postoperative pain and an earlier recovery , there is still controversy about its role in hernia surgery . In general , laparoscopy produces less trauma to tissues than open surgery . This has been reflected by the reduced acute phase inflammatory response observed after laparoscopic surgery compared to open surgery in various setting s , such as cholecystectomy or hysterectomy . The aim of this study was to evaluate the acute phase response after bilateral hernia repair by comparing the open Stoppa procedure with the laparoscopic totally extraperitoneal prosthetic repair ( TEPP ) . Methods : Patients were r and omly allocated to either technique after written informed consent was obtained . Measurements were made of complete blood count , erythrocyte sedimentation rate ( ESR ) , C-reactive protein ( CRP ) , interleukin-1b ( IL-1b ) , IL-6 , and tumor necrosis factor-a ( TNF-a ) preoperatively and 4 , 24 , and 48 h postoperatively . VAS pain scores , consumption of analgesics , and delay before resumption of normal activities were also recorded . All the procedures were performed under general anesthesia by or in the presence of the same surgeon . Results : Thirty-nine patients were included : 19 underwent the Stoppa procedure and 20 had a laparoscopic repair .  The two groups were well matched for age , sex , ASA score , and preoperative values . The operation took longer ( p < 0.001 ) in the group undergoing TEPP . Patients resumed their normal activities earlier ( p < 0.05 ) after laparoscopy . In the open group , there was a larger decrease of the lymphocyte count after 4 ( p < 0.01 ) and 24 h ( p = 0.04 ) ; an increased elevation of ESR after 48 h ( p = 0.02 ) ; a larger increase of IL-6 after 4 ( p = 0.05 ) , 24 ( p = 0.003 ) , and 48 h ( p < 0.001 ) ; and a larger increase in CRP after 24 ( p = 0.05 ) and 48 h ( p = 0.01 ) . There was no morbidity . There was no difference in postoperative IL-1b , TNF-a , total white blood cell count , polymorphonuclear count , VAS for pain , or need for analgesics between the two groups , except on the operative day . Conclusions : The acute phase inflammatory response in clearly more active after the open Stoppa procedure than after TEPP , indicating that the former is associated with increased tissue trauma . This may play a role in the earlier recovery seen after the TEPP procedure Background The concentration of C-reactive protein ( CRP ) , a biomarker of systemic inflammation , is determined by genetic , clinical and demographic factors including gender , smoking and body mass index ( BMI ) . The influence of age on CRP dynamic changes following insult has , however , been poorly characterised . Methods We used  unilateral hernia repair as a model of st and ardised insult to investigate the influence of baseline demographic and clinico-pathological factors affecting the dynamic changes in CRP , interleukin ( IL ) 6 and tumour necrosis factor-α over a time course of 48 h following injury . Results We derived CRP negativisation kinetics on 100 prospect ively enrolled male subjects with mean age of 60.6 years ( range 24–90 years ) and mean BMI of 25.7 kg/m2 ( range 17.9–37 kg/m2 ) . Patients who failed to normalise CRP to<10 mg/l at 48 h ( n=74 ) were significantly older ( p<0.001 ) , had longer surgical times ( p=0.05 ) , higher waist/hip ratio ( p=0.02 ) . Multiple regression analysis confirmed age as the only independent predictor of delayed CRP normalisation ( p=0.03 ) . Persistent CRP elevation was associated with higher peak CRP values ( p<0.001 ) , higher IL-6 concentrations at 24 ( p=0.01 ) and 48 h ( p=0.03 ) . Conclusions CRP decline following insult is delayed in elderly patients as a result of unopposed IL-6 release . Age should be routinely incorporated in the assessment of CRP response to avoid misinterpretation of age-related delay in CRP clearance with ongoing systemic inflammation Laparoscopic surgery may reduce the inflammatory response to surgery by the avoidance of a skin incision which is frequently the site of maximum tissue trauma . We hypothesized that the inflammatory response is less with minimally invasive procedures . The aim of this study was to evaluate the response of inflammatory mediators following laparoscopic and open hernia repair . Thirty-four patients undergoing unilateral primary inguinal hernia repair were prospect ively assigned to either laparoscopic mesh hernia repair ( n=14 ) , open mesh hernia repair ( n=11 ) , or a Bassini repair ( n=9 ) . Serum sample s withdrawn prior to surgery , 6 h after surgery , and then again at 24 h after surgery were assayed for interleukin-6 and C-reactive protein content . Interleukin-6 levels at 24 h in the laparoscopic ( 13.1±3.1 pg/ml ) , open mesh ( 15.5±2.5 pg/ml ) , or Bassini group ( 15.4±2.0 pg/ml ) did not differ significantly . Neither did C-reactive protein levels at 24 h in the laparoscopic ( 12.4±2.7 pg/ml ) , open mesh ( 23.0±7.8 pg/ml ) , or Bassini group ( 18.6±6.6 pg/ml ) differ significantly . The response of inflammatory mediators to hernia repair is not modified by undertaking the procedure laparoscopically BACKGROUND The use of minimal access surgery for repair of groin hernias is controversial . The aim of this study was to compare endoscopic tension-free hernia repair with open tension-free hernia repair within a r and omized clinical trial . METHODS One hundred twenty patients were r and omized by four surgeons during a 1-year period . Early outcome measures were then analyzed by intention to treat . RESULTS Median postoperative pain scores ( 63 [ interquartile range ( IQR ) , 23 to 81 ] versus 35 [ IQR , 17 to 62 ] ; p = 0.004 ) and analgesia requirements ( 2.5 [ IQR , 2 to 4 ] doses verus 2.0 [ IQR , 1 to 3 ] doses ; p = 0.0008 ) were significantly less for patients undergoing endoscopic hernia repair .  Hospital stay ( 1 [ IQR , 0 to 1 ] day versus 2 [ IQR , 1 to 2 ] days ; p < 0.0001 ) was also significantly reduced for the endoscopic group . Wound complications occurred significantly more frequently in the open group . No difference in pulmonary function or metabolic response to trauma ( interleukin-6 , C-reactive protein , glucose , albumin ) was observed between the groups . CONCLUSIONS This study shows significant short-term advantages for endoscopic tension-free repair over open tension-free repair . However , larger studies with a longer follow-up period are required to establish the relative merits of both procedures in the management of patients with groin hernias As a tension-free repair technique , Lichtenstein operation has gained great popularity worldwide during the last decade . Expert centres do this technique using local anaesthesia in nearly 95 % of cases . However , general anaesthesia is used in many hospitals , while regional anaesthesia is preferred in some centres . To date , no study has compared different types of anesthesia in respect of inflammatory response and oxidative stress specifically . The objective of this prospect i ve study was to compare local , spinal and general types of anesthesia regarding their effects on inflammatory response and oxidative stress in Lichtenstein hernia repair . Lichtenstein hernia repair causes only a mild oxidative stress . While total WBC and neutrophil count responses fade away after 24 hours in patients who are operated under local anaesthesia  , these changes in spinal and general types of anaesthesia cases stay valid at 24th hour . Spinal anaesthesia is seen to be more advantageous than local and general types of anaesthesia when C-reactive protein as an acute phase marker is considered . Total antioxidant status shows minor alterations in three types of anaesthesia , however , general anaesthesia seems to be the least reliable among them . Overall , local and spinal anaesthesia methods can be accepted as better alternatives in comparison with general anaesthesia in regard to oxidative stress ( Tab . 2 , Ref . 25 ) . Full Text ( Free , PDF ) www.bmj.sk BACKGROUND The purpose of this study was to evaluate the involvement of proinflammatory cytokines ( interferon-gamma [ INF-gamma ] , interleukin [IL]-6 ) and anti-inflammatory cytokines ( IL-4 , IL-l0 , IL-13 ) in patients undergoing Lichtenstein tension-free hernioplasty ( LH ) using polypropylene prosthetic material s  or conventional Bassini hernia ( BH ) repair . METHODS Thirty-five male patients ( age range 25 to 60 years ) with unilateral inguinal hernia without complications or recurrence were included in this study . R and omly , patients underwent conventional operation and had their inguinal hernia repair performed with polypropylene mesh . Peripheral venous blood sample s were collected 24 hours prior to surgery and then 6 , 24 , 48 , and 168 hours postoperatively . Fifteen healthy controls were included . RESULTS We present evidence that LH patients showed both an increased serum level of Thelper 1 (Th1)-like cytokines ( IFN-gamma ) and an increase in Thelper 2 (Th2)-like cytokines ( IL-6 and IL-l0 ) , associated with a slight reduction of peripheral blood mononuclear cells ( P BMC ) producing IL-6 and a normal level of P BMC producing IFN-gamma , IL-l0 , IL-13 , and IL-4 . Whereas BH patients showed in part an amplification of Th2-like cells , characterized by the sustained serum production of IL-6 and IL-l0 , associated with an increase in IL-l0 secreted by in vitro stimulated PMBC . CONCLUSIONS Our data show that LH is associated with a higher production of inflammatory cytokines ( IFN-gamma and IL-6 ) compared with BH , likely induced by the presence of the polypropylene prostheses OBJECTIVE To see if the inflammatory responses during and after laparoscopic and open inguinal hernia repairs differed . DESIGN R and omised prospect i ve study . SETTING County hospital , Denmark . PATIENTS 18 men aged 25 - 77 years with unilateral inguinal hernias . INTERVENTIONS Ten patients had a laparoscopic repair and 8 an open tension-free repair .  MAIN OUTCOME MEASURES Serum concentrations of interleukin (IL)-2 receptors ( R ) of the alpha group ( IL-2Ralpha ) , IL-6 , anti-IL-6 , IL-10 , tumour necrosis factor (TNF)-alpha , sTNF-RI and sTNF-RII before and 2 , 6 , 12 , and 24 hours after the repairs . Duration of operation and time for return to normal activities or work were also recorded . RESULTS Serum IL-6 concentrations increased significantly after operation in both groups ( p < 0.0001 ) , but the increase was significantly higher after open than after laparoscopic surgery at all sampling times ( p = 0.00 ) at 6 hours postoperatively ) . Anti-IL-6 and IL-10 remained undetectable at all time points . There were no significant differences or increases in the concentrations of TNF-alpha or sTNF-RII . However , sTNF-RI concentrations increased significantly in both groups ( p < 0.001 ) though there was no difference in between the two groups . IL-2Ralpha decreased significantly in both groups ( p < 0.01 ) with no differences between the groups . The median operation time was 85 min ( range 55 - 100 min ) in the laparoscopic group and 52 min ( range 45 - 79 min ) in the " open " group ( p < 0.01 ) . Median time to return to normal activities/work were 2 and 13 days after laparoscopic and open operations , respectively ( p < 0.01 ) . CONCLUSION The surgical trauma of laparoscopic inguinal hernia repair is less than that of open tension-free hernia operations as assessed by circulating mediators of the postoperative inflammatory response . The clinical relevance of this finding must be evaluated in larger r and omised studies OBJECTIVE To compare systemic stress responses after  laparoscopic  and  open hernia repair  to find out if the laparoscopic approach caused less stress than an open operation . DESIGN Prospect i ve r and omised trial . SETTING Teaching hospital , Sanliurfa , Turkey . SUBJECTS 50 patients who required preperitoneal hernia repair were r and omised to be treated by either the open or laparoscopic approach ( n = 25 in each ) . INTERVENTIONS Sample s of venous blood were taken before operation and at 2 , 24 , and 48 hours afterwards for measurement of the concentrations of : glucose , cortisol , malonyldialdehyde ( MDA ) , C-reactive protein ( CRP ) , creatine phosphokinase ( CPK ) , caeruloplasmin , transferrin , fibrinogen , and albumin , and counts of leucocytes , neutrophils , and lymphocytes . MAIN OUTCOME MEASURES Changes in these indicators of a stress response . RESULTS Concentrations of glucose , cortisol , CRP , MDA , and CPK , and counts of leucocytes and neutrophils increased significantly , and the concentration of albumin decreased significantly , in both groups postoperatively . Lymphocyte counts were lower postoperatively but not significantly so . Concentrations of CRP , MDA , and CPK , and leucocyte counts were significantly lower in the laparoscopic group . CONCLUSION These findings suggest that there is less systemic stress response after laparoscopic than after open hernia repair BACKGROUND : The present clinical trial was design ed to compare the results of bilateral inguinal hernia repair between patients who underwent the conventional Stoppa technique and laparoscopic total extraperitoneal repair ( LTE ) with a single mesh and without staple fixation . PATIENTS AND METHODS : This controlled , r and omised clinical trial was conducted at General Surgery and Trauma of the Clinics Hospital , Medical School , the University of São Paulo between September 2010 and February 2011 . Totally , 50 male patients , with a bilateral inguinal hernia , older than 25 years were considered eligible for the study . The following parameters were analysed during the early post-operative period : ( 1 ) The intensity of surgical trauma , operation time , C-reactive protein ( CRP ) levels , white blood cell count , bleeding and pain intensity ; ( 2 ) quality of life assessment ; and ( 3 ) post-operative complications . RESULTS : LTE procedure was longer than the Stoppa procedure ( 134.6 min ± 38.3 vs. 90.6 min ± 41.3 ; P < 0.05 ) . The levels of CRP were higher in the Stoppa group ( P < 0.05 ) but the number of leucocytes , haematocrit , and haemoglobin were similar between the groups ( P > 0.05 ) . There was no difference in pain during the 1st and 7th post-operative , physical functioning , physical limitation , the impact of pain on daily activities , and the Carolinas Comfort Scale during the 7th and 15th post-operative ( P > 0.05 ) . Complications occurred in 88 % of Stoppa group ( 22 patients ) and 64 % in LTE group ( 16 patients ) ( P < 0.05 ) . CONCLUSION : The comparative study between the Stoppa and LTE approaches for the bilateral inguinal hernia repair demonstrated that : ( 1 ) The LTE approach showed less surgical trauma despite the longer operation time ; ( 2 ) Quality of life during the early post-operative period were similar ; and ( 3 ) Complication rates were higher in the Stoppa group Background This study evaluated the role of the acute phase C-reactive protein ( CRP ) in the postoperative course of a large series of rectal resections on the basis of a prospect i ve data base . Main focus of this study was the early identification of complications . Material s and methods Three hundred eighty-three rectal resections with primary anastomosis for rectal cancer were screened for infectious postoperative complications . Forty-eight complicated cases were identified and matched with 48 patients with an uneventful postoperative course . Results In the postoperative setting , CRP peaked on postoperative day ( POD ) 2 with a median serum CRP of 140 mg/l and gradually declined thereafter in uncomplicated cases . In complicated cases , CRP elevation generally persisted after POD 2 , whereas white blood cells and body temperature were within normal range in the early postoperative period . A cutoff CRP value of 140 mg/dl on PODs 3 and 4 result ed in predictive values of 85.7 and 90.5 % ( adjusted to the prevalence : 37.6 and 50.3 % ) , sensitivities of 80.0 and 54.3 % , and specificities of 81.0 and 92.3 % for a complicated postoperative course ( P < 0.001 ) , respectively . Conclusion Persistent CRP elevation and elevation of serum CRP  above 140 mg/dl on PODs 3–4 are predictive of infectious postoperative complications and should prompt intense clinical search for an inflammatory process , especially for an anastomotic leak if pneumonia and wound infection are unlikely or excluded AIM OF THE STUDY To evaluate the early effect of inguinal hernia repair by the tension-free method compared to the conventional And rew 's technique on lipid peroxidation . PATIENTS - METHODS Thirty-four patients subjected to elective hernia repair were enrolled in the study divided in two groups . Group A ( n=18 ) underwent  hernia repair  by the tension-free method using a polypropylene mesh . Group B ( n=16 ) underwent  hernia repair by the And rew 's technique ( i.e. a modification of the Bassini 's technique ) . Venous blood sample s were drawn preoperatively and at 12 , 24 and 48 h postoperatively . Malondialdehyde ( MDA ) was estimated by the thiobarbiturate assay . RESULTS Neutrophil counts were significantly higher in patients of group B compared to group A at 12 and 48 h postoperatively . Concentrations of fibrinogen were similar between the two groups . MDA was significantly higher in patients of group B hours compared to group A at 12 , 24 and 48 h postoperatively . Positive correlation was found between neutrophil counts and MDA at 12 h ( r : + 0.43 , P : 0.015 ) and 48 h ( r : + 0.496 , P : 0.005 ) but not at 24 h. No correlation was found between serum fibrinogen and MDA . CONCLUSION Hernia repair by the And rews 's technique elicits a sustained triggering of lipid peroxidation , compared to the tension-free method
target: The systemic inflammatory response was normalized before or on the seventh postoperative day .
  Conclusions Hernia repair elicits a systemic inflammatory response characterized by an increase in CRP , IL-6 , leukocytes , neutrophils , IL-1 , IL-10 , fibrinogen , and α1-antitrypsin and a decrease in lymphocytes and albumin .
  A higher inflammatory response was found after mesh repair compared with non-mesh repair and after open mesh repair compared with laparoscopic mesh repair
background: Purpose All surgical procedures elicit a complex systemic inflammatory response effectuated and modulated by cytokines .
  The purpose of this systematic review was to present an overview of the inflammatory response and the serum markers associated with hernia repair and to compare the response between patients treated with and without mesh .