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Do we need changes in the organization of training in the hernia treatment in Poland? A survey on the acknowledgment of the recommendations of international hernia societies by surgeons

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Mitura K., Dąbrowiecki S., Śmietański M., Matyja A.
Polish Journal of Surgery
|
2017
|
vol. 89(5)
12-18
EN
In the therapy of an inguinal hernia, there is a huge variety in the way of treating and the choice of surgical technique. Practice shows that the intraoperative improvisation and surgeons’ own modifications of the original techniques have become part of routine procedure. No mandatory hernia registration system causes the actual detailed herniology status in our country remains unknown. The aim of the study was to summarize the results of a survey on knowledge of a hernia according to the standards developed by international hernia societies compared with everyday clinical practice. During the International Conference Hernia in Poland, which took place on 10 December 2016 in Zakopane we conducted an interactive session among 106 surgeons dealing with hernias. Surgeons responded to 66 questions about daily surgical practice and decision making in their centers, and 27 questions for the assessment of the world’s latest treatment recommendations regarding groin hernias. The most common method of using the implant technique Lichtenstein, used by 91% of doctors. 20% of surgeons in planned operations in adult men routinely uses no mesh technique. Almost 80% of respondents do not apply TEP or TAPP. Only 45.7% of surgeons customize surgical technique to the patient. Only 7 of the 27 analyzed recommendation has been accepted by more than 90% of respondents. 9 of the 27 recommendations were approved by less than half of the surgeons. In the case of 11 recommendations, surgeons simultaneously failed to comply with these recommendations in daily practice. Deficiencies in the system of training and the underfunding of medical procedures cause insufficient TAPP/ TEP availability in Poland in an inguinal hernia. Improvement of the surgeons’ knowledge on how to perform surgery
2
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Czy w organizacji szkoleń w zakresie leczenia przepuklin w Polsce potrzebne są zmiany? Wyniki badania ankietowego przeprowadzonego wśród chirurgów operujących przepukliny, a dotyczące zakresu stosowania zaleceń międzynarodowych towarzystw herniologicznych

100%
Mitura K., Dąbrowiecki S., Śmietański M., Matyja A.
Polish Journal of Surgery
|
2017
|
vol. 89(5)
12-18
PL
In the therapy of an inguinal hernia, there is a huge variety in the way of treating and the choice of surgical technique. Practice shows that the intraoperative improvisation and surgeons’ own modifications of the original techniques have become part of routine procedure. No mandatory hernia registration system causes the actual detailed herniology status in our country remains unknown. The aim of the study was to summarize the results of a survey on knowledge of a hernia according to the standards developed by international hernia societies compared with everyday clinical practice. During the International Conference Hernia in Poland, which took place on 10 December 2016 in Zakopane we conducted an interactive session among 106 surgeons dealing with hernias. Surgeons responded to 66 questions about daily surgical practice and decision making in their centers, and 27 questions for the assessment of the world’s latest treatment recommendations regarding groin hernias. The most common method of using the implant technique Lichtenstein, used by 91% of doctors. 20% of surgeons in planned operations in adult men routinely uses no mesh technique. Almost 80% of respondents do not apply TEP or TAPP. Only 45.7% of surgeons customize surgical technique to the patient. Only 7 of the 27 analyzed recommendation has been accepted by more than 90% of respondents. 9 of the 27 recommendations were approved by less than half of the surgeons. In the case of 11 recommendations, surgeons simultaneously failed to comply with these recommendations in daily practice. Deficiencies in the system of training and the underfunding of medical procedures cause insufficient TAPP/ TEP availability in Poland in an inguinal hernia. Improvement of the surgeons’ knowledge on how to perform surgery
3
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Safety and efficacy of a Ventralight ST echo ps implant for a laparoscopic ventral hernia repair – a prospective cohort study with a one-year follow-up

52%
Stetsko T., Bury K., Lubowiecka I., Szymczak C., Tomaszewska A., Śmietański M., Stetsko T., Bury K., Lubowiecka I., Szymczak C., Tomaszewska A., Śmietaski M.
Polish Journal of Surgery
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2016
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vol. 88(1)
7-14
EN
Laparoscopic ventral hernia repair has become popular technique. Every year, companies are introducing new products Thus, every mesh prior to introduction in clinical settings should be tested with a dedicated tacker to discover the proper fixation algorithm. The aim of the study was to assess the safety and efficacy of the Ventralight ST implant with an ECHO positioning system and a dedicated fixation device, the SorbaFix stapler, in a prospective cohort of patients. Material and methods. The study was a prospective single centre cohort study with a one-year followup period. Fifty-two patients received operations for a ventral hernia using a laparoscopic IPOM mesh – Ventralight ST ECHO PS. The size of the mesh and the fixation method were based on mathematical considerations. A recurrence of the hernia and pain after 1, 2 and 12 months were assessed as the primary endpoints. Results. Two recurrences were noted, one in parastomal and one in a large incisional hernia. Pain was observed in 22 patients (41%) and mostly disappeared after 3 months (7%). The intensity of pain was low (VAS <2). However, 2 patients still experienced severe pain (VAS>6) until the end of the study. Conclusion. The Ventralight ST Echo PS implant fixed with a Sorbafix stapler is a valuable and safe option for a laparoscopic ventral hernia repair. In our opinion, the implant could be used in all patients due to the hernia ring diameter. According to the mathematical models and clinical practice, we do not recommend this implant in orifices with a width larger than 10 cm.
4
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Bezpieczeństwo i skuteczność zastosowania wewnątrzbrzusznego implantu Ventralight SY w laparoskopowym zaopatrzeniu przepuklin brzusznych – badanie prospektywne z rocznym okresem obserwacji

52%
Stetsko T., Bury K., Lubowiecka I., Szymczak C., Tomaszewska A., Śmietański M., Stetsko T., Bury K., Lubowiecka I., Szymczak C., Tomaszewska A., Śmietaski M.
Polish Journal of Surgery
|
2016
|
vol. 88(1)
11-24
PL
Celem badania była ocena bezpieczeństwa i skuteczności zastosowania implantu Ventralight ST z systemem pozycjonującym ECHO i dedykowanym urządzeniem mocującym – staplerem SorbaFix w prospektywnym badaniu kohortowym. Marteriał i metodyka. Badanie zaplanowano jako prospektywne jednoośrodkowe badanie kohorty chorych z jednorocznym okresem obserwacyjnym. Do badania włączono 52 chorych poddanych interwencji z powodu przepukliny brzusznej za pomocą laparoskopowego zaopatrzenia z implantem Ventralight ST ECHO PS. Wielkość siatki i sposób mocowania oparto na teoretycznych założeniach matematycznych. Głównym ocenianym parametrem było wystąpienie nawrotu w 12-miesięcznej obserwacji. Wyniki. Zanotowano dwa nawroty przepukliny, jeden u chorego z przepukliną okołostomijną i drugi w dużej przepuklinie pooperacyjnej. Ból obserwowano u 22 chorych (41%) po zabiegu. U większości chorych ból ustępował po okresie 3 miesięcy (7%). Obserwowano niskie natężenie bólu (VAS <2). Jednak silny ból występował u 2 chorych (VAS >6) w całym okresie obserwacji. Wnioski. Użycie implantu Ventralight ST Echo PS mocowanego stapleremSorbafix jest wartościową i bezpieczną opcją w laparoskopowym zaopatrzeniu przepukliny brzusznej. Rozwiązanie może być użyte do zaopatrzenia chorych zakwalifikowanych do laparoskopii z uwzględnieniem wielkości przepukliny. W odniesieniu do modeli matematycznych i przedstawionych danych klinicznych autorzy nie rekomendują używania opisanego implantu do przepuklin o pierścieniu większym niż 10 cm.
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