P. H. P. Davids

Long-term Results of a Randomized Double-blinded Prospective Trial of a Lightweight (Ultrapro) Versus a Heavyweight Mesh (Prolene) in Laparoscopic Total Extraperitoneal Inguinal Hernia Repair (TULP-trial).

Objective:The aim of the randomized clinical trial was to compare the 2 years of clinical outcomes of a lightweight (Ultrapro) vs a heavyweight (Prolene) mesh for laparoscopic total extraperitoneal (TEP) inguinal hernia repair. Background:Lightweight meshes reduce postoperative pain and stiffness in open anterior inguinal hernia repair. The discussion about a similar benefit for laparoscopic repair is ongoing, but concerns exist about higher recurrence rates. Methods:Between March 2010 and October 2012, male patients who presented with a primary, reducible unilateral inguinal hernia who underwent day-case TEP repair were eligible. Outcome parameters included chronic pain, recurrence, foreign body feeling, and quality of life scores. Results:During the study period, 950 patients were included. One year postoperatively the presence of relevant pain (Numeric Rating Score 4–10) was significantly higher in the lightweight mesh group (2.9%) compared with the heavyweight mesh group (0.7%) (P = 0.01), and after 2 years this difference remained significant (P = 0.03). There were 4 (0.8%) recurrent hernias in the heavyweight mesh group and 13 (2.7%) in the lightweight group (P = 0.03). No differences in foreign body feeling or quality of life scores were detected. Conclusions:In TEP hernia surgery, there was no benefit of lightweight over heavyweight meshes observed 2 years postoperatively.

Teaching Colorectal Surgery in the Laparoscopic Era; Is It Safe?

OBJECTIVES With the introduction of laparoscopic colorectal surgery, the question is raised as to whether laparoscopic colectomies can safely be performed by surgical registrars, when supervised by experienced laparoscopic surgeons. In this study we have compared surgical outcomes of surgical registrars, fellows, and staff surgeons in a Dutch teaching hospital. DESIGN, SETTING, AND PARTICIPANTS Using a prospective database, the surgical outcomes of staff surgeons, fellows, and surgical registrars were compared. Pre- and postoperative complications were evaluated, including anastomotic failure. The percentage of reintervention, mortality, readmission, total hospital stay, and operating time were evaluated. The quality of the surgical resection was assessed by comparing the number of resected lymph nodes in malignant cases and the percentage of patients with adequate resection margins. RESULTS Analysis was performed in 420 patients. The majority of surgery was performed by staff surgeons. Outcomes of surgery for staff surgeons, fellows, and surgical registrars were comparable with respect to complications, percentage of conversions, and oncological adequacy. CONCLUSIONS Comprehensive training as a colorectal surgeon should include competence in laparoscopic resections. Our results show that laparoscopic colorectal surgery can safely be performed by surgical registrars with no increase of the number of conversions to laparotomy or the number of complications.

More adequate lymph node dissection after laparoscopic colorectal surgery.

The aim of this study was to determine whether there is a difference in the amount of lymph nodes harvested during open and laparoscopic surgery and whether this might influence the subsequent offering of adjuvant chemotherapy. All patients who underwent colorectal surgery for colorectal malignancies from July 2006 to April 2008 were included in our prospective database and in the study. In the laparoscopic group, 11/55 (20%) patients with stage II tumors had <10 lymph nodes in the pathology specimen when compared with 44/110 (40%) in the open group (P=0.01). The average number of lymph nodes was 12.1 for laparoscopic as compared with 10.2 lymph nodes for open resection (P=0.009). We demonstrate a significant increase in the number of resected lymph nodes with laparoscopic surgery. Significantly more patients in the open surgery group had <10 negative lymph nodes and were subsequently offered chemotherapy for their high-risk stage II colorectal malignancies.