Two Controversial Concepts: Standard Procedure in a Standard Patient Versus Tailored Surgery with Procedures Adjusted to Individual Patients

  • U. Klinge
  • A. Fiebeler


Surgeons have been working for decades to improve their technique and to develop better procedures. In doing so, they try to prove the effect of every modification by clinical randomized controlled trials (RCTs). The process should result in a best technique that can then be considered the gold standard. This recommendation is outlined in so-called guidelines offering evidence-based knowledge to every physician. However, although RCTs have been performed with increasing efforts, these often fail to confirm any significant differences between the groups involved. Furthermore, after replication by other investigators, the overall results differ considerably in outcome, making interpretation of the results rather complicated. Even the collection of several trials in meta-analyses often does not ease interpretation. It appears that for some questions, the RCT instrument needs some support to verify the superiority of one procedure over another.


Hernia Repair Incisional Hernia Standard Patient Mesh Repair Technical Failure 
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  1. 1.
    Schumpelick V, Fitzgibbons R (2007) Recurrent hernia-prevention and treatment. Springer, BerlinCrossRefGoogle Scholar
  2. 2.
    Eklund A, Rudberg C, Leijonmarck CE, et al. (2007) Recurrent inguinal hernia: randomized multicenter trial comparing laparoscopic and Lichtenstein repair. Surg Endosc 21:634–40CrossRefPubMedGoogle Scholar
  3. 3.
    McCormack K, Scott NW, Go PM, Ross S, Grant AM (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev 2003 (1):CD001785PubMedGoogle Scholar
  4. 4.
    Klinge U, Krones CJ (2005) Can we be sure that the meshes do improve the recurrence rates? Hernia 9:1–2CrossRefPubMedGoogle Scholar
  5. 5.
    Klinge U, Binnebösel M, Rosch R, Mertens P (2006) Hernia recurrence as a problem of biology and collagen. J Minim Access Surg 2:151–4CrossRefGoogle Scholar
  6. 6.
    Luijendijk RW, Hop WC, van den Tol MP, et al. (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343:392–8CrossRefPubMedGoogle Scholar
  7. 7.
    Burger JW, Luijendijk RW, Hop WC, et al. (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240:578–83; discussion 583–5PubMedGoogle Scholar
  8. 8.
    Flum DR, Horvath K, Koepsell T (2003) Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg 237:129–35CrossRefPubMedGoogle Scholar
  9. 9.
    Rosemar A, Hana N, Ulf A, Staffan H, Pär N (2008) Groin hernia surgery and body mass index: a study based on a national register (S) In: Proceedings of the 30th Congress of EHS GREPA, Sevilla, Spain, 7–10 May 2008Google Scholar
  10. 10.
    Klinge U, Dahl E, Mertens P (2007) Problem poser-how to interpret divergent prognostic evidence of simultaneously measured tumor markers? Comput Math Methods Med 8:71–75CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  • U. Klinge
    • 1
  • A. Fiebeler
  1. 1.Institute for Applied Medical Engineering Helmholtz Institute for Applied Medical TechnologyRWTH Aachen UniversityAachenGermany

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