Henning Niebuhr

Hanse-Hernienzentrum Hamburg · Hanse-Hernienzentrum Hamburg

Introduction Since 2011, the German Hernia Society has developed the German Hernia School (GHS) as a standardized hernia surgery training program for younger surgeons, consisting of the Hernia Compact basic module. It is a standardized three-day training program (cadaver workshop, ultrasound simulation training, and hands-on training). After 12 yea...

Purpose Intraoperative fascial traction (IFT) for the treatment of large ventral hernias and loss of domain (LOD) hernias is a promising tool in abdominal wall surgery. However, little is known about the extent of gain in myofascial advancement especially for the anterior rectus sheath. We, therefore, used a cadaveric model to determine the mediali...

Introduction Since 2011, the German Hernia Society has developed the German Hernia School (GHS) as a standardized hernia surgery training program for younger surgeons, consisting of the Hernia Compact basic module. It is a standardized three day training program (cadaver workshop, ultrasound simulation training, and hands-on training). After 12 yea...

Aim To evaluate the effectiveness, clinical practicability, and complication rate of the fascial traction procedure for the treatment of large ventral hernias. Method This observational study evaluated 90 patients from 1 specialised center with an intraoperatively measured fascial distance of more than 10 cm who were treated by Intraoperative Fasc...

Zusammenfassung Leistenhernienoperationen stellen mit ca. 300.000 Eingriffen jährlich in Deutschland, Österreich und der Schweiz (DACH-Region) die häufigste Operation überhaupt dar. Trotz des bekundeten politischen Willens und des zunehmenden Drucks der Gesetzgeber zur Vermeidung kostenintensiver stationärer Behandlungen, so viele Operationen wie m...

The AWEX and IFT procedures are based on the principle of intraoperative stretching of the contracted musculature and pursue the objective of mainaining the abdominal wall integrity in the reconstruction of large incisional hernia and laparostoma. The amazing efficacy of the principle was already established while the technique was beginning to be...

Objective The aim was to evaluate the effectiveness, clinical practicability, and complication rate of the intraoperative fascial traction (IFT) procedure for the treatment of large ventral hernias.Method This study evaluated 50 patients from 11 specialized centers with an intraoperatively measured fascial distance of more than 8 cm, who were treat...

Aim The hydrocele of the femoral canal (Femorocele) is one of the rarest entities of femoral hernia (1). All of the reported cases were an intraoperative diagnosis and were treated with an open approach. We are reporting, the probably first femorocele diagnosed and treated laparoscopically. Material and Methods A 57-years-old female patient was pr...

Aim We present our approach of treating a W3 (EHS-Classification) incisional hernia with heterotopic ossification in the abdominal wall. Material and Methods a 62-years-old female patient presented with a hernia in her inverted-T incision (midline and transverse) after undergoing multiple laparotomies. The CT-scan showed calcified structures withi...

Aim Measurable and controlled stretching of the fascia for 30 minutes during surgery to achieve primary tension-free abdominal wall closure in LOD hernias. This prospective observational study aimed to clarify the extent to which this traction method can function as an alternative to component separation methods. Material and Methods We have alrea...

IntroductionThere are hardly any studies on the outcome of scrotal compared with medial and lateral inguinal hernias. Therefore, this present multivariable analysis of data from the Herniamed Registry compared the outcome of scrotal vs. lateral vs. medial inguinal hernias and explored the relationship between hernia localization and outcomes.Method...

Background The abdominal wall expanding system (AWEX) was first applied in 2012 and published in 2017. This novel technique was developed to reconstruct complex incisional hernias and residual skin-grafted laparostoma after treatment of an open abdomen, when primary midline closure was impossible. The main aim was the anatomical reconstruction of t...

IntroductionRectus abdominis diastasis (RAD) ± concomitant hernia is a complex hernia entity of growing significance in everyday clinical practice. Due to a multitude of described surgical techniques, a so far missing universally accepted classification and hardly existing comparative studies, there are no clear recommendations in guidelines. There...

Introduction: How best to treat a small (< 2 cm) umbilical hernia continues to be the subject of controversial debate. The recently published guidelines for treatment of umbilical hernias from the European Hernia Society and Americas Hernia Society recommend open mesh repair for defects ≥ 1 cm. Since the quality of evidence is limited for hernias...

Introduction Based on meta-analyses and registry data, the European Hernia Society and the Americas Hernia Society have published guidelines for the treatment of umbilical hernias. These recommend that umbilical hernia should generally be treated by placing a non-absorbable (permanent) flat mesh into the preperitoneal space with an overlap of the h...

Incisional hernias are common late complications of abdominal surgery, with a 1-year post-laparotomy incidence of about 20%. A giant hernia is often preceded by severe peritonitis of various causes. The Fasciotens® Abdomen device is used to stretch the fascia in a measurably controlled manner during surgery to achieve primary tension-free abdominal...

Groin hernia is one of the most common surgical conditions worldwide. Clinical examination can reveal the majority of inguinal hernias. Small inguinal and femoral hernias (in women) may be missed. Dynamic inguinal ultrasound (DIUS) can fill this diagnostic gap. A standardized technique of DIUS is, therefore, important and will be described. The res...

IntroductionThe use of drains continues to be a controversial topic in surgery. In a review of that topic for incisional hernia it was not possible to find sufficient evidence of the need for a drain. Likewise, for inguinal hernia surgery the data available are insufficient.Methods In a multivariable analysis of data from the Herniamed Registry for...

IntroductionThe proportion of recurrent repairs in the total collective of inguinal hernia repairs among men is 11.3–14.3% and among women 7.0–7.4%. The rate of re-recurrences is reported to be 2.9–9.2%. To date, no case series has been published on second and ≥ third recurrences and their treatment outcomes. Only case reports are available.Materia...

In 2014 the International Endohernia Society (IEHS) published the first international “Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias”. Guidelines reflect the currently best available evidence in diagnostics and therapy and give recommendations to help surgeons to standardize their techniques and to improve t...

In 2014, the International Endohernia Society (IEHS) published the first international “Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias.” Guidelines reflect the currently best available evidence in diagnostics and therapy and give recommendations to help surgeons to standardize their techniques and to improve...

This article was updated to include the middle initial of author L. N. Jorgensen’s name.

Surgical techniques: The HerniaSurge guidelines have the highest evidence with respect to a strong recommendation for mesh-based surgical techniques. This evidence is equally valid for the Lichtenstein procedure as for the minimally invasive procedures TEP/TAPP. In the case of discrete symptomatic or asymptomatic inguinal hernias, watchful waiting...

Background: The reported range of seroma formation in the literature after TEP repair is between 0.5 and 12.2% and for TAPP between 3.0 and 8.0%. Significant clinical factors associated with seroma formation include old age, a large hernia defect, an extension of the hernia sac into the scrotum, as well as the presence of a residual indirect sac....

Background: In inguinal hernia repair, chronic pain must be expected in 10-12% of cases. Around one-quarter of patients (2-4%) experience severe pain requiring treatment. The risk factors for chronic pain reported in the literature include young age, female gender, perioperative pain, postoperative pain, recurrent hernia, open hernia repair, perio...

Purpose: Although clinical examination is the gold standard for the diagnosis of groin hernia, imaging procedures can improve the detection of femoral hernias, incipient hernias, and less-common types of hernias (e.g., an obturator hernia). The aim of this study is to evaluate the sensitivity and specificity of dynamic inguinal ultrasound (DIUS)....

IntroductionOn the basis of six meta-analyses, the guidelines of the European Hernia Society (EHS) recommend laparo-endoscopic recurrent repair following previous open inguinal hernia operation and, likewise, open repair following previous laparo-endoscopic operation. So far no data are available on implementation of the guidelines or for compariso...

Despite all the progress made in inguinal hernia surgery driven by the development of meshes and laparoendoscopic operative techniques, the proportion of recurrent inguinal hernias is still from 12% to 13%. Recurrences can present very soon after primary inguinal hernia repair generally because of technical failure. However, they can also develop m...

In den neuen weltweiten Guidelines aller internationalen Herniengesellschaften werden nur noch die netzbasierten Methoden total extraperitoneale Hernioplastik (TEP), transabdominelle präperitoneale Hernioplastik (TAPP) und Lichtenstein empfohlen. Die beste netzfreie Technik, die Shouldice-Operation, sollte nur noch eingesetzt werden, wenn der Patie...

Whereas for TEP the guidelines do not recommend mesh fixation on the basis of meta-analyses regardless of the defect size, for TAPP mesh fixation can be omitted only up to a defect size of 3 cm because of the paucity of studies on this topic. Hence, this study now seeks to explore this subject on the basis of prospective data from the Herniamed Her...

Evaluation of endoscopic TAPP hernia repair: medical outcome, quality of life and economy: day case vs. short stay. Between October 2001 and June 2006 840 patients after hernia repair could be included. TAPP was performed in 58% (both side repair n = 305), and LICHTENSTEIN in 38% (both side: n=0), SHOULDICE in 4% (both side repair: n=0). Day case s...

The potential for improvement of the results of laparoscopic operations as well as necessity of enhanced efficiency in the health-care systems are the main reasons for development and practical use of robotic systems in the field of laparoscopic surgery. While robotic systems imitate the human camera-holder the Image Tracking System (ImagTrac, Olym...

The potential for improvement of the results of laparoscopic operations as well as necessity of enhanced efficiency in the health-care systems are the main reasons for development and practical use of robotic systems in the field of laparoscopic surgery. While robotic systems imitate the human camera-holder the Image Tracking System (ImagTrac, Olym...

A prospective trial reveals that routine ultrasound in suspected appendicitis in the hands of experts can lead to a specificity of 94% and a sensitivity of 90% in opposite to 82% and 78% for clinical findings alone. The rate of "negative laparotomies" has decreased from 22% to 11%.

The TAPP (transabdominal preperitoneal) technique is the most frequently performed laparoscopic hernia operation. This technique was used 263 times. Overall there were 37 complications (14%), 9% major (recurrences and paresthesias) and 5% minor (hematomas) ones. The rate of recurrences was 12 (4.5%). From these results it is felt that in select pat...

Zusammenfassung Die transperitoneale, präperitoneale laparoskopische Hernioplastik (TAPP) ist die am meisten praktizierte laparoskopische Hernienoperation. Bei 263 Operationen traten 37 Komplikationen (14&percnt;) auf, in 9&percnt; handelte es sich um gröβere Komplikationen wie Rezidive oder Parästhesien. In 5&percnt; der Fälle traten geringfügiger...

Although the required pneumoperitoneum for laparoscopic cholecystectomy and laparoscopic hernial repair means stress for the elderly, it does not affect them negatively from a clinical point of view. On the contrary, the patient profits by a low complication rate, a quick recovery and a shorter stay in hospital.

Zusammenfassung Im Rahmen einer prospektiven Studie sind wir seit Einführung der laparoskopischen Appendektomie in unserer Klinik im Februar 1991 der Frage nachgegangen, ob die laparoskopische Technik für den Patienten vorteilhafter ist als das konventionelle Vorgehen. Im Zeitraum zwischen Februar 1991 und April 1995 haben wir 81 Patienten laparosk...

To determine whether clear advantages for the patients postoperative outcome could be achieved in using laparoscopic appendectomy, we performed a prospective trial comparing, since the introduction of the laparoscopic techniques in our clinic in February 1991, the laparoscopic with the open procedure. Between February 1991 and April 1995 we carried...

Over the last few years, laparoscopic surgery has gained widespread acceptance in surgical practice. The indications range has expanded extraordinarily in that time. Some of the practiced procedures are already considered the gold standard, while others are still on the way there. The fascinating technique and results notwithstanding, a number of r...

Mit der vorliegenden prospektiven, randomisierten Studie sind wir der Frage nachgegangen, ob die prinzipielle intraoperative Cholangiographie vorteilhaft für Operateur und Patient ist, oder ob die alleinige prä- und postoperative Sonographie ausreichend Sicherheit in der Beurteilung des Gallenwegssystems bietet.

Laparoscopic cholecystectomy and appendectomy are widely accepted in clinical practice. In the initial stage, when the method is introduced, there are a number of mistakes, risks, and complications possible. The surgeons, the staff, the instruments, the anesthetist, and, last but not least, the patient, are among the possible contributing causes. W...

Zusammenfassung In einer Übersicht wird über die verschiedenen gebräuchlichen Verfahren der Reparatur der medialen Leistenhernie berichtet: Original-Bassini-Methode, modifizierte Bassini-Technik, Shouldice-Technik. Die Verfahren nach McVay-Lotheisen, Kirschner, Girard und Halsted-Ferguson werden referiert. Eingegangen wird auch auf neuere, alternat...

In our animal trial we proved a plug technique to close an experimentally induced lesion in the antral prepyloric stomach wall laparoscopically. In all animals (18 minipigs, 20 kg) we observed secure closure and a strong scar tissue within mucosal and serosal layers. Conclusion: The plug technique is a simple and secure method to repair lesions in...

Based on the results of a prospective trial to establish the value of routine ultrasound examination in cases of polytrauma or blunt abdominal trauma, we report on our standard ultrasound examination and computer assisted documentation of the findings. Between May 1988 and December 1990 we examined 233 patients with polytrauma or blunt abdominal tr...

Between 4/90 and 2/91 we repaired 105 inguinal hernias according to Shouldice's technique. Instead of an absorbable suture (PDS no.0) we used a PTFE suture no.0. By this study we tried to assure that it is allowed to use as well the non resorbable PTFE suture no.0. in hernia repair as the slowly resorbable PDS suture no.0. We compared the rate of p...

Unlabelled: During 1978 to 1987 361 patients (312 female, 49 male) were treated with Variokopf-prosthesis (a bipolar hip prosthesis with a variable head) after femoral neck fracture, per- or subtrochanteric fracture. The mean age was 83 years. During postoperative treatment 73 patients (20.2%) died. 288 could be discharged. 98 of these died before...

During 1978 to 1987 361 patients (312 female, 49 male) were treated with Variokopf-prosthesis (a bipolar hip prosthesis with a variable head) after femoral neck fracture, per- or subtrochanteric fracture. The mean age was 83 years. During postoperative treatment 73 patients (20.2%) died. 288 could be discharged. 98 of these died before the follow-u...

We report two cases of rare tumours of the pancreas: one case of a cystadenoma and one case of a PP-oma with no hormonal activity. Both cases were discovered accidentally while screening examination of other reasons. Guided by these cases we draw the following conclusions: 1. Ultrasound is the outstanding screening in diagnosis of rare pancreas tum...

Forty five years after being injured by a grenade splinter a now 74-year old man suddenly developed colicky pain in the right upper abdomen, accompanied by colourless stools, jaundice and fever. The white cell count was 21,000/microliters, bilirubin was raised to 10.9 mg/dl, and ultrasound examination revealed a sharply circumscribed echo in the di...