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Guarnieri technique and hernia center?
I stumbled on this, along with a link to a hernia center in Italy where it was seemingly developed and is still in use. However, other than one or two (old) journal articles, I find few references to it, making me wonder:
1. Is it, in fact, a good technique?
2. Is it sufficiently similar to one of the more frequently-discussed techniques to be considered the same?
3. If one is true, and two is false, then what has prevented its proliferation?
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12 Replies
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Collectively, the approach appears abandoned. It might be worthwhile to consider a key point claimed at
that Guarnieri’site: “considered “tension free” even in cases where the mesh is not used.”
I am unable to evaluate it, but know that if valid, then the approach would have to be exemplary. -
quote dog:i think dr. Kang made Great Comment …almost like he knows ours most surgeons .:} ..Yes it isn’t common to meet surgeons with very detailed with delicate approaches ! .Here is the Best Statement that every surgeon[B] must learn by heart .. Made By one German doctor credited his success. Once again for a few here who didn’t read it ![ before /B]
Dr. Reinpold of Hernia Centre Hamburg-Wilhelmsburg[B]”The avoidance of chronic pain is a primary concern in inguinal hernia repair and may be considered the most important clinical outcome. This problem preceded modern mesh-based techniques; however, as recurrence rates have decreased, pain has become the more prevalent and important complication. Understanding the causative mechanisms and risk factors of inguinodynia help to prevent, diagnose, and treat this condition. Groin pain, especially in the absence of a bulge, often needs interdisciplinary diagnostics and no operation. Detailed diagnostics, meticulous operative technique with profound knowledge of the anatomy, proper nerve identification and handling, optimization of prosthetic materials, and careful fixation are of utmost importance. Further research on how to avoid CPIP and explore the effectiveness of treating it is necessary.”[/
[h=1]I found a publication of two great surgeons, in which Fitgibons, from page 121 also examines the Guarnieri method, expressing very positive evaluations, and claims that it would be more difficult to write oneself than to practice oneself. Even I, not being a doctor, just pass on some passages, which may be of interest.Nyhus and Condon’s Hernia[/h] a cura di Robert J. Fitzgibbons, A. Gerson Greenburg, Lloyd Milton Nyhus
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quote drkang:Hi UhOh!,I have searched about the Guarnieri technique to answer your question on whether it is similar to my repair method.
The only similarity is that direct inguinal hernia and indirect inguinal hernia are treated in separate ways. I have read that this technique is no longer used even in that hospital, and I can guess why. In my opinion, it is because this technique is too complicated. On picture, it looks like a very detailed and delicate method but not only is it extremely difficult to carry it out the way it is on picture, it would not be easy to get successful results. Reason being, surgery in reality, is like a battle so it does not proceed as planned or pictured. This is why surgeries have to be as simple as it can be. That way, the possibility of errors or unforeseen situations will be minimized and increase in the possibility of a successful surgery will follow. Furthermore, the simpler the method, more doctors will be able to provide equal quality of the surgery, which leads to its generalization.
One big reason behind the widespread implementation of mesh repair is that it is simple and easy for doctors to repeat the process. Thus, I believe that simplicity and easy-to-follow are important conditions for new tissue repair methods in the future.
i think dr. Kang made Great Comment …almost like he knows ours most surgeons .:} ..Yes it isn’t common to meet surgeons with very detailed with delicate approaches ! .Here is the Best Statement that every surgeon[B] must learn by heart .. Made By one German doctor credited his success. Once again for a few here who didn’t read it ![ before /B]
Dr. Reinpold of Hernia Centre Hamburg-Wilhelmsburg[B]”The avoidance of chronic pain is a primary concern in inguinal hernia repair and may be considered the most important clinical outcome. This problem preceded modern mesh-based techniques; however, as recurrence rates have decreased, pain has become the more prevalent and important complication. Understanding the causative mechanisms and risk factors of inguinodynia help to prevent, diagnose, and treat this condition. Groin pain, especially in the absence of a bulge, often needs interdisciplinary diagnostics and no operation. Detailed diagnostics, meticulous operative technique with profound knowledge of the anatomy, proper nerve identification and handling, optimization of prosthetic materials, and careful fixation are of utmost importance. Further research on how to avoid CPIP and explore the effectiveness of treating it is necessary.”[/
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I have searched about the Guarnieri technique to answer your question on whether it is similar to my repair method.
The only similarity is that direct inguinal hernia and indirect inguinal hernia are treated in separate ways. I have read that this technique is no longer used even in that hospital, and I can guess why. In my opinion, it is because this technique is too complicated. On picture, it looks like a very detailed and delicate method but not only is it extremely difficult to carry it out the way it is on picture, it would not be easy to get successful results. Reason being, surgery in reality, is like a battle so it does not proceed as planned or pictured. This is why surgeries have to be as simple as it can be. That way, the possibility of errors or unforeseen situations will be minimized and increase in the possibility of a successful surgery will follow. Furthermore, the simpler the method, more doctors will be able to provide equal quality of the surgery, which leads to its generalization.
One big reason behind the widespread implementation of mesh repair is that it is simple and easy for doctors to repeat the process. Thus, I believe that simplicity and easy-to-follow are important conditions for new tissue repair methods in the future.
drkangi think dr. Kang made Great Comment …almost like he knows ours most surgeons .:} ..Yes it isn’t common to meet surgeons with very detailed with delicate approaches ! .Here is the Best Statement that every surgeon must learn by heart .. Made By one German doctor credited his success. Once again for a few here who didn’t read it !
Dr. Reinpold of Hernia Centre Hamburg-Wilhelmsburg“The avoidance of chronic pain is a primary concern in inguinal hernia repair and may be considered the most important clinical outcome. This problem preceded modern mesh-based techniques; however, as recurrence rates have decreased, pain has become the more prevalent and important complication. Understanding the causative mechanisms and risk factors of inguinodynia help to prevent, diagnose, and treat this condition. Groin pain, especially in the absence of a bulge, often needs interdisciplinary diagnostics and no operation. Detailed diagnostics, meticulous operative technique with profound knowledge of the anatomy, proper nerve identification and handling, optimization of prosthetic materials, and careful fixation are of utmost importance. Further research on how to avoid CPIP and explore the effectiveness of treating it is necessary.”
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quote drkang:Hi UhOh!,
I have searched about the Guarnieri technique to answer your question on whether it is similar to my repair method.
The only similarity is that direct inguinal hernia and indirect inguinal hernia are treated in separate ways. I have read that this technique is no longer used even in that hospital, and I can guess why. In my opinion, it is because this technique is too complicated. On picture, it looks like a very detailed and delicate method but not only is it extremely difficult to carry it out the way it is on picture, it would not be easy to get successful results. Reason being, surgery in reality, is like a battle so it does not proceed as planned or pictured. This is why surgeries have to be as simple as it can be. That way, the possibility of errors or unforeseen situations will be minimized and increase in the possibility of a successful surgery will follow. Furthermore, the simpler the method, more doctors will be able to provide equal quality of the surgery, which leads to its generalization.
One big reason behind the widespread implementation of mesh repair is that it is simple and easy for doctors to repeat the process. Thus, I believe that simplicity and easy-to-follow are important conditions for new tissue repair methods in the future.
[USER=”2019″]drkang[/USER] Thank you! It’s impossible for someone like me (not a doctor of any kind) to understand based on diagrams/descriptions what constitutes a “simple” or “complex” surgery. Looking forward to the day (hopefully soon) that your team publishes and there is the possibility of bringing a more effective technique to market.
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Hi UhOh!,
I have searched about the Guarnieri technique to answer your question on whether it is similar to my repair method.
The only similarity is that direct inguinal hernia and indirect inguinal hernia are treated in separate ways. I have read that this technique is no longer used even in that hospital, and I can guess why. In my opinion, it is because this technique is too complicated. On picture, it looks like a very detailed and delicate method but not only is it extremely difficult to carry it out the way it is on picture, it would not be easy to get successful results. Reason being, surgery in reality, is like a battle so it does not proceed as planned or pictured. This is why surgeries have to be as simple as it can be. That way, the possibility of errors or unforeseen situations will be minimized and increase in the possibility of a successful surgery will follow. Furthermore, the simpler the method, more doctors will be able to provide equal quality of the surgery, which leads to its generalization.
One big reason behind the widespread implementation of mesh repair is that it is simple and easy for doctors to repeat the process. Thus, I believe that simplicity and easy-to-follow are important conditions for new tissue repair methods in the future.
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Dr Guarnieri’s technique is among many tissue repair options. It hasn’t caught on in US. Some in Europe use it. It’s mostly historic. There are no major advantages between that and the others.
Dr Nicolo is retired. As far as I’m aware, his role is mostly historic and as a translator.
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quote UhOh!:So you’re saying that the current generation of surgeons at that center have abandoned the mesh-free version of the founder’s signature technique entirely?
I have a friend operated right there in direct abdominal hernia: I can visit him, and I will ask details next weeck
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So you’re saying that the current generation of surgeons at that center have abandoned the mesh-free version of the founder’s signature technique entirely?
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Good morning, I went to visit this center 2 years ago just because the videos showed that we practice a technique without prosthesis, developed by a great surgeon, the father Guarnieri Antonio.
At the medical examination I asked if the ernioraffia was practiced, but the surgeon replied that now they all use the prosthesis -
Bumping this older thread… Still curious whether any of the docs on here are familiar with this technique (or, in fact, set of techniques)? Looks like they’ve presented at several hernia society conferences, and the co-author of the book is a past president of the AHS.
[USER=”2019″]drkang[/USER] : I’m curious whether there are any similarities with your repair technique, given the way it’s described (less tension than Shouldice, more targeted than Desarda, different for direct/indirect)?
[USER=”935″]drtowfigh[/USER] : Do you know if the co-author, Dr. Nicolo, who is in the U.S. uses this technique himself (or if he just translated the materials to English, which it looks like he’s done elsewhere)? Figured you might be familiar through AHS…Is there a good reason its use never became widespread, or is it more a victim of circumstance, like many other innovations released at just the wrong time? It seems they published at a time when mesh was gaining significant popularity, without many of its complications having been brought to light, so possible nobody would have been paying attention to a new non-mesh technique?
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I haven’t got to the technique description yet but that “Online Book” under the Doctor heading is an excellent overall review of all of the repair techniques. Thanks for sharing that. It’s very high level and full of references and illustrations.
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