***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Operation to cure groin hernia remains a clinical problem . The most effective technique for hernia repairs is unknown and the presented recurrence rate varies between 1 % and 10 % at five years . Although surgeries with improved techniques with implanted material s are performed worldwide , they are limited because of the cost associated with hernia repair . OBJECTIVE To determine the results of the presented two umbrella made-mesh plugs for inguinal hernia repair compared to other methods of herniorrhaphy . MATERIAL AND METHOD The 194 patients , aged 16 - 86 years who had primary diagnosis of indirect inguinal hernia were prospect ively selected into two periods of elective surgery . The first period included , 58 cases operated with Bassini repair and 11 cases needed relaxing incision , 42 in Bassini repair with umbrella made-mesh plug from polypropylene mesh and six cases that needed relaxing incision . The second period included 40 cases of Lichtenstein repair , 54 cases using umbrella made-mesh plug with patching tail . The outcomes for study were postoperative complications , hospital staying time , and recurrence rate of hernia within two years . RESULTS All these patients had no mortality . Mean operative time was 31.8 minutes ( 25 - 50 ) of Bassini repair 47.7 minutes ( 30 - 60 ) of Bassini repair with umbrella made-mesh plug , 53.2 minutes ( 38 - 60 ) of Lichtenstein repair and 54.8 minutes ( 40 - 65 ) for usage of umbrella made-mesh plug with patching tail . Overall duration of hospital stay was one to seven days ( mean 3.5 days ) . Some complications were ecchymosis or seroma three in Bassini repair , three in Bassini repair with umbrella made-mesh plug , and one in Lichtenstein repair Wound infections were found with one case of Bassini repair and two of Bassini repair with umbrella made-mesh plug . Within two years of follow-up time , eight of 58 ( 13.8 % ) had recurrence by Bassini repair while three of 42 ( 7.1 % ) in Bassini repair with umbrella made-mesh plug , but no recurrence in Lichtenstein repair or umbrella made-mesh plug with patching tail . CONCLUSION The usage of both umbrella made-mesh plugs were safe for 94/96 cases of groin herniorrhaphy with only two infected meshes . The used mesh material ( polypropylene ) was easily made with an umbrella like shape during operation and lowered the cost . The mesh plug with patching tail had a suitable use for patching at wide hernia floor , so relaxing incisions were unnecessarily done . For cases with small or no space of floor defect , repaired by mesh plug without patching may be adequate . Their two-year recurrence rates were lower than Bassini repair alone whereas the repair by using umbrella made-mesh plug with patching tail and Lichtenstein repair had no recurrence . There was no difference in postoperative complications among all operations Objective : Many patients with an inguinal hernia are asymptomatic or have little in the way of symptoms from their hernia . Repair is often associated with long-term chronic pain and has a recurrence rate of 5 % to 10 % . Our aim was to compare operation with a wait- and -see policy in patients with an asymptomatic hernia . Methods : A total of 160 male patients 55 years or older were r and omly assigned to observation or operation . Patients were assessed clinical ly and sent question naires at 6 months and 1 year . The primary endpoint was pain and general health status at 12 months ; other outcome measures included costs to the health service and the rate of operation for a new symptom or complication . Results : At 12 months , there were no significant differences between the r and omized groups of observation or operation , in visual analogue pain scores at rest , 3.7 mm versus 5.2 mm ( mean difference , −1.6 ; 95 % confidence interval ( CI ) , −4.8 to 1.6 , P = 0.34 ) , or on moving , 7.6 mm versus 5.7 mm ( mean difference , −1.9 ; 95 % CI , −6.1 to 2.4 , P = 0.39 ) . Also , the number of patients 29 versus 24 ( difference in proportion , 8 % ; 95 % CI , −7 % to 23 % , P = 0.31 ) , who recorded pain on moving and the number taking regular analgesia , 9 versus 17 ( difference in proportion , −10 % ; 95 % CI , −21 % to 2 % , P = 0.14 ) was similar . At 6 months , there were significant improvements in most of the dimensions of the SF-36 for the operation group , while at 12 months although the trend remained the same the differences were only significant for change in health ( mean difference , 7.3 ; 95 % CI , 0.4 to 14.3 , P = 0.039 ) . The rate of crossover from observation to operation 23 patients at a median follow-up of 574 days was higher than predicted . The observation group also suffered 3 serious hernia-related adverse events compared with none in the operation group . Conclusions : Repair of an asymptomatic inguinal hernia does not affect the rate of long-term chronic pain and may be beneficial to patients in improving overall health and reducing potentially serious morbidity The European Hernia Society ( EHS ) is proud to present the EHS Guidelines for the Treatment of  Inguinal Hernia in Adult Patients . The Guidelines contain recommendations for the treatment of inguinal hernia from diagnosis till aftercare . They have been developed by a Working Group consisting of expert surgeons with representatives of 14 country members of the EHS . They are evidence -based and , when necessary , a consensus was reached among all members . The Guidelines have been review ed by a Steering Committee . Before finalisation , feedback from different national hernia societies was obtained . The  Appraisal of Guidelines for REsearch and Evaluation ( AGREE ) instrument was used by the Cochrane Association to vali date the Guidelines . The Guidelines can be used to adjust local protocol s , for training purpose s and quality control . They will be revised in 2012 in order to keep them up date d. In between revisions , it is the intention of the Working Group to provide every year , during the EHS annual congress , a short up date of new high-level evidence ( r and omised controlled trials [ RCTs ] and meta-analyses ) . Developing guidelines leads to questions that remain to be answered by specific research . Therefore , we provide recommendations for further research that can be performed to raise the level of evidence concerning certain aspects of inguinal hernia treatment . In addition , a short summary , specifically for the general practitioner , is given . In order to increase the practical use of the Guidelines by consultants and residents , more details on the most important surgical techniques , local infiltration anaesthesia and a patient information sheet is provided . The most important challenge now will be the implementation of the Guidelines in daily surgical practice . This remains an important task for the EHS . The establishment of an EHS school for teaching inguinal hernia repair surgical techniques , including tips and tricks from experts to overcome the learning curve ( especially in endoscopic repair ) , will be the next step . Working together on this project was a great learning experience , and it was worthwhile and fun . Cultural differences between members were easily overcome by educating each other , respecting different views and always coming back to the principles of evidence -based medicine . The members of the Working Group would like to thank the EHS board for their support and especially Ethicon for sponsoring the many meetings that were needed to finalise such an ambitious project CONTEXT Many men with inguinal hernia have minimal symptoms . Whether deferring surgical repair is a safe and acceptable option has not been assessed . OBJECTIVE To compare pain and the physical component score ( PCS ) of the Short Form-36 Version 2 survey at 2 years in men with minimally symptomatic inguinal hernias treated with watchful waiting or surgical repair .  DESIGN , SETTING , AND PARTICIPANTS R and omized trial conducted January 1 , 1999 , through December 31 , 2004 , at 5 North American centers and enrolling 720 men ( 364 watchful waiting , 356 surgical repair ) followed up for 2 to 4.5 years . INTERVENTIONS Watchful-waiting patients were followed up at 6 months and annually and watched for hernia symptoms ; repair patients received st and ard open tension-free repair and were followed up at 3 and 6 months and annually . MAIN OUTCOME MEASURES Pain and discomfort interfering with usual activities at 2 years and change in PCS from baseline to 2 years . Secondary outcomes were complications , patient-reported pain , functional status , activity levels , and satisfaction with care . RESULTS Primary intention-to-treat outcomes were similar at 2 years for watchful waiting vs surgical repair :  pain limiting activities ( 5.1 % vs 2.2 % , respectively ; P = .06 [ corrected ] ) ; PCS ( improvement over baseline , 0.29 points vs 0.13 points ; P = .79 ) . Twenty-three percent of patients assigned to watchful waiting crossed over to receive surgical repair ( increase in hernia-related pain was the most common reason offered ) ; 17 % assigned to receive repair crossed over to watchful waiting .  Self-reported pain in watchful-waiting patients crossing over improved after repair . Occurrence of postoperative hernia-related complications was similar in patients who received repair as assigned and in watchful-waiting patients who crossed over . One watchful-waiting patient ( 0.3 % ) experienced acute hernia incarceration without strangulation within 2 years ; a second had acute incarceration with bowel obstruction at 4 years , with a frequency of 1.8/1000 patient-years inclusive of patients followed up for as long as 4.5 years . CONCLUSIONS Watchful waiting is an acceptable option for men with minimally symptomatic inguinal hernias . Delaying surgical repair until symptoms increase is safe because acute hernia incarcerations occur rarely . Clinical Trials Registration Clinical Trials.gov Identifier : NCT00263250 Background In recent years long-term discomfort  after inguinal hernia surgery has become an issue of great concern to hernia surgeons . Long-term results on discomfort from large r and omised studies are sparse . Methods One-thous and one-hundred and eighty-three patients were r and omised in a multicentre trial with the primary aim of comparing recurrence rates after laparoscopic TAPP and Shouldice repair . Evaluating late discomfort and its possible risk factors were secondary objectives , and are reported here . The patients were clinical ly examined after 1 and 5 years , and answered question naires 2 and 3 years postoperation . Results Of 1,068 operated patients , 867 were eligible for analysis after 5 years ( 81.2 % ) . The percentage of patients experiencing discomfort of any kind were 8.5 % in the TAPP group and 11.4 % ( p = 0.156 ) in the Shouldice group . Although discomfort was usually mild it was severe for 0.2 and 0.7 % , respectively . Severe pain the first postoperative week was a risk factor for late discomfort in the Shouldice group ( OR 2.25 , P = 0.022 ) but not in the TAPP group . No other risk factor for late discomfort was found . Conclusion There was no difference between late discomfort at five-year follow-up after laparoscopic TAPP and Shouldice repair .  Discomfort was mostly mild and pain during the first postoperative week was a prognostic variable for late discomfort in Shouldice patients UNLABELLED By Evidence Based Medicine ( EBM ) principles , several meta-analyses concluded that use of mesh is superior to the non-mesh operations in inguinal hernia surgery . Wound infection is a potential complication of all hernia repairs and deep-seated infection involving an inserted mesh may result in chronic groin sepsis . In the event of incarcerated or strangulated hernias , however ; placement of prosthetic material is presumed to increase that risk of infection . AIM Aim of the study is to compare the outcome of tension-free mesh repair to Bassini technique used to treat strangulated inguinal hernia . PATIENTS AND METHODS In the period from May 2004 to December 2006 , 54 patients were su bmi tted to emergency operation because of strangulated inguinal hernia . The patients were r and omized into two groups ( 27 patients in each group ) . Group A patients underwent open tension-free anterior repair utilizing a monofilament polypropylene mesh according to Lichtenstein " tension-free " technique , whereas group B patients underwent Bassini technique . Mesh hernioplasty was not attempted in patients with preoperative peritonitis , inflammatory hernia and for those in whom bowel resection was perfumed for ischemic necrosis caused by strangulated inguinal hernia and they were excluded from the study . Assessment of the primary outcome included surgical complications and hospital stay and secondary outcome was the recurrence of hernia . RESULTS Postoperative complication rate did not differ significantly between the two groups . Postoperative hospital stay was also significantly longer in group B compared to group A ( 5+/-3.4 days versus 3+/-2.1 days , p<0.01 ) . During the follow-up , ( mean 22+/-6months ) , three patients had recurrence after Bassini operation ( group B ) , but there was no recurrent hernia after mesh herniorrhaphy ( group A ) ( 0/27=0 % versus 3/27=7 , 11.1 % , p<0.001 ) . CONCLUSION The use of Lichtenstein " tension-free " technique in emergency treatment of strangulated 
    Output:
    
Mesh and non-mesh repairs are effective surgical approaches in treating hernias , each demonstrating benefits in different areas .
Compared to non-mesh repairs , mesh repairs probably reduce the rate of hernia recurrence , and reduce visceral or neurovascular injuries , making mesh repair a common repair approach .
Mesh repairs may result in a reduced length of hospital stay and time to return to activities of daily living , but these results are uncertain due to variation in the results of the studies .