***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: 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 Background Irritation of inguinal nerves with laparoscopic hernia repair may cause chronic neuralgia and hypoesthesia . Hypoesthesia in particular is generally not assessed objective ly . We objective ly investigated hypoesthesia and chronic pain  after transabdominal preperitoneal inguinal hernia repair ( TAPP ) with titanium spiral tacks ( STs ) compared with tissue adhesive ( TA ) for mesh fixation . Methods Mesh fixation in 80 TAPP procedures was r and omized to fixation with ST ( n = 40 ) or TA ( n = 40 ) . The outcome parameters included hypoesthesia assessed with von Frey monofilaments , early postoperative and chronic pain with the visual analog scale ( VAS ) , morbidity ( surgical-site infection , hematoma/seroma , relapse of hernia , trocar hernia ) , and recovery time to normal activity . Results Median ( range ) follow-up was 38 ( 13–56 ) months . Demographic and baseline parameters were similar in the two groups . Prevalence of hypoesthesia was significantly higher at all postoperative times in the ST group ( 6 weeks : 32 vs. 6 % ; 6 months : 38 vs. 14 % ; 12 months : 34 vs. 13 % ; 13–56 months : 32 vs. 4 % ) . Mean hypoesthesia scores over all time points were significantly higher in the ST group . The percentages of regions with hypoesthesia ( abdominal , inguinal , or genitofemoral ) following all procedures were higher in the ST group after 6 weeks ( 14 vs. 2 % ) , 6 months ( 15 vs. 5 % ) , and 13–56 months ( 22 vs. 4 % ) . The intensity of pain decreased significantly in both groups over time . Conclusions Postoperative hypoesthesia depends on the method of mesh fixation during TAPP and is significantly reduced with TA compared with stapling Background Mesh reinforcement has become the st and ard of care in the open and laparoscopic repair of inguinal hernia .  Chronic pain after inguinal hernia repair is often due to nerve injury by penetrating mesh fixation devices such as staples ( ST ) , tacks , or sutures . In several studies on hernioplasty , atraumatic mesh fixation with fibrin sealant ( FS ) proved to be efficient in terms of fixation strength and elasticity . Unfortunately , most of these studies did not provide a st and ardized follow-up and assessment of the development of chronic pain ( CP ) and the quality of life ( QoL ) . Therefore , a r and omized controlled trial comparing CP and QoL after FS fixation of mesh with ST  in transabdominal preperitoneal hernioplasty ( TAPP ) was performed at our department . The primary end point of our study was to assess the patient outcome by using a visual analog scale ( VAS ) and the short form 36 ( SF-36 ) . The evaluation of recurrence rates was the secondary aim . Methods According to the r and omization , a macroporous mesh ( TiMESH ® ) was fixed in group A ( 44 patients with 54 inguinal hernias ) with FS ( TISSEEL ) or in group B ( 45 patients with 56 inguinal hernias )  with ST ( EMS ® Stapler ) . The observation period was 1 year with regular clinical check ups and assessment of VAS and SF-36 . Results Patient characteristics expressed by BMI , ASA scores , and Schumpelick hernia classification were similar in both treatment groups . In each group there was one recurrence within 8 ( FS ) and 9 months ( ST ) postsurgery . The mean preoperative pain values scored by VAS were 1.7 ( range = 0–7.5 ) in the FS group and 2.2 ( range = 0–6 ) in the ST group . Postoperative mean VAS scores measured at 1 year postsurgery were 0.4 ( range = 0–3 ) in the FS group and 0.9 ( range = 0–7.5 ) in the ST group . One year postsurgery there was no significant difference between the two groups with respect to the parameter pain in the SF-36 and VAS . Conclusion Fibrin sealant fixation leads to a low rate of hernia recurrence and avoids tissue trauma . ST provide similar results in the h and of the expert but bear inherent risks of complications due to tissue perforation Background The laparoscopic repair of groin hernias generally involves mesh fixation to avoid displacement and recurrence . Fixation usually uses staples that can lead to nerve injury and chronic postoperative pain . Laparoscopic repairs are associated with a risk of chronic pain of up to 22.5 % . The use of fibrin glue ( Tisseel ) may represent an alternative method of mesh fixation preventing the risk of nerve injury . Methods Sixty-six patients had groin hernia repair using a totally extraperitoneal ( TEP ) laparoscopic procedure .  Mesh fixation was achieved using 2 ml of fibrin glue . Comparison was made with an earlier series of 102 patients operated on according to the same procedure in which mesh fixation used tack staples . Complications , length of stay , recurrence , and postoperative chronic pain were assessed . Results No difference was found between the two series , except there was a significantly higher rate of postoperative chronic pain in the staples series ( 14.7 vs 4.5 % , p = 0.037 ) and there was one recurrence ( 1.5 % ) in the fibrin glue group of patients . Conclusions Fibrin glue achieved an adequate mesh fixation with a lower incidence of chronic postoperative pain . Although a prospect i ve r and omized study is needed , Tisseel appears to be an alternative to staples for mesh fixation and may help reduce the postoperative pain problems after hernia repair Purpose The use of fibrin sealant ( FS ) ( Tisseel ™ ) for mesh fixation in patients undergoing laparoscopic groin hernia surgery is a well-recognised technique in Europe , but no study to date has examined effect on quality of life ( QoL ) on patients undergoing FS mesh fixation .  A prospect i ve study was therefore conducted to examine the effects on QoL of patients undergoing laparoscopic groin hernia surgery using FS in the United Kingdom . Material s and methods Between March 2007 and January 2011 , all patients undergoing laparoscopic total extra preperitoneal ( TEP ) groin hernia repair using FS were included in the study . A vali date d hernia question naire from The Royal College of Surgeons of Engl and supplemented by the EORTC QLQ C-30 to assess the pre- and postoperative QoL , pain scores and health outcome measures was used . All the patient ’s demographics , duration of surgery , size of hernia , recurrence , morbidity and hospital stay were recorded . Results Data from 92 patients ( 87 males and 5 females ) with a median age of 46 years ( range , 19–82 years ) was collected for the study ( response rate of 92/121 , 73 % ) . A total of 58 patients ( 63 % ) had a unilateral and 34 patients ( 37 % ) a bilateral hernia repair , of which 6 ( 7 % ) were recurrent inguinal hernia . The mean operating time for a unilateral hernia was 36 min ( 30–62 ) , and that for a bilateral hernia was 59 min ( 51–83 ) . There were no conversions to open surgery out of the 92 patients included with the recorded morbidity of 7 % . There were no early recurrences . Eighty-nine patients ( 98 % ) of patients were discharged in the first 24 h after surgery . There was a significant statistical difference recorded in patients visual analogue pain score ( VAS 0–10 ) before and after surgery ( P < 0.0001 , Mann – Whitney U test ) . The physical , emotional , social and health components of the question naire were statistically significant pre- and postoperatively ( P < 0.001 Mann – Whitney U test ) . Conclusion Groin hernia TEP repair with FS fixation did not have a detrimental effect on QoL and pain scores . In addition , the low early recurrence rate provided good evidence of the mesh fixation properties of FS . FS can therefore be continued to be recommended , as an alternative fixation method in laparoscopic groin hernia surgery Introduction Chronic pain after  hernia repair  is common , and it is unclear to what extent the different operation techniques influence its incidence . The aim of the present study was to compare the three major st and ardized techniques of hernia repair with regard to postoperative pain . Patients and methods Two hundred and eighty male patients with primary hernias were prospect ively , r and omly selected to undergo Shouldice , tension-free Lichtenstein or laparoscopic transabdominal pre-peritoneal ( TAPP ) hernioplasty repairs .  Patients were examined after 52 months with emphasis on chronic pain and its limitations to their quality of life . Results Chronic pain was present in 36 % of patients after Shouldice repair , in 31 % after Lichtenstein repair and in 15 % after TAPP repair . Pain correlated with physical strain in 25 % of patients after Shouldice , in 20 % after Lichtenstein and in 11 % after TAPP repair . Limitations to daily life , leisure activities and sports occurred in 14 % of patients after Shouldice , 13 % after Lichtenstein and 2.4 % after TAPP repair . Conclusion Chronic pain after hernia surgery is significantly more common with the open approach to the groin by Shouldice and Lichtenstein methods . The presence of the prosthetic mesh was not associated with significant postoperative complaints . The TAPP repair represents the most effective approach of the three techniques in the h and s of an experienced surgeon BACKGROUND The use of fibrin for mesh fixation in laparascopic hernioplasty has theoretical advantages in that it could result in reducing postoperative pain . The objective of this study is to demonstrate this improvement in postoperative pain with the highest level of evidence possible . METHODS Unicenter single surgeon prospect i ve r and omized double-blind study of transabdominal preperitoneal ( TAPP ) bilateral hernioplasties  comparing autologous fibrin sealant ( FG ) used for mesh fixation on one side and staples ( SG ) on the other . Data were collected regarding anthropometric measures , costs , complications and pain evaluation at postoperative days 7 , 30 and 180 using a visual analogue scale . The patients were also asked to answer the following simple question : " On which side do you have more pain ? " RESULTS Twenty-two eligible patients were included in the study . Both groups were comparable . The operating time was significantly longer ( 30 min more ) in the FG . The incidence of seroma was similar in both groups , and that of hematoma was higher in the SG ( 0 vs. 9.1 % ) . At 1 week , the visual analogue scale scores were significantly lower in the FG ( median : 1.7 vs. 4.5 ; MWU:103.5 , p < 0.05 ) . At 1 month , this difference became clinical and statistically insignificant . 72.7 % of the patients referred more pain on the side with staples at 1 week , 38 % at 1 month , and 0 % at 6 months ( after patients with hernia recurrence were excluded ) . The recurrence rate was higher in the FG ( 9.9 vs. 13.6 % ) . A hernia in the FG cost 200 Euros more than that 
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There were also no differences found in meta- analysis of seroma and hematoma formation between the two methods of fixation .
Conclusions Meta- analysis of RCTs comparing TG with tack fixation in laparoscopic inguinal hernia surgery depicts a significant reduction in chronic pain with no increase in recurrence rates .