human
***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: Endoscopic techniques are commonly used for many different types of surgery . It is cl aim ed that videoendoscopic procedures have the advantage of being less traumatic and of offering higher postoperative patient comfort than conventional open techniques . The extent of tissue trauma can be evaluated on the basis of the inflammatory response observed in the wake of surgery . Available studies that have compared endoscopic and conventional techniques suggest that endoscopic cholecystectomy , laparoscopic colorectal resection , and thoracoscopic pulmonary resection have immunologic advantages over conventional approaches . The objective of this prospect i ve study was to determine whether endoscopic hernia repair techniques are also preferable to conventional procedures and to what extent the anesthetic technique ( local or general anesthesia ) influences the postoperative inflammatory response . For this purpose , biochemical monitoring of cytokine activity [ C-reactive protein ( CRP ) , prostagl and in F1α ( PGF1α ) , neopterin , interleukin-6 ( IL-6 ) ] was done prospect ively in 101 patients [ totally extraperitoneal approach ( TEP ) n=32 , unilateral n=12 , bilateral n=20 ; Shouldice n=69 , local anesthesia ( LA ) n=23 , general anesthesia ( GA ) n=46 ] before and until 3 days after surgery . The parameters IL-6 and PGF1α suggested that the immune trauma immediately after surgery was significantly higher in the group of patients with endoscopic hernia repair than in the group of patients who received a Shouldice repair . No significant differences were observed after the first postoperative day . A comparison between the TEP group and the patients who received conventional surgery under local anesthesia showed that the TEP approach was also associated with a higher postoperative neopterin level . Within the first 3 days after surgical intervention , bilateral endoscopic hernia repair induced no significantly higher inflammatory response than the surgical treatment of unilateral conditions . The anesthetic procedure that was used in the Shouldice operation had no significant effect on inflammatory response . Unlike other types of endoscopic surgery , the repair of groin hernias using an endoscopic technique can not be regarded as a minimally invasive procedure that is less traumatic than conventional approaches . Instead , the conventional Shouldice procedure appears to cause the lowest inflammatory response and to be the least traumatic approach to hernia repair , especially when it is performed under local anesthesia BACKGROUND The purpose of this study was to evaluate the involvement of inflammatory mediators in patients undergoing Lichtenstein tension-free hernioplasty ( LH ) using polypropylene prosthetic material s or conventional Bassini hernia repair ( BH ) .  METHODS Thirty patients male with unilateral inguinal hernia without complications or recurrence were included in this study . R and omly , patients underwent LH or BH .  Peripheral venous bloods sample s were collected 24 hours prior to surgery and then 6 , 24 , 48 and 168 hours postoperatively . RESULTS We present evidence s that LH patients showed a higher increased serum level of fibrinogen , C-reactive protein , alpha-1-antitrypsin , and interleukin-6 than BH patients . Postoperative visual analogue scales for pain were reduced on mobilization for patients undergoing LH compared with BH . Neutrophils were significantly increased only in LH compared with baseline . Ceruloplasmin , transferrin , and albumin levels were unmodified after BH or LH . CONCLUSIONS In conclusion our data show that although LH induces less pain and more rapid postoperative recovery , it is associated with an higher inflammatory response compared with BH , likely due to polypropylene mesh Objective : The objective of this study was to determine the best treatment of incisional hernia , taking into account recurrence , complications , discomfort , cosmetic result , and patient satisfaction . Background : Long-term results of incisional hernia repair are lacking . Retrospective studies and the midterm results of this study indicate that mesh repair is superior to suture repair . However , many surgeons are still performing suture repair . Methods : Between 1992 and 1998 , a multicenter trial was performed , in which 181 eligible patients with a primary or first-time recurrent midline incisional hernia were r and omly assigned to suture or mesh repair .  In 2003 , follow-up was up date d. Results : Median follow-up was 75 months for suture repair and 81 months for mesh repair patients . The 10-year cumulative rate of recurrence was 63 % for suture repair and 32 % for mesh repair ( P < 0.001 ) . Abdominal aneurysm ( P = 0.01 ) and wound infection ( P = 0.02 ) were identified as independent risk factors for recurrence . In patients with small incisional hernias , the recurrence rates were 67 % after suture repair and 17 % after mesh repair ( P = 0.003 ) . One hundred twenty-six patients completed long-term follow-up ( median follow-up 98 months ) . In the mesh repair group , 17 % suffered a complication , compared with 8 % in the suture repair group ( P = 0.17 ) . Abdominal pain was more frequent in suture repair patients ( P = 0.01 ) , but there was no difference in scar pain , cosmetic result , and patient satisfaction . Conclusions : Mesh repair results in a lower recurrence rate and less abdominal pain and does not result in more complications than suture repair . Suture repair of incisional hernia should be ab and oned Background Kugel repair , a minimally invasive technique , has become an alternative to laparoscopic groin hernia repair , but the technique has not been adequately evaluated by assessment of objective parameters . A prospect i ve r and omized clinical study was carried out to compare the systemic inflammatory response to surgical trauma and clinical outcomes in patients who underwent groin hernia repair by the Kugel and totally extraperitoneal ( TEP ) laparoscopic methods . Methods Forty consecutive patients admitted for unilateral groin hernia were r and omized to Kugel ( n = 20 ) or TEP ( n = 20 ) repair under general anesthesia .  Operation time , length of hospital stay , pain severity , time to return to normal activities , cost , and systemic inflammatory and hormone responses to surgical trauma were compared . Results There were no significant between-group differences in duration of operation , length of hospital stay , time to return to normal activities , or mean visual analogue scale ( VAS ) score ( p > 0.05 for each ) . Serum cortisol , high-sensitivity C-reactive protein ( hsCRP ) , and interleukin (IL)-6 concentrations before surgery , and 1 and 24 h after surgery , did not differ significantly in the two groups ( p > 0.05 ) . There were no recurrences or complications during follow-up . Cost per patient was US $ 546 lower in the Kugel group . Conclusion Kugel herniorrhaphy is a minimally invasive technique that offers all the advantages of TEP and is more cost-effective Background In previous comparisons of inflammatory and stress responses to open ( OR ) and laparoscopic ( LR ) hernia repair , all operations were performed under general anesthesia . Since local anesthesia is widely used for OR , a comparison of this approach with LR seemed relevant . Methods Patients with recurrent inguinal hernia were r and omized to OR under local anesthesia ( n = 30 ) or LR under general anesthesia ( n = 31 ) . The magnitude of the surgical trauma was assessed by measuring markers of coagulation ( prothrombin fragment 1 + 2 ) , endothelial activation ( von Willebr and factor ) , inflammation [ leukocytes , interleukin-6 , -8 and -10 , granulocyte macrophage colony-stimulating factor , and C-reactive protein ( CRP ) ] , and endocrine stress ( cortisol ) in blood collected before operation , 4 h postincision , and on postoperative day 2 . Results Leukocyte counts and interleukin-6 and CRP levels increased in both groups , with the CRP increase being significantly greater in the OR group . The other markers did not increase significantly . Conclusion The acute phase response was more pronounced after OR , even when this was done under local anesthesia . Both techniques seemed rather atraumatic Background This study aim ed to compare laparoendoscopic single-site ( LESS ) total extraperitoneal ( TEP ) repair with conventional laparoscopic TEP repair for the treatment of inguinal hernias .  To date , no other studies have compared the LESS and conventional laparoscopic TEP approaches for the treatment of  inguinal hernia  in a prospect i ve r and omized study setting . Methods For this study , 100 patients undergoing inguinal hernia repair were prospect ively r and omized into either the  LESS TEP group or the conventional laparoscopic TEP group . Pre- , intra- , and postoperative factors were recorded . The primary end point was postoperative pain . The patients were interviewed at outpatient clinics at 1 week , 3 months , and 6 months postoperatively . Results The demographic data were comparable between the two groups . The median operative time was longer in the LESS TEP group ( 63.5 min ) than in the conventional TEP group ( 50.5 min ) ( p = 0.001 ) . No conversion was performed in either group . The mean pain score 2 h postoperatively during rest was significantly higher in the conventional TEP group than in the LESS TEP group ( 3.9 vs. 2.6 ; p = 0.02 ) . The postoperative results were comparable between the groups in terms of analgesic requirements , systemic stress responses , complications , and postoperative convalescence . Conclusions The LESS TEP technique is associated with a longer operative time but offers the minor benefit of a reduction in immediate postoperative pain Over the past decade , hernia surgery has undergone a considerable transformation with the use of prosthetic material s. The most used polypropylene meshes induce a rapid acute inflammatory response followed by chronic foreign body reaction . Many factors influence this response such as density , size , physical characteristics , different texture and porosity of each bio material . The aim of this study is to assess whether the implant of monofilament or multifilament meshes , in the inguinal hernioplasty , determine a different inflammatory response .  Thirty-two male patients were included in the study and were r and omly divided into two groups . In the first group ( MO ) inguinal hernioplasty was performed using monofilament polypropylene mesh , while in the second one ( MU ) multifilament prosthesis was used . Peripheral venous blood sample s were collected 24 hours before surgery and then 6,24,48 and 168 hours posto-peratively . Modifications in leukocyte count , C-reactive protein ( CRP ) , alpha-1 antitrypsin ( α1-AT ) , interleukin (IL)-1 , IL-6 , IL-1 ra and IL-10 serum levels were recorded at all sampling times . We present evidence that serum levels of CRP , ( α1-AT ) , leukocytes and cytokines were significantly increased post-operatively in both groups , returning to basal values 168 hours afterwards . In particular , the production of all pro-inflammatory mediators was higher in the MU group , whereas the anti-inflammatory cytokine ( IL-10 , IL-1ra ) production was higher in MO patients . Our results indicate that polypropylene multifilament mesh allows a higher intense acute inflammatory response as compared to monofilament mesh implantation The aim of the study was to analyze the acute inflammatory response after implantation of a heavyweight mesh of polypropylene ( PP ) compared with a composite mesh of light PP and polyglactin 910 ( PG ) in patients undergoing inguinal hernioplasty . A total of 30 male patients with inguinal hernia were included in the study and divided into 2 groups ( PP and PP-PG ) according to the mesh used . Changes of leukocytes , cytokines , growth factors , and acute phase proteins were evaluated in the sera . Leukocytes and acute phase proteins were significantly increased postoperatively in both groups , and the values were slightly higher in the PP group . Cytokine levels were significantly increased postoperatively in both groups ; a slight increase was observed in the PP-PG group , especially for the proinflammatory cytokine . Growth factors decreased significantly in both groups immediately after surgery . The authors found that the use of the mesh is a stimulator of inflammatory response , and the 2 types of mesh induce a similar inflammatory response Background Angiogenesis is strongly influenced by vascular endothelial growth factor ( VEGF ) and basic fibroblast growth factor ( b-FGF ) , whose production is also regulated by interferon (IFN)-γ and interleukin (IL)-10 . The aim of this study was to evaluate the modifications of serum VEGF , b-FGF , IFN-γ and IL-10 levels in patients with inguinal hernia undergoing hernioplasty with the Lichtenstein technique ( LH ) using polypropylene mesh or with Bassini open conventional inguinal hernia repair ( BH ) .  Material s and methods R and omly , 16 patients underwent BH , and 16 were treated with the LH technique using polypropylene mesh .  Blood sample s were collected 24 h prior to surgery and then 6 , 24 , 48 and 168 h postoperatively . The serum concentrations of VEGF , b-FGF , IFN-γ and IL-10 were evaluated . Results In BH patients , a peak of VEGF synthesis at 6 h with a normalization of this parameter 24 h after surgery has been observed . In the same subjects , b-F 
    Output:
    
agent
The systemic inflammatory response was normalized before or on the seventh postoperative day .
Conclusions Hernia repair elicits a systemic inflammatory response characterized by an increase in CRP , IL-6 , leukocytes , neutrophils , IL-1 , IL-10 , fibrinogen , and α1-antitrypsin and a decrease in lymphocytes and albumin .
A higher inflammatory response was found after mesh repair compared with non-mesh repair and after open mesh repair compared with laparoscopic mesh repair
***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: Endoscopic techniques are commonly used for many different types of surgery . It is cl aim ed that videoendoscopic procedures have the advantage of being less traumatic and of offering higher postoperative patient comfort than conventional open techniques . The extent of tissue trauma can be evaluated on the basis of the inflammatory response observed in the wake of surgery . Available studies that have compared endoscopic and conventional techniques suggest that endoscopic cholecystectomy , laparoscopic colorectal resection , and thoracoscopic pulmonary resection have immunologic advantages over conventional approaches . The objective of this prospect i ve study was to determine whether endoscopic hernia repair techniques are also preferable to conventional procedures and to what extent the anesthetic technique ( local or general anesthesia ) influences the postoperative inflammatory response . For this purpose , biochemical monitoring of cytokine activity [ C-reactive protein ( CRP ) , prostagl and in F1α ( PGF1α ) , neopterin , interleukin-6 ( IL-6 ) ] was done prospect ively in 101 patients [ totally extraperitoneal approach ( TEP ) n=32 , unilateral n=12 , bilateral n=20 ; Shouldice n=69 , local anesthesia ( LA ) n=23 , general anesthesia ( GA ) n=46 ] before and until 3 days after surgery . The parameters IL-6 and PGF1α suggested that the immune trauma immediately after surgery was significantly higher in the group of patients with endoscopic hernia repair than in the group of patients who received a Shouldice repair . No significant differences were observed after the first postoperative day . A comparison between the TEP group and the patients who received conventional surgery under local anesthesia showed that the TEP approach was also associated with a higher postoperative neopterin level . Within the first 3 days after surgical intervention , bilateral endoscopic hernia repair induced no significantly higher inflammatory response than the surgical treatment of unilateral conditions . The anesthetic procedure that was used in the Shouldice operation had no significant effect on inflammatory response . Unlike other types of endoscopic surgery , the repair of groin hernias using an endoscopic technique can not be regarded as a minimally invasive procedure that is less traumatic than conventional approaches . Instead , the conventional Shouldice procedure appears to cause the lowest inflammatory response and to be the least traumatic approach to hernia repair , especially when it is performed under local anesthesia BACKGROUND The purpose of this study was to evaluate the involvement of inflammatory mediators in patients undergoing Lichtenstein tension-free hernioplasty ( LH ) using polypropylene prosthetic material s or conventional Bassini hernia repair ( BH ) .  METHODS Thirty patients male with unilateral inguinal hernia without complications or recurrence were included in this study . R and omly , patients underwent LH or BH .  Peripheral venous bloods sample s were collected 24 hours prior to surgery and then 6 , 24 , 48 and 168 hours postoperatively . RESULTS We present evidence s that LH patients showed a higher increased serum level of fibrinogen , C-reactive protein , alpha-1-antitrypsin , and interleukin-6 than BH patients . Postoperative visual analogue scales for pain were reduced on mobilization for patients undergoing LH compared with BH . Neutrophils were significantly increased only in LH compared with baseline . Ceruloplasmin , transferrin , and albumin levels were unmodified after BH or LH . CONCLUSIONS In conclusion our data show that although LH induces less pain and more rapid postoperative recovery , it is associated with an higher inflammatory response compared with BH , likely due to polypropylene mesh Objective : The objective of this study was to determine the best treatment of incisional hernia , taking into account recurrence , complications , discomfort , cosmetic result , and patient satisfaction . Background : Long-term results of incisional hernia repair are lacking . Retrospective studies and the midterm results of this study indicate that mesh repair is superior to suture repair . However , many surgeons are still performing suture repair . Methods : Between 1992 and 1998 , a multicenter trial was performed , in which 181 eligible patients with a primary or first-time recurrent midline incisional hernia were r and omly assigned to suture or mesh repair .  In 2003 , follow-up was up date d. Results : Median follow-up was 75 months for suture repair and 81 months for mesh repair patients . The 10-year cumulative rate of recurrence was 63 % for suture repair and 32 % for mesh repair ( P < 0.001 ) . Abdominal aneurysm ( P = 0.01 ) and wound infection ( P = 0.02 ) were identified as independent risk factors for recurrence . In patients with small incisional hernias , the recurrence rates were 67 % after suture repair and 17 % after mesh repair ( P = 0.003 ) . One hundred twenty-six patients completed long-term follow-up ( median follow-up 98 months ) . In the mesh repair group , 17 % suffered a complication , compared with 8 % in the suture repair group ( P = 0.17 ) . Abdominal pain was more frequent in suture repair patients ( P = 0.01 ) , but there was no difference in scar pain , cosmetic result , and patient satisfaction . Conclusions : Mesh repair results in a lower recurrence rate and less abdominal pain and does not result in more complications than suture repair . Suture repair of incisional hernia should be ab and oned Background Kugel repair , a minimally invasive technique , has become an alternative to laparoscopic groin hernia repair , but the technique has not been adequately evaluated by assessment of objective parameters . A prospect i ve r and omized clinical study was carried out to compare the systemic inflammatory response to surgical trauma and clinical outcomes in patients who underwent groin hernia repair by the Kugel and totally extraperitoneal ( TEP ) laparoscopic methods . Methods Forty consecutive patients admitted for unilateral groin hernia were r and omized to Kugel ( n = 20 ) or TEP ( n = 20 ) repair under general anesthesia .  Operation time , length of hospital stay , pain severity , time to return to normal activities , cost , and systemic inflammatory and hormone responses to surgical trauma were compared . Results There were no significant between-group differences in duration of operation , length of hospital stay , time to return to normal activities , or mean visual analogue scale ( VAS ) score ( p > 0.05 for each ) . Serum cortisol , high-sensitivity C-reactive protein ( hsCRP ) , and interleukin (IL)-6 concentrations before surgery , and 1 and 24 h after surgery , did not differ significantly in the two groups ( p > 0.05 ) . There were no recurrences or complications during follow-up . Cost per patient was US $ 546 lower in the Kugel group . Conclusion Kugel herniorrhaphy is a minimally invasive technique that offers all the advantages of TEP and is more cost-effective Background In previous comparisons of inflammatory and stress responses to open ( OR ) and laparoscopic ( LR ) hernia repair , all operations were performed under general anesthesia . Since local anesthesia is widely used for OR , a comparison of this approach with LR seemed relevant . Methods Patients with recurrent inguinal hernia were r and omized to OR under local anesthesia ( n = 30 ) or LR under general anesthesia ( n = 31 ) . The magnitude of the surgical trauma was assessed by measuring markers of coagulation ( prothrombin fragment 1 + 2 ) , endothelial activation ( von Willebr and factor ) , inflammation [ leukocytes , interleukin-6 , -8 and -10 , granulocyte macrophage colony-stimulating factor , and C-reactive protein ( CRP ) ] , and endocrine stress ( cortisol ) in blood collected before operation , 4 h postincision , and on postoperative day 2 . Results Leukocyte counts and interleukin-6 and CRP levels increased in both groups , with the CRP increase being significantly greater in the OR group . The other markers did not increase significantly . Conclusion The acute phase response was more pronounced after OR , even when this was done under local anesthesia . Both techniques seemed rather atraumatic Background This study aim ed to compare laparoendoscopic single-site ( LESS ) total extraperitoneal ( TEP ) repair with conventional laparoscopic TEP repair for the treatment of inguinal hernias .  To date , no other studies have compared the LESS and conventional laparoscopic TEP approaches for the treatment of  inguinal hernia  in a prospect i ve r and omized study setting . Methods For this study , 100 patients undergoing inguinal hernia repair were prospect ively r and omized into either the  LESS TEP group or the conventional laparoscopic TEP group . Pre- , intra- , and postoperative factors were recorded . The primary end point was postoperative pain . The patients were interviewed at outpatient clinics at 1 week , 3 months , and 6 months postoperatively . Results The demographic data were comparable between the two groups . The median operative time was longer in the LESS TEP group ( 63.5 min ) than in the conventional TEP group ( 50.5 min ) ( p = 0.001 ) . No conversion was performed in either group . The mean pain score 2 h postoperatively during rest was significantly higher in the conventional TEP group than in the LESS TEP group ( 3.9 vs. 2.6 ; p = 0.02 ) . The postoperative results were comparable between the groups in terms of analgesic requirements , systemic stress responses , complications , and postoperative convalescence . Conclusions The LESS TEP technique is associated with a longer operative time but offers the minor benefit of a reduction in immediate postoperative pain Over the past decade , hernia surgery has undergone a considerable transformation with the use of prosthetic material s. The most used polypropylene meshes induce a rapid acute inflammatory response followed by chronic foreign body reaction . Many factors influence this response such as density , size , physical characteristics , different texture and porosity of each bio material . The aim of this study is to assess whether the implant of monofilament or multifilament meshes , in the inguinal hernioplasty , determine a different inflammatory response .  Thirty-two male patients were included in the study and were r and omly divided into two groups . In the first group ( MO ) inguinal hernioplasty was performed using monofilament polypropylene mesh , while in the second one ( MU ) multifilament prosthesis was used . Peripheral venous blood sample s were collected 24 hours before surgery and then 6,24,48 and 168 hours posto-peratively . Modifications in leukocyte count , C-reactive protein ( CRP ) , alpha-1 antitrypsin ( α1-AT ) , interleukin (IL)-1 , IL-6 , IL-1 ra and IL-10 serum levels were recorded at all sampling times . We present evidence that serum levels of CRP , ( α1-AT ) , leukocytes and cytokines were significantly increased post-operatively in both groups , returning to basal values 168 hours afterwards . In particular , the production of all pro-inflammatory mediators was higher in the MU group , whereas the anti-inflammatory cytokine ( IL-10 , IL-1ra ) production was higher in MO patients . Our results indicate that polypropylene multifilament mesh allows a higher intense acute inflammatory response as compared to monofilament mesh implantation The aim of the study was to analyze the acute inflammatory response after implantation of a heavyweight mesh of polypropylene ( PP ) compared with a composite mesh of light PP and polyglactin 910 ( PG ) in patients undergoing inguinal hernioplasty . A total of 30 male patients with inguinal hernia were included in the study and divided into 2 groups ( PP and PP-PG ) according to the mesh used . Changes of leukocytes , cytokines , growth factors , and acute phase proteins were evaluated in the sera . Leukocytes and acute phase proteins were significantly increased postoperatively in both groups , and the values were slightly higher in the PP group . Cytokine levels were significantly increased postoperatively in both groups ; a slight increase was observed in the PP-PG group , especially for the proinflammatory cytokine . Growth factors decreased significantly in both groups immediately after surgery . The authors found that the use of the mesh is a stimulator of inflammatory response , and the 2 types of mesh induce a similar inflammatory response Background Angiogenesis is strongly influenced by vascular endothelial growth factor ( VEGF ) and basic fibroblast growth factor ( b-FGF ) , whose production is also regulated by interferon (IFN)-γ and interleukin (IL)-10 . The aim of this study was to evaluate the modifications of serum VEGF , b-FGF , IFN-γ and IL-10 levels in patients with inguinal hernia undergoing hernioplasty with the Lichtenstein technique ( LH ) using polypropylene mesh or with Bassini open conventional inguinal hernia repair ( BH ) .  Material s and methods R and omly , 16 patients underwent BH , and 16 were treated with the LH technique using polypropylene mesh .  Blood sample s were collected 24 h prior to surgery and then 6 , 24 , 48 and 168 h postoperatively . The serum concentrations of VEGF , b-FGF , IFN-γ and IL-10 were evaluated . Results In BH patients , a peak of VEGF synthesis at 6 h with a normalization of this parameter 24 h after surgery has been observed . In the same subjects , b-F 
    Output:
    