Incidence of postoperative complications in transabdominal preperitoneal repair for groin hernia is influenced by poor performance status rather than by old age

Retrospective analysis of transabdominal preperitoneal hernia repair in emergency cases: A cohort study

PURPOSE

This study aimed to evaluate the feasibility, safety, and efficacy of laparoscopic transabdominal preperitoneal hernia repair (TAPP) for inguinal hernias in emergency settings, providing insights from a long-term follow-up.

METHODS

We retrospectively analyzed all patients who underwent emergency TAPP repair in ASST Nord Milano from January 2005 to December 2023. A prospectively collected database of 54 consecutive TAPP hernia repairs was reviewed. The study evaluated the feasibility and safety of TAPP through operative time and the conversion rate. Effectiveness was gauged by recurrence and complication rates as well as acute and chronic pain using the Visual Analog Scale (VAS). Long-term follow-up included assessing recovery to normal activity.

RESULTS

Overall, data from 54 consecutive patients were analyzed. Median age was 72 (IQR = 11), with 21 men and 33 women (38.8% vs. 61.2%). The primary diagnosis was a primary hernia (61.1%), while a recurrent type was identified in 21 patients (38.9%). Femoral hernia was identified in 36 cases (48%). The median operative time was 100 min (IQR = 53 min) with 6 cases of conversion (11.1%). One recurrence (1.85%) was noted and the complication rate was 5.55 %. At a median follow-up of 38 months, there was a low grade of chronic pain (VAS 3) in a patient (1.85%) and one recurrence (1.85%).

CONCLUSION

TAPP is a safe, feasible, and effective option for emergency inguinal hernia repair, exhibiting low complication and recurrence rates on long-term follow-up when performed by surgeons with minimally invasive surgery experience and in selected patients.

Risk Factors for Postoperative Complications in Hernia Repair

Background and objective Hernias of the abdominal wall were prevalent in people of all ages worldwide, with an overall prevalence of 1.7 percent. Recently, laparoscopic and Lichtenstein mesh repairs have become popular as they provide a rapid return to normal activities with low recurrence rates. There is a relatively high risk of complications following hernia repair, such as wound seroma/hematoma, urinary retention, and superficial incisional infection. As for complications that may develop after hernia repair, we discussed risk factors contributing to postoperative complications after hernia repair in this study. Methods This study was a retrospective descriptive study of all patients who underwent hernia repair. The cohort of patients data would be collected from patients using an interview-based questionnaire. The data obtained will be entered into a spreadsheet and analyzed using the Statistical Package for the Social Sciences (SPSS) 23.0 package (IBM Corp., Armonk, NY). Results In the current study, we collected data from 274 patients with hernia. The majority of participants were male (79.9%, n = 219), while (37.7%, n = 100) overweight, and (29.8%, n = 79) obese. Among the participants, (82.8%, n = 227) did not experience any complications, while (17.2%, n = 47) reported complications. The types of complications observed were as follows: seroma formation (2.9%, n = 8), wound infection (5.8%, n = 16), and mesh infection (1.8 %, n = 5). There were no significant associations between gender and the presence of complications. However, a significant association was found between BMI and complications (p < 0.001). Diabetes mellitus also showed a significant association with complications (p = 0.005), with a higher proportion of complications among participants with diabetes. Conclusion In the current study, we found a significant prevalence of postoperative complications with significant risk factors such as obesity and diabetic mellitus. Additional investigation is warranted to validate these correlations and investigate supplementary variables that could potentially contribute to postoperative problems in hernia surgery.

Safety and Feasibility of Laparoscopic Transabdominal Preperitoneal Hernia Repair for Octo- and Nonagenarians

Background: The feasibility of laparoscopic hernia repair in octo- and nonagenarians has not been investigated in detail. The aim of this retrospective study was to evaluate the safety and feasibility of laparoscopic hernia repair in octo- and nonagenarians. Methods: This study included 607 patients who underwent transabdominal preperitoneal laparoscopic hernia repair at our hospital between April 2014 and October 2020. Patients were divided into an over 80 group (112 patients aged 80 years and older) and a control group (495 patients younger than 80 years). The clinical outcomes were compared between the groups. In addition, among patients aged 80 years and older, those who underwent elective laparoscopic hernia repair (laparoscopic group: 111 patients) were compared with patients who underwent elective open hernia repair during the same study period (open group: 79 patients). Results: The number of patients who underwent bilateral hernia repair was significantly larger in the over 80 group (26.7% versus 11.7%, P < .001). The incidence of postoperative complications was not significantly different between the over 80 group and the control group. Compared with open group, the number of patients who underwent bilateral hernia repair was significantly larger in the laparoscopic group (27.0% versus 2.5%, P < .001). The incidence of postoperative complications (2.7% versus 10.1%) and the incidence of readmission (0.9% versus 6.3%) were significantly greater in the open group. Conclusions: Laparoscopic hernia repair in octo- and nonagenarian patients yields safe and noninferior outcomes. Laparoscopic hernia repair in octo- and nonagenarian patients is considered more suitable for detecting and repairing contralateral hernias simultaneously.

Anesthetic management of geriatric patients

The number of elderly patients who frequently access health care services is increasing worldwide. While anesthesiologists are developing the expertise to care for these elderly patients, areas of concern remain. We conducted a comprehensive search of major international databases (PubMed, Embase, and Cochrane) and a Korean database (KoreaMed) to review preoperative considerations, intraoperative management, and postoperative problems when anesthetizing elderly patients. Preoperative preparation of elderly patients included functional assessment to identify preexisting cognitive impairment or cardiopulmonary reserve, depression, frailty, nutrition, polypharmacy, and anticoagulation issues. Intraoperative management included anesthetic mode and pharmacology, monitoring, intravenous fluid or transfusion management, lung-protective ventilation, and prevention of hypothermia. Postoperative checklists included perioperative analgesia, postoperative delirium and cognitive dysfunction, and other complications. A higher level of perioperative care was required for older surgical patients, as multiple chronic diseases often makes them prone to developing postoperative complications, including functional decline and loss of independence. Although the guiding evidence remains poor so far, elderly patients have to be provided optimal perioperative care through close interdisciplinary, interprofessional, and cross-sectional collaboration to minimize unwanted postoperative outcomes. Furthermore, along with adequate anesthetic care, well-planned postoperative care should begin immediately after surgery and extend until discharge.