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Rodrigues-Gonçalves V, Verdaguer M, Bravo-Salva A, Moratal M, Blanco R, Ochoa-Segarra F, Pereira-Rodríguez JA, López-Cano M. Open preperitoneal vs. open anterior repair for the treatment of emergency femoral hernia: a bicentric retrospective study. Hernia 2023; 27:127-138. [PMID: 36083415 DOI: 10.1007/s10029-022-02673-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/30/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE The aim of this study is to compare the postoperative results, in terms of complications and recurrence, between the anterior and open preperitoneal approaches in emergency femoral hernia. METHODS This bi-centric retrospective cohort study included patients who underwent emergency femoral hernia repair between January 2010 and December 2018. Postoperative complications and recurrence were analyzed comparing anterior and open preperitoneal approaches. The predictors of complications, mortality and recurrence were investigated using multivariate logistic regression. RESULTS A total of 204 patients met the inclusion criteria. Open anterior approach was performed in 128 (62.7%) patients and open preperitoneal was performed in 76 (37.3%). Open preperitoneal approach was associated with lower rates of recurrence (P = 0.033) and associated midline laparotomies (P = 0.006). Multivariable analysis identified patients with chronic nephropathy (OR, 3.801; 95%CI, 1.034-13.974; P = 0.044), preoperative bowel obstruction (OR, 2.376; 95%CI, 1.118-5.047; P = 0.024) and required midline laparotomy (OR, 12.467; 95%CI, 11.392-102.372; P = 0.030) as risk factors for complications and ASA ≥ III (OR, 7.820; 95%CI, 1.279-47.804; P = 0.026), COPD (OR, 5.064; 95%CI, 1.188-21.585; P = 0.028), necrotic contents (OR, 36.968; 95%CI, 4.640-294.543; P = 0.001), and required midline laparotomy (OR, 11.047; 95%CI, 1.943-62.809; P = 0.007). as risk factors for 90-day mortality. Male gender (OR, 4.718; 95%CI, 1.668-13.347; P = 0.003) and anterior approach (OR, 5.292; 95%CI, 1.114-25.149; P = 0.036) were risk factors for recurrence. CONCLUSION Open preperitoneal approach may be superior to anterior approach in the emergency setting because it can avoid the morbidity of associated midline laparotomies, with a lower long-term recurrence rate.
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Affiliation(s)
- V Rodrigues-Gonçalves
- General Surgery Department, Abdominal Wall Surgery Unit, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Paseo Vall d`Hebron 119-129, 08035, Barcelona, Spain.
| | - M Verdaguer
- General Surgery Department, Abdominal Wall Surgery Unit, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Paseo Vall d`Hebron 119-129, 08035, Barcelona, Spain
| | - A Bravo-Salva
- Servei de Cirurgia General, Hospital del Mar, Parc de Salut Mar, Department de Ciències, Experimentals I de La Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - M Moratal
- General Surgery Department, Abdominal Wall Surgery Unit, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Paseo Vall d`Hebron 119-129, 08035, Barcelona, Spain
| | - R Blanco
- General Surgery Department, Abdominal Wall Surgery Unit, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Paseo Vall d`Hebron 119-129, 08035, Barcelona, Spain
| | - F Ochoa-Segarra
- Servei de Cirurgia General, Hospital del Mar, Parc de Salut Mar, Department de Ciències, Experimentals I de La Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - J A Pereira-Rodríguez
- Servei de Cirurgia General, Hospital del Mar, Parc de Salut Mar, Department de Ciències, Experimentals I de La Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - M López-Cano
- General Surgery Department, Abdominal Wall Surgery Unit, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Paseo Vall d`Hebron 119-129, 08035, Barcelona, Spain
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2
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Rodrigues-Gonçalves V, Verdaguer M, Moratal M, Blanco R, Bravo-Salva A, Pereira-Rodíguez JA, López-Cano M. Open Emergent Groin Hernia Repair: Anterior or Posterior Approach? JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2022; 1:10586. [PMID: 38314156 PMCID: PMC10831659 DOI: 10.3389/jaws.2022.10586] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/23/2022] [Indexed: 02/06/2024]
Abstract
Introduction: The current literature has not yet provided a definitive conclusion on the best emergency groin hernia repair. The aim of this study was first to compare the short and long-term outcomes between open preperitoneal and anterior approach in emergency groin hernia repair and second to identify risk factors for postoperative complications, mortality, and recurrence. Materials and Methods: This retrospective cohort study included patients who underwent emergency groin hernia repair between January 2010 and December 2018. Short and long-term outcomes were analyzed comparing approach and repair techniques. The predictors of complications and mortality were investigated using multivariate logistic regression. Cox regression multivariate analysis were used to explore risk factors of recurrence. Results: A total of 316 patients met the inclusion criteria. The most widely used surgical techniques were open preperitoneal mesh repair (34%) and mesh plug (34%), followed by Lichtenstein (19%), plug and patch (7%) and tissue repair (6%). Open preperitoneal mesh repair was associated with lower rates of recurrence (p = 0.02) and associated laparotomies (p < 0.001). Complication and 90-day mortality rate was similar between the techniques. Multivariable analysis identified patients aged 75 years or older (OR, 2.08; 95% CI, 1.14-3.80; p = 0.016) and preoperative bowel obstruction (OR, 2.11; 95% CI, 1.20-3.70; p = 0.010) as risk factors for complications and Comprehensive Complication Index ≥26.2 as risk factor for 90-day mortality (OR, 44.76; 95% CI, 4.51-444.59; p = 0.01). Female gender was the only risk factor for recurrence. Conclusion: Open preperitoneal mesh repair may be superior to other techniques in the emergency setting, because it can avoid the morbidity of associated laparotomies, with a lower long-term recurrence rate.
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Affiliation(s)
- V. Rodrigues-Gonçalves
- Abdominal Wall Surgery Unit, General Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - M. Verdaguer
- Abdominal Wall Surgery Unit, General Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - M. Moratal
- Abdominal Wall Surgery Unit, General Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - R. Blanco
- Abdominal Wall Surgery Unit, General Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - A. Bravo-Salva
- General Surgery, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Department de Ciéncies Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - J. A. Pereira-Rodíguez
- General Surgery, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Department de Ciéncies Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - M. López-Cano
- Abdominal Wall Surgery Unit, General Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
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3
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Pavithira GJ, Dutta S, Sundaramurthi S, Nelamangala Ramakrishnaiah VP. Outcomes of Emergency Abdominal Wall Hernia Repair: Experience Over a Decade. Cureus 2022; 14:e26324. [PMID: 35911260 PMCID: PMC9311230 DOI: 10.7759/cureus.26324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 11/30/2022] Open
Abstract
Background Abdominal wall hernias are a common surgical entity encountered by the general surgeon. Approximately 10% of abdominal wall hernia patients require emergency surgery. However, these surgeries are associated with a high rate of postoperative morbidity and mortality. This study aimed to analyze the morbidity and mortality in patients undergoing emergency abdominal wall hernia repair and to determine the factors associated with surgical site infection (SSI) and recurrence in these patients attending a tertiary care hospital in south India. Methodology Our study was a single-centered, 10-year retrospective and a one-year prospective study conducted in a tertiary care center in India. All patients who underwent emergency abdominal wall hernia repair between April 2009 and May 2020 were included. Patients' demographic details, comorbidities, intraoperative findings, 30-day surgical outcomes including SSI, and recurrence were studied. Results Out of 383 patients in our study, 63.9% had an inguinal hernia, and 54% of the patients underwent tissue repair. SSI was the most common morbidity (21.9%). Postoperative sepsis was the only independent factor associated with perioperative mortality according to the logistic regression analysis (odds ratio = 22.73, p = 0.022). Conclusions Tissue repair for emergency hernia surgery has better outcomes than mesh repair in clean-contaminated cases.
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Affiliation(s)
- G J Pavithira
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Souradeep Dutta
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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4
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Bouliaris K, Efthimiou M, Chatzikomnitsa P, Kolla C, Doudakmanis C, Zervas K, Giaglaras A, Koukoulis GD. Manual Reduction of Incarcerated Abdominal Wall Hernias. A Feasible Option during COVID-19 Pandemic: A Prospective Study. Surg J (N Y) 2022; 8:e46-e51. [PMID: 35128053 PMCID: PMC8807094 DOI: 10.1055/s-0041-1742178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 12/07/2021] [Indexed: 12/05/2022] Open
Abstract
Background
Incarcerated hernia is a common surgical emergency with considerable morbidity or even mortality. Manual reduction (taxis) and elective surgery could be an alternative management approach. This study examines the role of taxis with the adjuvant use of the visual analogue scale (VAS) score in treating incarcerated hernias and thereby decreasing the emergency surgery rate, especially during the novel coronavirus disease 2019 (COVID-19) pandemic.
Methods
All adult patients admitted to the emergency department of our hospital with incarcerated hernias of anterior abdominal wall were prospectively submitted to hernia manual reduction. The VAS score was used as an adjuvant tool for monitoring the success of this maneuver. Patients with successful taxis and low VAS score were hospitalized for a 24-hour period of observation. On their discharge, they were scheduled for an elective hernia repair. Patients with unsuccessful taxis or with less than a 50% reduction in VAS score after successful taxis were submitted to emergency surgical repair. Age, sex, type of hernias, time until taxis, VAS scores before and after taxis, length of hospital stay, and adverse events for both groups were recorded.
Results
Between September 2018 and September 2020, 86 patients with incarcerated hernias were included. The types of hernias were incisional in 8 patients, umbilical in 15 patients, inguinal in 56 patients, and femoral in 7 patients. Taxis was successful in 66% of patients with a mean reduction in VAS score from 83 to 17 mm. Following successful taxis, patients were hospitalized for a 24-hour period of observation. No taxis-related complications were observed. Fifty-two patients were safely discharged from hospital and scheduled for an elective repair during the first month. Thirty-four patients were operated emergently. Five patients had successful taxis but with a reduction of posttaxis VAS score less than 50% (a mean reduction from 86 to 62 mm), while taxis failed in twenty-nine patients. Patients with emergency surgery had longer time until reduction and longer stay of hospitalization. In this group, two patients required admission to the intensive care unit while one patient died.
Conclusion
In this protocolized approach, taxis is a safe and feasible option for most patients with incarcerated hernias. It should be kept in our armament, especially in times when emergency surgery capabilities are under strain like the ongoing COVID-19 pandemic.
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Affiliation(s)
| | | | | | - Christina Kolla
- Department of General Surgery, General Hospital of Larissa, Larissa, Greece
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5
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Pereira-Rodriguez JA, Bravo-Salva A, Montcusí-Ventura B, Hernández-Granados P, Rodrigues-Gonçalves V, López-Cano M. Early outcomes of component separation techniques: an analysis of the Spanish registry of incisional Hernia (EVEREG). Hernia 2021; 25:1573-1580. [PMID: 34213681 PMCID: PMC8613122 DOI: 10.1007/s10029-021-02449-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/21/2021] [Indexed: 11/25/2022]
Abstract
AIM To analyze the outcomes of component separation techniques (CST) to treat incisional hernias (IH) in a large multicenter cohort of patients. METHODS All IH repair using CST, registered in EVEREG from July 2012 to December 2019, were included. Data on the pre-operative patient characteristics and comorbidities, IH characteristics, surgical technique, complications, and recurrence were collected. Outcomes between anterior (ACS) and posterior component separation (PCS) techniques were compared. Risk factors for complications and recurrences were analyzed. RESULTS During the study period, 1536 patients underwent CST (45.5% females) with a median age of 64.0 years and median body mass index (BMI) of 29.7 kg/m2. ACS was the most common technique (77.7%). Overall complications were frequent in both ACS and PCS techniques (36.5%), with a higher frequency of wound infection (10.6% vs. 7.0%; P = 0.05) and skin necrosis (4.4% vs. 0.1%; P < 0.0001) with the ACS technique. Main factors leading to major complications were mesh explant (OR 1.72; P = 0.001), previous repair (OR 0.75; P = 0.038), morbid obesity (OR 0.67; P = 0.015), ASA grade (OR 0.62; P < 0.0001), COPD (OR 0.52; P < 0.0001), and longitudinal diameter larger than 10 cm (OR 0.58; P = 0.001). After a minimum follow-up of 6 months (median 15 months; N = 590), 59 (10.0%) recurrences were diagnosed. Operations performed in a non-specialized unit were significantly associated with recurrences (HR 4.903, CI 1.64-14.65; P = 0.004). CONCLUSION CST is a complex procedure with a high rate of complications. Both ACS and PCS techniques have similar complication and recurrence rates. Operations performed in a specialized unit have better outcomes.
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Affiliation(s)
- J A Pereira-Rodriguez
- Department of Surgery, Hospital del Mar - Parc de Salut Mar, Passeig Maritim 25-29, 08003, Barcelona, Spain. .,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
| | - A Bravo-Salva
- Department of Surgery, Hospital del Mar - Parc de Salut Mar, Passeig Maritim 25-29, 08003, Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - B Montcusí-Ventura
- Department of Surgery, Hospital del Mar - Parc de Salut Mar, Passeig Maritim 25-29, 08003, Barcelona, Spain
| | | | | | - M López-Cano
- Abdominal Wall Surgery Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
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6
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Surek A, Gemici E, Ferahman S, Karli M, Bozkurt MA, Dural AC, Donmez T, Karabulut M, Alis H. Emergency surgery of the abdominal wall hernias: risk factors that increase morbidity and mortality-a single-center experience. Hernia 2020; 25:679-688. [PMID: 32914294 DOI: 10.1007/s10029-020-02293-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/27/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Morbidity and mortality are higher in urgently operated abdominal hernia cases compared to elective surgeries. The present study aims to investigate the factors that cause increased morbidity and mortality in emergency surgical operations. METHODS The files of a total of 426 patients who were operated for non-reducible abdominal hernia between 2015 and 2020 were reviewed retrospectively. Patients' ages, genders, comorbidities, Charlson Comorbidity Index (CCI), ASA score, BMI, hernia types, duration of symptom, laboratory values, intestinal strangulations or necroses, whether intestinal resection was performed, whether mesh was preferred for hernia repair, and rates of morbidity and mortality were recorded. Factors affecting morbidity and mortality rates were analyzed. RESULTS Factors such as gender, BMI (> 30), duration of symptom (> 24 h), presence of bowel necrosis and resection, type of hernia and prolonged operation time were found to cause an increase in morbidity. In the multivariate analysis, however, gender, duration of symptom and BMI (> 30) were statistically significant factors causing increased morbidity (p = 0.009, p < 0.001, p = 0.032, respectively). Advanced age, high ASA scores, CCI and duration of symptom were determined as factors affecting the increase in mortality. In the multivariate analysis, the effect of high ASA scores and advanced age on high mortality rate was statistically significant (p < 0.023, p = 0.039, respectively). CONCLUSIONS The mortality rate is higher, especially in elderly patients with high comorbidity. Therefore, we argue that the cases of abdominal wall hernia should be operated under elective conditions even if they do not give any clinical findings to prevent problems in older ages.
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Affiliation(s)
- A Surek
- Department of General Surgery, Ministry of Health Bakırkoy Dr Sadi Konuk Training and Research Hospital, Building A, Floor 4, Tevfik Saglam Street. Nr: 11, Bakirkoy, 34147, İstanbul, Turkey.
| | - E Gemici
- Department of General Surgery, Ministry of Health Bakırkoy Dr Sadi Konuk Training and Research Hospital, Building A, Floor 4, Tevfik Saglam Street. Nr: 11, Bakirkoy, 34147, İstanbul, Turkey
| | - S Ferahman
- Department of General Surgery, Ministry of Health Bakırkoy Dr Sadi Konuk Training and Research Hospital, Building A, Floor 4, Tevfik Saglam Street. Nr: 11, Bakirkoy, 34147, İstanbul, Turkey
| | - M Karli
- Department of General Surgery, Ministry of Health Bakırkoy Dr Sadi Konuk Training and Research Hospital, Building A, Floor 4, Tevfik Saglam Street. Nr: 11, Bakirkoy, 34147, İstanbul, Turkey
| | - M A Bozkurt
- Department of General Surgery, Ministry of Health Bakırkoy Dr Sadi Konuk Training and Research Hospital, Building A, Floor 4, Tevfik Saglam Street. Nr: 11, Bakirkoy, 34147, İstanbul, Turkey
| | - A C Dural
- Department of General Surgery, Ministry of Health Bakırkoy Dr Sadi Konuk Training and Research Hospital, Building A, Floor 4, Tevfik Saglam Street. Nr: 11, Bakirkoy, 34147, İstanbul, Turkey
| | - T Donmez
- Department of General Surgery, Ministry of Health Bakırkoy Dr Sadi Konuk Training and Research Hospital, Building A, Floor 4, Tevfik Saglam Street. Nr: 11, Bakirkoy, 34147, İstanbul, Turkey
| | - M Karabulut
- Department of General Surgery, Ministry of Health Bakırkoy Dr Sadi Konuk Training and Research Hospital, Building A, Floor 4, Tevfik Saglam Street. Nr: 11, Bakirkoy, 34147, İstanbul, Turkey
| | - H Alis
- Department of General Surgery, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey
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Huckaby LV, Dadashzadeh ER, Handzel R, Kacin A, Rosengart MR, van der Windt DJ. Improved Understanding of Acute Incisional Hernia Incarceration: Implications for Addressing the Excess Mortality of Emergent Repair. J Am Coll Surg 2020; 231:536-545.e4. [PMID: 32822886 DOI: 10.1016/j.jamcollsurg.2020.08.735] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Incisional hernia develops in up to 20% of patients undergoing abdominal operations. We sought to identify characteristics associated with poor outcomes after acute incisional hernia incarceration. STUDY DESIGN We performed a retrospective cohort study of adult patients with incisional hernias undergoing elective repair or with acute incarceration between 2010 and 2017. The primary end point was 30-day mortality. Logistic regression was used to determine adjusted odds associated with 30-day mortality. The American College of Surgeons Surgical Risk Calculator was used to estimate outcomes had these patients undergone elective repair. RESULTS A total of 483 patients experienced acute incarceration; 30-day mortality was 9.52%. Increasing age (adjusted odds ratio 1.05; 95% CI, 1.02 to 1.08) and bowel resection (adjusted odds ratio 3.18; 95% CI, 1.45 to 6.95) were associated with mortality. Among those with acute incarceration, 231 patients (47.9%) had no documentation of an earlier surgical evaluation and 252 (52.2%) had been evaluated but had not undergone elective repair. Among patients 80 years and older, 30-day mortality after emergent repair was high (22.9%) compared with estimated 30-day mortality for elective repair (0.73%), based on the American College of Surgeons Surgical Risk Calculator. Estimated mortality was comparable with observed elective repair mortality (0.82%) in an age-matched cohort. Similar mortality trends were noted for patients younger than 60 years and aged 60 to 79 years. CONCLUSIONS Comparison of predicted elective repair and observed emergent repair mortality in patients with acute incarceration suggests that acceptable outcomes could have been achieved with elective repair. Almost one-half of acute incarceration patients had no earlier surgical evaluation, therefore, targeted interventions to address surgical referral can potentially result in fewer incarceration-related deaths.
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Affiliation(s)
| | - Esmaeel Reza Dadashzadeh
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA; Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA
| | - Robert Handzel
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA; Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA
| | - Alexa Kacin
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Matthew R Rosengart
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA; Pittsburgh Surgical Outcomes Research Center, University of Pittsburgh, Pittsburgh, PA
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8
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Timm B, O'Connor E, Bolton D, Liodakis P. Are we failing to consent to an increasingly common complication? Incisional hernias at robotic prostatectomy. J Robot Surg 2020; 14:861-864. [PMID: 32152901 DOI: 10.1007/s11701-020-01063-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/03/2020] [Indexed: 11/29/2022]
Abstract
The use of robot-assisted laparoscopic radical prostatectomy (RALP) continues to increase in the management of prostate cancer by minimally invasive approach, with shorter convalescence, reduced blood transfusion and improving oncological outcomes when compared to open surgery. There is a growing evidence base that RALP is significantly associated with incisional hernia (IH) at the specimen extraction site compared to open surgery. A series of 186 RALP patients between August 2012 and August 2018 was reviewed, where 1-7 years follow-up had been observed. The study endpoint was IH rate at the supraumbilical specimen extraction site utilized by the surgeon. Incisional hernia rate at specimen extraction site was 8.6% and incidental 1.1% IH rate at a lateral port site (not associated with specimen removal). Average age at operation was 60.9 years old and hernias were diagnosed at a mean of 11.8 months post-surgery. Common demographics in the population suffering from IH were previous abdominal surgery, adhesiolysis, history of smoking and obesity. Supraumbilical extraction site hernias are an underreported complication of RALP which may impact on quality of life and prompt further surgical correction. Patients should be asked for consent regarding the possibility of this complication ensuing.
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Affiliation(s)
- Brennan Timm
- Department of Urology, Austin Health, Heidelberg, VIC, Australia. .,North Eastern Urology, Heidelberg, VIC, Australia.
| | - Ellen O'Connor
- Department of Urology, Austin Health, Heidelberg, VIC, Australia
| | - Damien Bolton
- Department of Urology, Austin Health, Heidelberg, VIC, Australia
| | - Peter Liodakis
- Department of Urology, Austin Health, Heidelberg, VIC, Australia.,North Eastern Urology, Heidelberg, VIC, Australia
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9
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Glauser P, Pina-Vaz J, Hoffmann H, Kirchhoff P, Staerkle R, und Torney MS. Inguinal and femoral hernia repair in octogenarians and nonagenarians – A population-based analysis. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2020. [DOI: 10.4103/ijawhs.ijawhs_31_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Pereira JA, Montcusí B, López-Cano M, Hernández-Granados P, Fresno de Prado L. Risk factors for bad outcomes in incisional hernia repair: Lessons learned from the National Registry of Incisional Hernia (EVEREG). Cir Esp 2018; 96:436-442. [PMID: 29754694 DOI: 10.1016/j.ciresp.2018.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/15/2018] [Accepted: 03/24/2018] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Registries are powerful tools for identifying factors predicting bad results. Our objective was to analyse data from the Spanish Registry of Incisional Hernia (EVEREG) to detect risk situations for the development of complications and recurrences. METHODS We have analysed data of the cohort of hernias registered during the period from July 2012 to June 2014. We have compared the data between complicated and non-complicated patients in the short and long term follow-up. Data compared were: patient demographics, comorbid condition, hernia defect characteristics and surgical technique to determine which of them may be predictors of poor outcomes. RESULTS During the period of study, we collected data from 1,336 hernias (43.7% males; 56.3% females) with a mean age of 63.6 years (SD 12.4) and BMI of 30.4 (SD 5.4). In the multivariate analysis, factors associated with complications were: age >70 years, previous neoplasm, diameter greater than 10cm, previous repair and bowel resection. Factors related with recurrences were: parastomal hernia, previous repair, emergency repair, postoperative complications and reoperation. A separation of components was the only protective factor for this type of analysis (OR 0.438; CI 0.27-0.71; p=0.0001). CONCLUSIONS Risk factors for the development of complications and recurrences must be considered for promoting preoperative patient prehabilitation, planning the surgical technique and referring patients to specialized abdominal wall units.
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Affiliation(s)
- José Antonio Pereira
- Servicio de Cirugía General, Hospital Universitari del Mar, Barcelona, España; Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, España.
| | - Blanca Montcusí
- Servicio de Cirugía General, Hospital Universitari del Mar, Barcelona, España
| | - Manuel López-Cano
- Servicio de Cirugía General, Hospital Vall d'Hebron, Barcelona, España; Departament de Cirurgia, Universitat Autònoma de Barcelona, Barcelona, España
| | | | - Laura Fresno de Prado
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, España
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11
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Pereira JA, López-Cano M, Hernández-Granados P, Feliu X. Resultados iniciales del Registro Español de Hernia Incisional. Cir Esp 2016; 94:595-602. [DOI: 10.1016/j.ciresp.2016.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/05/2016] [Accepted: 09/27/2016] [Indexed: 02/04/2023]
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12
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Impact of obesity on postoperative 30-day outcomes in emergent open ventral hernia repairs. Am J Surg 2016; 212:1068-1075. [DOI: 10.1016/j.amjsurg.2016.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 09/07/2016] [Accepted: 09/10/2016] [Indexed: 11/22/2022]
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Predicting 30-day postoperative mortality for emergent anterior abdominal wall hernia repairs using the American College of Surgeons National Surgical Quality Improvement Program database. Hernia 2016; 21:323-333. [DOI: 10.1007/s10029-016-1538-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 09/08/2016] [Indexed: 11/27/2022]
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Management of strangulated abdominal wall hernias with mesh; early results. North Clin Istanb 2015; 2:26-32. [PMID: 28058336 PMCID: PMC5175047 DOI: 10.14744/nci.2015.03522] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 02/11/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Surgery for abdominal wall hernias is a common procedure in general surgery practice. The main causes of delay for the operation are comorbid problems and patient unwillingness, which eventually, means that some patients are admitted to emergency clinics with strangulated hernias. In this report, patients who admitted to the emergency department with strangulated adominal wall hernias are presented together with their clinical management. METHODS Patients who admitted to our clinic between January 2009 and November 2011 and underwent emergency operation were included in the study retrospectively. Demographic characteristics, hernia type, length of hospital stay, surgical treatment and complications were assessed. RESULTS A total 81 patients (37 female, 44 male) with a mean age of 52.1±17.64 years were included in the study. Inguinal, femoral, umbilical and incisional hernias were detected in 40, 26, 9 and 6 patients respectively. Polypropylene mesh was used in 75 patients for repair. Primary repair without mesh was used in six patients. Small bowel (n=10; 12.34%), omentum (n=19; 23.45%), appendix (n=1; 1.2%) and Meckel's diverticulum (n=1; 1.2%) were resected. Median length of hospital stay was 2 (1-7) days. Surgical site infection was detected in five (6.2%) patients. No significant difference was detected for length of hospital stay and surgical site infection in patients who had mesh repair (p=0.232 and 0.326 respectively). CONCLUSION The need for bowel resection is common in strangulated abdominal wall hernias which undergo emergency operation. In the present study, an increase of morbidity was seen in patients who underwent bowel resection. No morbidity was detected related to the usage of prosthetic materials in repair of hernias. Hence, we believe that prosthetic materials can be used safely in emergency cases.
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Abstract
Reports on the outcomes of emergency and elective femoral hernia surgery are scarce. Most studies do not distinguish femoral hernia from other types of groin hernia; studies of femoral hernia alone are few in number. The main objective of the present study was to identify factors affecting morbidity of femoral hernia patients. We retrospectively analyzed data on 80 patients who underwent femoral hernia surgery between June 2009 and June 2013. Patients who did and did not experience morbidity were compared in terms of age, sex, hernia location, the presence of any comorbid disease, the type of anesthesia employed, the operative technique used, the type of surgical intervention, and performance of small bowel resection. Forty-three patients (53.8%) underwent emergency surgery because of incarceration. Of these, 18 (41.9%) experienced strangulation and underwent resection. Postoperative complications developed in 11 patients (13.8%). Upon multiple logistic regression analysis, visceral organ resection (of the small bowel and/or omentum) was the only independent predictor of significant morbidity (P < 0.05; odds ratio [OR]: 14.010, 95% confidence interval [CI]: 1.001-196.143). When diagnosed, femoral hernias should be electively repaired as soon as possible. The cumulative probability of strangulation rises over time. A requirement for bowel resection seems to significantly increase morbidity.
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Verhelst J, Timmermans L, van de Velde M, Jairam A, Vakalopoulos KA, Jeekel J, Lange JF. Watchful waiting in incisional hernia: Is it safe? Surgery 2015; 157:297-303. [DOI: 10.1016/j.surg.2014.09.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 08/27/2014] [Accepted: 09/10/2014] [Indexed: 10/24/2022]
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Sasaki A, Takeuchi Y, Izumi K, Morimoto A, Inomata M, Kitano S. Two-stage laparoscopic treatment for strangulated inguinal, femoral and obturator hernias: totally extraperitoneal repair followed by intestinal resection assisted by intraperitoneal laparoscopic exploration. Hernia 2014; 20:483-8. [PMID: 24908448 DOI: 10.1007/s10029-014-1272-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 05/23/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Total extraperitoneal preperitoneal (TEP) repair is widely used for inguinal, femoral, or obturator hernia treatment. However, mesh repair is not often used for strangulated hernia treatment if intestinal resection is required because of the risk of postoperative mesh infection. Complete mesh repair is required for hernia treatment to prevent postoperative recurrence, particularly in patients with femoral or obturator hernia. CASES We treated four patients with inguinocrural and obturator hernias (a 72-year-old male with a right indirect inguinal hernia; an 83-year-old female with a right obturator hernia; and 86- and 82-year-old females with femoral hernias) via a two-stage laparoscopic surgery. All patients were diagnosed with intestinal obstruction due to strangulated hernia. First, the incarcerated small intestine was released and then laparoscopically resected. Further, 8-24 days after the first surgery, bilateral TEP repairs were performed in all patients; the postoperative course was uneventful in all patients, and they were discharged 5-10 days after TEP repair. At present, no hernia recurrence has been reported in any patient. CONCLUSION The two-stage laparoscopic treatment is safe for treatment of strangulated inguinal, femoral, and obturator hernias, and complete mesh repair via the TEP method can be performed in elderly patients to minimize the occurrence of mesh infection.
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Affiliation(s)
- A Sasaki
- Department of Surgery, Japan Community Health Care Organization (JCHO) Nankai Medical Center, 11-20, Saiki, Oita, 876-0857, Japan.
| | - Y Takeuchi
- Department of Surgery, Japan Community Health Care Organization (JCHO) Nankai Medical Center, 11-20, Saiki, Oita, 876-0857, Japan
| | - K Izumi
- Department of Surgery, Japan Community Health Care Organization (JCHO) Nankai Medical Center, 11-20, Saiki, Oita, 876-0857, Japan
| | - A Morimoto
- Department of Surgery, Japan Community Health Care Organization (JCHO) Nankai Medical Center, 11-20, Saiki, Oita, 876-0857, Japan
| | - M Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, 879-5593, Japan
| | - S Kitano
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, 879-5593, Japan
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Venara A, Hubner M, Le Naoures P, Hamel JF, Hamy A, Demartines N. Surgery for incarcerated hernia: short-term outcome with or without mesh. Langenbecks Arch Surg 2014; 399:571-7. [PMID: 24789811 DOI: 10.1007/s00423-014-1202-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 04/21/2014] [Indexed: 01/29/2023]
Abstract
BACKGROUND Incarcerated hernias represent about 5-15 % of all operated hernias. Tension-free mesh is the preferred technique for elective surgery due to low recurrence rates. There is however currently no consensus on the use of mesh for the treatment of incarcerated hernias, especially in case of bowel resection. AIM The aims of this study were (i) to report our current practice for the treatment of incarcerated hernias, (ii) to identify risk factors for postoperative complications, and (iii) to assess the safety of mesh placement in potentially infected surgical fields. METHODS This retrospective study included 166 consecutive patients who underwent emergency surgery for incarcerated hernia between January 2007 and January 2012 in two university hospitals. Demographics, surgical details, and short-term outcome were collected. Univariate analysis was employed to identify risk factors for overall, infectious, and major complications. RESULTS Eighty-four patients (50.6 %) presented inguinal hernias, 43 femoral (25.9 %), 37 umbilical hernias (22.3 %), and 2 mixed hernias (1.2 %), respectively. Mesh was placed in 64 patients (38.5 %), including 5 patients with concomitant bowel resection. Overall morbidity occurred in 56 patients (32.7 %), and 8 patients (4.8 %) developed surgical site infections (SSI). Univariate risk factors for overall complications were ASA grade 3/4 (P = 0.03), diabetes (P = 0.05), cardiopathy (P = 0.001), aspirin use (P = 0.023), and bowel resection (P = 0.001) which was also the only identified risk factor for SSI (P = 0.03). In multivariate analysis, only bowel incarceration was associated with a higher rate of major morbidity (OR = 14.04; P = 0.01). CONCLUSION Morbidity after surgery for incarcerated hernia remains high and depends on comorbidities and surgical presentation. The use of mesh could become current practice even in case of bowel resection.
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Affiliation(s)
- A Venara
- Visceral and Endocrine Surgery Department, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France,
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Abstract
BACKGROUND The morbidity and mortality associated with acute primary ventral hernia repair have not been well described. We examined the rate of surgical site infection (SSI), hernia recurrence, and mortality in acute versus elective primary ventral hernia repair and identified predictors of morbidity and mortality after primary ventral hernia repair. METHODS A retrospective study on all patients undergoing open primary ventral hernia repair at a single institution (2000-2010) was performed. Primary outcomes were mortality at any time, SSI, and recurrence. Survival analysis for the entire, unmatched sample was conducted. We performed a risk-adjusted analysis of outcomes using two methods as follows: (1) case matching and (2) propensity score-adjusted regression model. RESULTS We identified 497 patients; 57 (11%) underwent acute primary ventral hernia repair. For the entire cohort, survival was worse for patients undergoing acute repair (log rank, 0.03). Following case matching on age, body mass index, American Society of Anesthesiologists score, and hernia size, there was no difference in mortality, SSI, or recurrence. After propensity score adjustment, acute surgery was not a predictor for mortality or SSI; however, incarcerated hernias predicted recurrence. CONCLUSION After risk adjustment, acute primary ventral hernia repair was not associated with higher mortality, infection, or recurrence compared with elective repair. LEVEL OF EVIDENCE Therapeutic study, level IV.
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20
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Azari Y, Perry Z, Kirshtein B. Strangulated groin hernia in octogenarians. Hernia 2013; 19:443-7. [PMID: 24366756 DOI: 10.1007/s10029-013-1205-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 12/12/2013] [Indexed: 02/03/2023]
Abstract
UNLABELLED The aim of the study was to determine risk factors for morbidity and mortality in patients older than 80 years, compared to younger patients, who undergo emergency strangulated groin hernia repair. METHODS This is a retrospective study of patients who underwent emergency surgery for strangulated groin hernia repair during 14 years. Patients were divided by age into three groups: younger than 59 (group A), 60-79 (group B), and older than 80 years (group C). Patient data included age, gender, hernia type, sac content, comorbidities, and surgical outcomes. RESULTS Two hundred patients were included in the study. There was no difference between groups in sex, hernia localization, and the type of repair. More comorbidities were found in octogenarians compared to the younger patients [group C vs. D (A + B)]. Small bowel resections and ICU admissions were more frequent in patients over 60 years compared to younger patients, 19.6 and 32.7 % vs. 1.7 and 0 %, respectively. Surgery was longer in group B. The rate of postoperative complications, repeated surgery, length of admission, and mortality were significantly higher in octogenarian (group C). Multivariate analysis found that age is a significant factor in the occurrence of non-surgical postoperative complications, but not in surgical complications. CONCLUSION Emergency surgery for strangulated hernia repair in patients over 80 years is more complicated than in younger patients, mostly due to the existing comorbidities. In order to reduce the high morbidity and mortality rates in emergency surgery associated with this age group, elective hernia surgery in elderly should be considered in selected patients with severe symptoms affecting their daily life.
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Affiliation(s)
- Y Azari
- Department of Surgery A, Soroka University Medical Center, Beersheba, Israel
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21
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Outcomes After Emergency Versus Elective Ventral Hernia Repair: A Prospective Nationwide Study. World J Surg 2013; 37:2273-9. [DOI: 10.1007/s00268-013-2123-5] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Martínez-Serrano MA, Pereira JA, Sancho J, Argudo N, López-Cano M, Grande L. Specific improvement measures to reduce complications and mortality after urgent surgery in complicated abdominal wall hernia. Hernia 2011; 16:171-7. [PMID: 21909976 DOI: 10.1007/s10029-011-0875-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Accepted: 08/04/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE Morbidity and mortality are increased after urgent surgery for complicated abdominal wall hernia. We analysed prospectively early morbidity and mortality after implementing specific management measures in patients undergoing urgent hernia repair. METHODS The study population included 244 patients with complicated abdominal wall hernia requiring surgical repair on an emergency basis over 1-year period. Patients were managed according to a protocol that included specific actions to be implemented in the pre-, intra- and postoperative periods. Outcomes of these patients were compared with those of 402 undergoing similar operations before development of the protocol. RESULTS Patients in whom acute complication was the first hernia symptom had higher mortality (7.2% vs 2.5%; P = 0.07) and were consulted later than 24 h (49.4% vs 36%; P = 0.044). Patients consulting later than 24 h had higher mortality (8.1% vs 1.4%, P = 0.017). Femoral hernias exhibited specific characteristics and were associated with higher mortality (13% vs 1.6%; P = 0.001). Overall, both groups had similar mortality (4.5% vs 4.1%; P = 0.8); complications (38.8% vs 37.7%; P = 0.2), and bowel resection rates (12.2% vs 11.5%; P = 0.8). Excluding the group of femoral hernias, the measures achieved a lower rate of severe complications (21.2% vs 10.3%; P = 0.04) and a decrease in mortality (2.9% vs 0.6%; P = 0.05) after bowel resection. CONCLUSIONS Specific measures for improvement of management and prevention of complications and mortality were effective in patients without femoral hernia. To reduce mortality, the best applicable measure is early detection and to prioritize the scheduled operation of femoral hernias and those affecting high risk patients. The implementation of preventive and educational programs in high risk patients is essential.
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Affiliation(s)
- M A Martínez-Serrano
- Department of General and Digestive Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Altom LK, Snyder CW, Gray SH, Graham LA, Vick CC, Hawn MT. Outcomes of Emergent Incisional Hernia Repair. Am Surg 2011. [DOI: 10.1177/000313481107700812] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examines the effect of emergent repair on incisional hernia repair outcomes at 16 Veteran's Affairs Medical Centers between 1998 and 2002. Of the 1452 cases reviewed, 63 (4.3%) were repaired emergently. Patients undergoing emergent repair were older ( P = 0.02), more likely to be black ( P = 0.02), and have congestive heart failure ( P = 0.001) or chronic obstructive pulmonary disease ( P = 0.001). Of emergent repairs, 76.2 per cent involved intestinal incarceration versus 7.2 per cent of elective repairs ( P < 0.0001), and 17.5 per cent had concomitant bowel resection compared with 3.9 per cent of elective cases ( P < 0.0001). Patients undergoing emergent repair were also more likely to receive primary suture repair (49.2 vs 31.1%, P = 0.003), develop a postoperative complication (26.0 vs 11.3%, P = 0.002), and have increased postoperative length of stay (7 vs 4 days, P < 0.0001). There were nine (14.3%) deaths at 30 days for the emergent group compared with 10 (0.7%) in the elective group ( P < 0.001). However, there was no significant difference between emergent and elective repairs in long-term complications. Emergent hernia repair is associated with increased mortality rates, early complications, and longer length of stay; however, long-term outcomes are equivalent to elective cases. These data suggest that technical outcomes for emergent repairs approach those of elective operations.
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Affiliation(s)
- Laura K. Altom
- Center for Surgical, Medical Acute Care Research and Transitions, Veteran's Affairs Medical Center, Birmingham, Alabama
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
- Health Services/Comparative Effectiveness Research Training Program, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Stephen H. Gray
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Laura A. Graham
- Center for Surgical, Medical Acute Care Research and Transitions, Veteran's Affairs Medical Center, Birmingham, Alabama
| | - Catherine C. Vick
- Center for Surgical, Medical Acute Care Research and Transitions, Veteran's Affairs Medical Center, Birmingham, Alabama
| | - Mary T. Hawn
- Center for Surgical, Medical Acute Care Research and Transitions, Veteran's Affairs Medical Center, Birmingham, Alabama
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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Lauscher JC, Rieck S, Loh JC, Gröne J, Buhr HJ, Ritz JP. Oligosymptomatic vs. symptomatic incisional hernias--who benefits from open repair? Langenbecks Arch Surg 2010; 396:179-85. [PMID: 20582602 DOI: 10.1007/s00423-010-0659-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Accepted: 06/10/2010] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Incisional hernias are one of the most often complications in abdominal surgery and therefore present a significant surgical and socioeconomic problem. To date, incisional hernias are always an indication for surgery, regardless of the patient's symptoms. However, it remains unclear to what extent the surgery actually results in symptomatic improvement and whether a relevant risk of incarceration exists. The purpose of this study was to investigate the motivation that led to incisional hernia repairs and whether patients benefit from surgery with regard to pain and subjective criteria. MATERIALS AND METHODS This prospective study included patients who underwent open abdominal incisional hernia repair using mesh implantation. Data collection was done preoperatively and 6 months postoperatively. The intensity of pain was evaluated using the Numeric Analog Scale (NAS). Patients were divided according to their preoperative level of pain into oligosymptomatic (NAS 0-3) and symptomatic (NAS 4-10) groups, and the postoperative outcome of both groups was compared. RESULTS Ninety patients were prospectively enrolled: 45 males (50.0%) and 45 females (50.0%); 43 patients (47.8%) were oligosymptomatic preoperatively, while 47 patients (52.2%) reported relevant pain. The most frequent motivation for surgery named by the oligosymptomatic patients was fear of incarceration (79.1%), while the symptomatic patients mostly mentioned pain (76.6%). At 6 months postoperatively, significantly more oligosymptomatic patients complained of relevant pain (p < 0.001). In the symptomatic patient group, there was a significant reduction in relevant pain (p < 0.001). At that time, the level of relevant pain was comparable in both groups (33.3% versus 35.6%). Seven of 87 patients (8.0%) experienced recurrence within 6 months. Three patients with acute incarceration were treated with emergency repair (3.2%). CONCLUSIONS In patients with oligosymptomatic incisional hernias, fear of incarceration is the most frequent motivation for surgical treatment, even though the actual risk of incarceration seems to be rather low. If the incisional hernia causes relevant discomfort preoperatively, the surgery provides significant relief. In contrast, there is no improvement regarding pain in the oligosymptomatic patient group. This leads to the conclusion that, in the case of oligosymptomatic incisional hernias, the general indication for surgical revision should be viewed critically.
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Affiliation(s)
- Johannes Christian Lauscher
- Department of General, Vascular, and Thoracic Surgery, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
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Mischinger HJ, Kornprat P, Werkgartner G, El Shabrawi A, Spendel S. [Abdominal wall closure by incisional hernia and herniation after laparostoma]. Chirurg 2010; 81:201-10. [PMID: 20145901 DOI: 10.1007/s00104-009-1818-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
As hernias and abdominal wall defects have a variety of etiologies each with its own complications and comorbidities in various constellations, efficient treatment requires patient-oriented management. There is no recommended standard treatment and the very different clinical pictures demand an individualized interdisciplinary approach. Particularly in the case of complicated hernias, the planning of the operation should focus on the problems posed by the individual patient. Treatment mainly depends on the etiology of the hernia, immediate or long-term complications and the efficiency of individual repair techniques. Abdominal wall repair for recurrent herniation requires direct closure of the fascia generally using the sublay technique with a lightweight mesh. It is still unclear whether persistent inflammation, mesh dislocation, fistula formation or other long-term complications are due to certain materials or to the surgical technique. With mesh infections it has been shown to be advantageous to remove a polytetrafluoroethylene (PTFE) mesh, while the combination of systemic and local treatment appears to suffice for a polypropylene or polyester mesh. Heavier meshes in the sublay position or plastic reconstruction with autologous tissue are indicated as substitutes for the abdominal wall for giant hernias, repeated recurrences and large abdominal wall defects. A laparostoma is increasingly more often created to treat septic intra-abdominal processes but is very often responsible for a complicated hernia. If primary repair of the abdominal wall is not an option, resorbable material or split skin is used for coverage under the auspices of a planned hernia repair.
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Affiliation(s)
- H-J Mischinger
- Klinische Abteilung für Allgemeinchirurgie, Universitätsklinik für Chirurgie, Medizinische Universität Graz, Auenbruggerplatz 29, 8036 Graz, Osterreich.
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