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Huguenin-Dezot M, Peisl S, Georgiou E, Candinas D, Beldi G, Helbling C, Zindel J. Glued suture-less peritoneum closure in laparoscopic inguinal hernia repair reduces acute postoperative pain. Sci Rep 2024; 14:11786. [PMID: 38782992 PMCID: PMC11116422 DOI: 10.1038/s41598-024-62364-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
Inguinal hernia repair is performed more than 20 million times per annum, representing a significant health and economic burden. Over the last three decades, significant technical advances have started to reduce the invasiveness of these surgeries, which translated to better recovery and reduced costs. Here we bring forward an innovative surgical technique using a biodegradable cyanoacrylate glue instead of a traumatic suture to close the peritoneum, which is a highly innervated tissue layer, at the end of endoscopy hernia surgery. To test how this affects the invasiveness of hernia surgery, we conducted a cohort study. A total of 183 patients that underwent minimally invasive hernia repair, and the peritoneum was closed with either a conventional traumatic suture (n = 126, 68.9%) or our innovative approach using glue (n = 57, 31.1%). The proportion of patients experiencing acute pain after surgery was significantly reduced (36.8 vs. 54.0%, p = 0.032) by using glue instead of a suture. In accordance, the mean pain level was higher in the suture group (VAS = 1.5 vs. 1.3, p = 0.029) and more patients were still using painkillers (77.9 vs. 52.4%, p = 0.023). Furthermore, the rate of complications was not increased in the glue group. Using multivariate regressions, we identified that using a traumatic suture was an independent predictor of acute postoperative pain (OR 2.0, 95% CI 1.1-3.9, p = 0.042). In conclusion, suture-less glue closure of the peritoneum is innovative, safe, less painful, and possibly leads to enhanced recovery and decreased health costs.
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Affiliation(s)
- Michaël Huguenin-Dezot
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
| | - Sarah Peisl
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Evangelos Georgiou
- Department Für Allgemein- Und Viszeralchirurgie, Spital Linth, Gasterstrasse 25, 8730, Uznach, Switzerland
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Guido Beldi
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Christian Helbling
- Department Für Allgemein- Und Viszeralchirurgie, Spital Linth, Gasterstrasse 25, 8730, Uznach, Switzerland
| | - Joel Zindel
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
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Baldini E, Lori E, Morini C, Palla L, Coletta D, De Luca GM, Giraudo G, Intini SG, Perotti B, Sorge A, Sozio G, Arganini M, Beltrami E, Pironi D, Ranalli M, Saviano C, Patriti A, Usai S, Vernaccini N, Vittore F, D’Andrea V, Nardi P, Sorrenti S, Palumbo P. Sutureless Repair for Open Treatment of Inguinal Hernia: Three Techniques in Comparison. J Clin Med 2024; 13:589. [PMID: 38276095 PMCID: PMC10816828 DOI: 10.3390/jcm13020589] [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: 01/03/2024] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
Currently, groin hernia repair is mostly performed with application of mesh prostheses fixed with or without suture. However, views on safety and efficacy of different surgical approaches are still partly discordant. In this multicentre retrospective study, three sutureless procedures, i.e., mesh fixation with glue, application of self-gripping mesh, and Trabucco's technique, were compared in 1034 patients with primary unilateral non-complicated inguinal hernia subjected to open anterior surgery. Patient-related features, comorbidities, and drugs potentially affecting the intervention outcomes were also examined. The incidence of postoperative complications, acute and chronic pain, and time until discharge were assessed. A multivariate logistic regression was used to compare the odds ratio of the surgical techniques adjusting for other risk factors. The application of standard/heavy mesh, performed in the Trabucco's technique, was found to significantly increase the odds ratio of hematomas (p = 0.014) and, most notably, of acute postoperative pain (p < 0.001). Among the clinical parameters, antithrombotic therapy and large hernia size were independent risk factors for hematomas and longer hospital stay, whilst small hernias were an independent predictor of pain. Overall, our findings suggest that the Trabucco's technique should not be preferred in patients with a large hernia and on antithrombotic therapy.
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Affiliation(s)
- Enke Baldini
- Department of Surgery, “Sapienza” University of Rome, 00161 Rome, Italy; (E.B.); (E.L.); (C.M.); (D.P.); (S.U.); (V.D.); (P.N.); (S.S.)
| | - Eleonora Lori
- Department of Surgery, “Sapienza” University of Rome, 00161 Rome, Italy; (E.B.); (E.L.); (C.M.); (D.P.); (S.U.); (V.D.); (P.N.); (S.S.)
| | - Carola Morini
- Department of Surgery, “Sapienza” University of Rome, 00161 Rome, Italy; (E.B.); (E.L.); (C.M.); (D.P.); (S.U.); (V.D.); (P.N.); (S.S.)
| | - Luigi Palla
- Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, 00161 Rome, Italy;
| | - Diego Coletta
- United Hospitals of Northern Marche (AOORMN)—Pesaro, 61121 Pesaro, Italy; (D.C.); (A.P.)
| | - Giuseppe M. De Luca
- Unit of Academic General Surgery “V. Bonomo”, University of Bari, 70124 Bari, Italy; (G.M.D.L.); (F.V.)
| | - Giorgio Giraudo
- Department of Surgery, Santa Croce e Carle Hospital (ASO) of Cuneo, 12100 Cuneo, Italy; (G.G.); (E.B.)
| | - Sergio G. Intini
- Department of Surgery, S. Maria Della Misericordia Hospital, ASUFC of Udine, 33100 Udine, Italy; (S.G.I.); (N.V.)
| | - Bruno Perotti
- Department of Surgery, Versilia Hospital of Viareggio, 55049 Camaiore, Italy; (B.P.); (M.A.)
| | - Angelo Sorge
- Day Surgery P.O.S. Giovanni Bosco, 80144 Naples, Italy; (A.S.); (C.S.)
| | - Giampaolo Sozio
- Department of Surgery, Alta Val D’Elsa Hospital of Poggibonsi—Siena, 53036 Poggibonsi, Italy; (G.S.); (M.R.)
| | - Marco Arganini
- Department of Surgery, Versilia Hospital of Viareggio, 55049 Camaiore, Italy; (B.P.); (M.A.)
| | - Elsa Beltrami
- Department of Surgery, Santa Croce e Carle Hospital (ASO) of Cuneo, 12100 Cuneo, Italy; (G.G.); (E.B.)
| | - Daniele Pironi
- Department of Surgery, “Sapienza” University of Rome, 00161 Rome, Italy; (E.B.); (E.L.); (C.M.); (D.P.); (S.U.); (V.D.); (P.N.); (S.S.)
| | - Massimo Ranalli
- Department of Surgery, Alta Val D’Elsa Hospital of Poggibonsi—Siena, 53036 Poggibonsi, Italy; (G.S.); (M.R.)
| | - Cecilia Saviano
- Day Surgery P.O.S. Giovanni Bosco, 80144 Naples, Italy; (A.S.); (C.S.)
| | - Alberto Patriti
- United Hospitals of Northern Marche (AOORMN)—Pesaro, 61121 Pesaro, Italy; (D.C.); (A.P.)
| | - Sofia Usai
- Department of Surgery, “Sapienza” University of Rome, 00161 Rome, Italy; (E.B.); (E.L.); (C.M.); (D.P.); (S.U.); (V.D.); (P.N.); (S.S.)
| | - Nicola Vernaccini
- Department of Surgery, S. Maria Della Misericordia Hospital, ASUFC of Udine, 33100 Udine, Italy; (S.G.I.); (N.V.)
| | - Francesco Vittore
- Unit of Academic General Surgery “V. Bonomo”, University of Bari, 70124 Bari, Italy; (G.M.D.L.); (F.V.)
| | - Vito D’Andrea
- Department of Surgery, “Sapienza” University of Rome, 00161 Rome, Italy; (E.B.); (E.L.); (C.M.); (D.P.); (S.U.); (V.D.); (P.N.); (S.S.)
| | - Priscilla Nardi
- Department of Surgery, “Sapienza” University of Rome, 00161 Rome, Italy; (E.B.); (E.L.); (C.M.); (D.P.); (S.U.); (V.D.); (P.N.); (S.S.)
| | - Salvatore Sorrenti
- Department of Surgery, “Sapienza” University of Rome, 00161 Rome, Italy; (E.B.); (E.L.); (C.M.); (D.P.); (S.U.); (V.D.); (P.N.); (S.S.)
| | - Piergaspare Palumbo
- Department of Surgery, “Sapienza” University of Rome, 00161 Rome, Italy; (E.B.); (E.L.); (C.M.); (D.P.); (S.U.); (V.D.); (P.N.); (S.S.)
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Xu Z, Zhao Y, Fu X, Hu W, Zhao C, Ge C, Ye H, Chen C. Laparoscopic versus Open Inguinal Hernia Repair in Aging Patients: A Propensity Score Matching-Based Retrospective Study. Ther Clin Risk Manag 2023; 19:657-666. [PMID: 37575687 PMCID: PMC10422990 DOI: 10.2147/tcrm.s423307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/02/2023] [Indexed: 08/15/2023] Open
Abstract
Objective Although laparoscopic repair has been widely carried out and promoted due to its minimally invasive advantages, open surgery is still popular compared to elderly patients. This study aims to compare the outcomes of laparoscopic (LIHR) vs open repair of inguinal hernias (OIHR) in elderly patients. Methods A retrospective analysis of the database was performed to identify elderly patients, from January 2021 through December 2022, who underwent surgery for an inguinal hernia. After a 1:1 propensity score matching (PSM) with a caliper of 0.1 was conducted to balance potential bias, binary logistic regressions were used for categorical and continuous outcomes. Results After PSM, 78 pairs of elderly patients were enrolled in this study, and there were no significant differences in baseline between LIHR and OIHR groups. Compared to OIHR, univariable and multivariable logistic regression analysis showed that LIHR was independently affected for reducing intraoperative hemorrhage (OR = 0.06, 95% CI: 0.02-0.18, P < 0.001) and shortening postoperative hospitalization time (OR = 0.29, 95% CI: 0.15-0.57, P < 0.001) in elderly patients. Furthermore, LIHR (OR = 0.28, 95% CI: 0.14-0.57, P < 0.001) and age (OR = 0.89, 95% CI: 0.82-0.96, P = 0.002) were independent affecting factors for relieving postoperative pain. Meanwhile, no obvious differences were detected in postoperative complications [LIHR 7.7% (6/78) vs OIHR 14.1% (11/78), P = 0.199]. Conclusion LIHR was closely associated with reducing intraoperative hemorrhage and shortening postoperative hospitalization time. Whilst LIHR and age were independently affecting factors for relieving postoperative pain.
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Affiliation(s)
- Zipeng Xu
- Department of General Surgery, Xishan People’s Hospital of Wuxi City, Wuxi, 214105, People’s Republic of China
| | - Yong Zhao
- Department of General Surgery, Wuxi Rehabilitation Hospital, Wuxi, 214007, People’s Republic of China
| | - Xu Fu
- Department of General Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical school, Nanjing, 210008, People’s Republic of China
| | - Weidong Hu
- Department of General Surgery, Xishan People’s Hospital of Wuxi City, Wuxi, 214105, People’s Republic of China
| | - Chunlong Zhao
- Department of General Surgery, Xishan People’s Hospital of Wuxi City, Wuxi, 214105, People’s Republic of China
| | - Chen Ge
- Department of General Surgery, Xishan People’s Hospital of Wuxi City, Wuxi, 214105, People’s Republic of China
| | - Hui Ye
- Department of Anesthesiology, ZhongDa Hospital, Southeast University, Nanjing, 210009, People’s Republic of China
- Department of Immunology, Ophthalmology & ORL, Complutense University School of Medicine, Madrid, 28040, Spain
| | - Chaobo Chen
- Department of General Surgery, Xishan People’s Hospital of Wuxi City, Wuxi, 214105, People’s Republic of China
- Department of General Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical school, Nanjing, 210008, People’s Republic of China
- Department of Immunology, Ophthalmology & ORL, Complutense University School of Medicine, Madrid, 28040, Spain
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Niebuhr H, Köckerling F, Fortelny R, Hoffmann H, Conze J, Holzheimer RG, Koch A, Köhler G, Krones C, Kukleta J, Kuthe A, Lammers B, Lorenz R, Mayer F, Pöllath M, Reinpold W, Schwab R, Stechemesser B, Weyhe D, Wiese M, Zarras K, Meyer HJ. [Inguinal hernia operations-Always outpatient?]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:230-236. [PMID: 36786812 PMCID: PMC9950173 DOI: 10.1007/s00104-023-01818-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 06/17/2023]
Abstract
Inguinal hernia operations represent the most frequent operations overall with 300,000 interventions annually in Germany, Austria and Switzerland (DACH region). Despite the announced political willingness and the increasing pressure from the legislator to avoid costly inpatient treatment by carrying out as many outpatient operations as possible, outpatient treatment has so far played a subordinate role in the DACH region. The Boards of the specialist societies the German Hernia Society (DHG), the Surgical Working Group Hernia (CAH of the DHG), the Austrian Hernia Society (ÖHG) and the Swiss Working Group Hernia Surgery (SAHC) make inroads into this problem, describe the initial position and assess the current situation.
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Affiliation(s)
- H Niebuhr
- Hamburger Hernien Centrum, Eppendorfer Baum 8, 20249, Hamburg, Deutschland.
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Zhu X, Liu Z, Shen J, Liu J, Tang R. Comparison of open and laparoscopic inguinal-hernia repair in octogenarians. Asian J Surg 2023; 46:738-741. [PMID: 35843826 DOI: 10.1016/j.asjsur.2022.06.149] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/17/2021] [Accepted: 06/28/2022] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Although the advantages of laparoscopic inguinal hernia repair in the general population have been reported, its role in octogenarians has yet to be elucidated. This retrospective study was designed to compare the outcomes of open and laparoscopic inguinal hernia repairs in octogenarians. MATERIALS AND METHODS The data of octogenarians who underwent laparoscopic (n = 81) or open (n = 121) inguinal hernia repair were collected from January 2017 to December 2019. Statistical analysis variables included basic epidemiological data of patients, surgical procedures, comorbidities, postoperative pain, complications, recurrence, and other data. RESULTS There were no significant differences between the two groups in terms of sex, body mass index, recurrent hernias, comorbidities, postoperative complications, and recurrence. The American Society of Anesthesiologists (ASA) class and the proportion of scrotal hernias in the open group were higher than those of the laparoscopic group, whereas the proportion of bilateral hernias in the laparoscopic group was higher than that in the open group. The postoperative pain scores of the laparoscopic group were lower than those of the open group. CONCLUSIONS In octogenarians, both laparoscopic and open inguinal hernia repairs are safe and feasible, but an appropriate surgical plan is crucial for obtaining better treatment effect.
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Affiliation(s)
- Xiaoqiang Zhu
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, School of Medicine, Tongji University, China
| | - Zhengni Liu
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, School of Medicine, Tongji University, China
| | - Jianfeng Shen
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, School of Medicine, Tongji University, China
| | - Jiajie Liu
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, School of Medicine, Tongji University, China
| | - Rui Tang
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, School of Medicine, Tongji University, China.
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Hajili K, Vega Hernandez A, Otten J, Richards D, Rudroff C. Risk factors for early and late morbidity in patients with cardiovascular disease undergoing inguinal hernia repair with a tailored approach: a single-center cohort study. BMC Surg 2023; 23:11. [PMID: 36641449 PMCID: PMC9840298 DOI: 10.1186/s12893-023-01905-y] [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: 09/02/2022] [Accepted: 01/04/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Inguinal hernia repair is a common procedure in surgery. Patients with cardiovascular disease have an increased operative risk for postoperative morbidity. The study aimed to identify the most beneficial surgical procedure for these patients. METHODS Patients undergoing elective surgery for unilateral or bilateral inguinal hernia between December 2015 and February 2020 were included. The cohort was divided into the group of patients with (CVD group) and without (NO group) cardiovascular disease and analyzed according to the postoperative morbidity distribution and correlated to the surgical technique used. RESULTS Of the 474 patients included 223 (47%) were operated on using the Lichtenstein technique and 251 (53%) using TAPP, respectively. In the CVD group the Lichtenstein procedure was more common (n = 102, 68.9%), in the NO group it was TAPP (n = 205, 62.9%; p < 0.001). 13 (8.8%) patients in the CVD group and 12 (3.7%) patients in the NO group developed a postoperative hematoma (p = 0.023). In the further subgroup analysis within the CVD group revealed cumarine treatment as a risk factor for postoperative hematoma development, whereas the laparoscopic approach did not elevate the morbidity risk. CONCLUSION CVD is a known risk factor for perioperative morbidity in general surgery, however, the TAPP method does not elevate the individual perioperative risk.
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Affiliation(s)
- Kamran Hajili
- grid.419829.f0000 0004 0559 5293Department for Cardiology and Intensive Care Medicine, Klinikum Leverkusen, Leverkusen, Germany ,grid.6190.e0000 0000 8580 3777Promotion in Medical Studies, Medical Faculty of the University of Cologne, Cologne, Germany
| | - Alberto Vega Hernandez
- Department of Visceral Surgery and Functional Surgery of the Lower Gastrointestinal Tract (UGI), Evangelisches Klinikum Koeln Weyertal, Weyertal 76, 50931 Cologne, Germany
| | - Jakob Otten
- Department of Visceral Surgery and Functional Surgery of the Lower Gastrointestinal Tract (UGI), Evangelisches Klinikum Koeln Weyertal, Weyertal 76, 50931 Cologne, Germany
| | - Dana Richards
- Department of Visceral Surgery and Functional Surgery of the Lower Gastrointestinal Tract (UGI), Evangelisches Klinikum Koeln Weyertal, Weyertal 76, 50931 Cologne, Germany
| | - Claudia Rudroff
- Department of Visceral Surgery and Functional Surgery of the Lower Gastrointestinal Tract (UGI), Evangelisches Klinikum Koeln Weyertal, Weyertal 76, 50931 Cologne, Germany
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Balch JA, Neal D, Crippen C, Johnson-Mann CN, Read TE, Loftus TJ, Al-Mansour MR. Safety of laparoscopic inguinal hernia repair in the setting of antithrombotic therapy. Surg Endosc 2022; 36:9011-9018. [PMID: 35674797 DOI: 10.1007/s00464-022-09360-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/16/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION There are a paucity of data regarding the safety of laparoscopic inguinal hernia repair in patients on antiplatelet and anticoagulant therapy (APT/ACT). We aim to compare the postoperative outcomes of laparoscopic (LIHR) vs. open repair of inguinal hernias (OIHR) in patients on APT/ACT. METHOD We conducted a retrospective cohort study using the Vizient Clinical DataBase. We included adults receiving APT/ACT who underwent outpatient, elective, and primary inguinal hernia repair between 2017 and 2019. Subgroup analysis was performed on patients receiving aspirin, non-aspirin antiplatelet, and anticoagulant therapy. Mixed-effects logistic regression was used to assess both the effect of APT/ACT on the probability of receiving LIHR vs OIHR and their respective outcomes. RESULT A total of 142,052 repairs were included, of which 21,441 (15%) were performed on patients receiving APT/ACT. Mean age was 69 years (± 10.5) and 93% were male. 19% of hernias were bilateral. 40% of operations were performed at teaching hospitals. On multivariable analysis, patients on non-aspirin antiplatelet or anticoagulant therapy were more likely to receive an open procedure (Odds Ratio (OR) = 1.2; 95% Confidence Intervals (CI) [1.1, 1.4] and OR = 1.4; CI [1.3, 1.5], respectively). LIHR was associated with a lower rate of length of stay > 1 day (OR = 0.65; CI [0.5, 0.9]). Rates of 30-day postoperative hematoma, transfusions, stroke, myocardial infarction, deep venous thrombosis, pulmonary embolism, readmission, and emergency department visits were similar between the two operative approaches. CONCLUSION Patients on APT/ACT represent a substantial proportion of those undergoing inguinal hernia repair. Non-aspirin antiplatelet or anticoagulant therapy are independent predictors of choosing an open repair. Laparoscopic repair appears to be safe in patients receiving APT/ACT under current perioperative management patterns.
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Affiliation(s)
- Jeremy A Balch
- Department of Surgery, University of Florida, PO Box 100108, Gainesville, FL, 32610-0108, USA
| | - Dan Neal
- Department of Surgery, University of Florida, PO Box 100108, Gainesville, FL, 32610-0108, USA
| | - Cristina Crippen
- Department of Surgery, University of Florida, PO Box 100108, Gainesville, FL, 32610-0108, USA
| | - Crystal N Johnson-Mann
- Department of Surgery, University of Florida, PO Box 100108, Gainesville, FL, 32610-0108, USA
| | - Thomas E Read
- Department of Surgery, University of Florida, PO Box 100108, Gainesville, FL, 32610-0108, USA
| | - Tyler J Loftus
- Department of Surgery, University of Florida, PO Box 100108, Gainesville, FL, 32610-0108, USA
| | - Mazen R Al-Mansour
- Department of Surgery, University of Florida, PO Box 100108, Gainesville, FL, 32610-0108, USA.
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Zhou Y, Rastegar V, Read TE, Al-Mansour MR. Safety of Laparoscopic Appendectomy in the Setting of Coagulopathy: An ACS-NSQIP Study. J Surg Res 2022; 275:103-108. [DOI: 10.1016/j.jss.2022.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/31/2021] [Accepted: 01/29/2022] [Indexed: 10/18/2022]
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Agapov MA, Kakotkin VV, Yudina VD, Kadrev AV, Garmanova TN. DEVELOPMENT OF THE TAILORED APPROACH IN INGUINAL HERNIA REPAIR. SURGICAL PRACTICE 2022. [DOI: 10.38181/2223-2427-2022-2-5-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of the study is to evaluate the effectiveness of a personalized algorithm for determining the technique of surgical treatment of inguinal hernias, which allows choosing the optimal operational tactics (its modifications) depending on the anthropometric, clinical, instrumental data of the patient.In the course of the study, the results of the application of a clinical algorithm in the Medical research and Educational center of Lomonosov Moscow State University for patients with unilateral non-incarcerated symptomatic inguinal hernias were analyzed. The frequencies of the main postoperative adverse outcomes of the research group were compared using the algorithm and patients of the German Herniamed Hernia Register, for whom only standard principles of surgical intervention selection are applied, the main provisions of the recommendations of the international HerniaSurge Group of experts. In some cases individual exceptional factors of patients were taken into account.The frequency of chronic pain and pain requiring repeated surgery was significantly lower than the average frequencies of the German Herniamed register (13.8% vs 28.7% (p<0.00001) and 0.99% vs 3.8% (p=0.0103) respectively). At the same time, the frequency of adverse outcomes, such as relapses and early postoperative complications, is similar to international population data.
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Affiliation(s)
- M. A. Agapov
- Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)
| | - V. V. Kakotkin
- Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)
| | - V. D. Yudina
- Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)
| | - A. V. Kadrev
- Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)
| | - T. N. Garmanova
- Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)
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Christou N, Ris F, Naumann D, Robert-Yap J, Mathonnet M, Gillion JF. Risk factors for surgical site infection after groin hernia repair: does the mesh or technique matter? Hernia 2021; 26:233-242. [PMID: 34596783 PMCID: PMC8881239 DOI: 10.1007/s10029-021-02512-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Surgical site infections (SSIs) following groin hernia repair (GHR) are getting rarer in high income countries despite a wider use of meshes. Among the risk factors for SSIs, those related to the mesh and the surgical technique have rarely been described. METHODS A registry-based multicenter study using prospectively collected data, including SSIs and their potential risk factors, was conducted in the French Hernia-Club. RESULTS Between 2012 and 2019, 21,976 consecutive unselected adult patients aged 64.8 ± 15.4 years old (88.9% male) underwent GHR (83.5% unilateral). Fifty four percent were laparoscopic; 97.6% used mesh. The overall incidence of SSI was 0.26%. The incidence of SSI was respectively, 0.24% and 0.19% (p = 0.420) in open vs laparoscopic repairs; 0.19% and 0.25% (p = 0.638) for polyester vs polypropylene mesh; In adjusted multivariate analysis focusing on macroporous meshes (which were the most implanted meshes: 23,148 out of 24,099), there were no differences in terms of SSIs' rates regarding the technique: open versus laparoscopy (p = 0.762) nor the type of mesh used: polypropylene versus polyester (p = 0.557). CONCLUSION The rate of SSI following GHR was low in this large registry study. Mesh type and surgical technique did not affect SSIs rates. Caution is advised when interpreting these data due to this very low rate of SSI and the potential for a type II error.
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Affiliation(s)
- N Christou
- Service de Chirurgie Digestive, Endocrinienne et Générale, CHU de Limoges, Avenue Martin Luther King, 87042, Limoges Cedex, France. .,University Hospitals Birmingham NHS Foundation Trust, Birmingham, B152TH, UK.
| | - F Ris
- Department of Visceral Surgery, Geneva University Hospitals and Medical School, Rue Gabrielle Perret, 4, 1205, Geneva, Switzerland
| | - D Naumann
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B152TH, UK
| | - J Robert-Yap
- Department of Visceral Surgery, Geneva University Hospitals and Medical School, Rue Gabrielle Perret, 4, 1205, Geneva, Switzerland
| | - M Mathonnet
- Service de Chirurgie Digestive, Endocrinienne et Générale, CHU de Limoges, Avenue Martin Luther King, 87042, Limoges Cedex, France
| | - J-F Gillion
- Unité de Chirurgie Viscérale Et Digestive, Hôpital Privé d'Antony, 1, Rue Velpeau, 92160, Antony, France
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11
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Hada G, Zhang S, Song Y, Jaiswar M, Xie Y, Jian F, Lei W. Safety of Inguinal Hernia Repair in the Elderly with Perioperative Continuation of Antithrombotic Therapy. Visc Med 2021; 37:315-322. [PMID: 34540948 DOI: 10.1159/000509895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/02/2020] [Indexed: 02/05/2023] Open
Abstract
Introduction This study aimed to evaluate the safety of an inguinal hernia repair (IHR) under local anesthesia (LA) in the elderly with a perioperative continuation of antithrombotic therapy (AT). Methods A total of 120 patients undergoing elective primary IHR between August 2018 and August 2019 at the West China Hospital of China were prospectively studied, among which 60 patients also had coexisting cardiovascular diseases and had a continuation of AT perioperatively (antithrombotic group); the other 60 patients were not on any prior AT (control group). The primary endpoints were intra- and postoperative hemorrhagic complications, the required interventions for complications based on the Clavien-Dindo classification, and postoperative thromboembolic complications. The secondary endpoints were nonhemorrhagic complications, intraoperative duration, and postoperative length of stay (LOS). Results None of the patients in both groups had significant intraoperative bleeding >10 mL, and there were no significant differences between the 2 groups in terms of the postoperative hemorrhagic complications: bruising (2 vs. 0%, p = 1.000), serosanguinous soakage (7 vs. 3%, p = 0.679), and no hematoma was observed. Interventions required for encountered complications based on the Clavien-Dindo classification grade I (7 vs. 5%, p = 1.000) were assessed. There were no episodes of postoperative thromboembolic complications within 60 days in both groups. There were also no significant differences between the 2 groups in terms of nonhemorrhagic complications, intraoperative duration, and postoperative LOS (p > 0.05 in all). Conclusions The perioperative continuation of AT did not increase the risk of intra- and postoperative hemorrhagic complications following IHR in the elderly. Thus, IHR under LA seems to be safe and feasible in this setting.
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Affiliation(s)
- Gonish Hada
- Department of Gastrointestinal Surgery, Hernia Center, West China Hospital, Sichuan University, Chengdu, China
| | - Sen Zhang
- Department of Gastrointestinal Surgery, Hernia Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yinghan Song
- Department of Day Care Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Mukesh Jaiswar
- Department of Gastrointestinal Surgery, Hernia Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yanyan Xie
- Department of Gastrointestinal Surgery, Hernia Center, West China Hospital, Sichuan University, Chengdu, China
| | - Fushan Jian
- Department of Gastrointestinal Surgery, Hernia Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wenzhang Lei
- Department of Gastrointestinal Surgery, Hernia Center, West China Hospital, Sichuan University, Chengdu, China
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12
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Bruzzone P, Bini F, Lancia M, Popivanov G, Giustozzi M, Marinozzi F, D'Andrea V, Cirocchi R. The role of computed tomography angiography 3D imaging in postoperative hemorrhage after groin mesh hernioplasty during anticoagulation therapy. Minerva Surg 2021; 76:286-287. [PMID: 33855375 DOI: 10.23736/s2724-5691.21.08704-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Paolo Bruzzone
- Paride Stefanini Department of General and Specialist Surgery, Sapienza University, Rome, Italy -
| | - Fabiano Bini
- Department of Mechanical and Aerospace Engineering, Sapienza University, Rome, Italy
| | - Massimo Lancia
- Department of General Surgery, Hospital of Terni, University of Perugia, Terni, Italy
| | - Georgi Popivanov
- Department of Surgery, Military Medical Academy, Sofia, Bulgaria
| | - Michela Giustozzi
- Unit of Internal Vascular and Emergency Medicine and Stroke, University of Perugia, Perugia, Italy
| | - Franco Marinozzi
- Department of Mechanical and Aerospace Engineering, Sapienza University, Rome, Italy
| | - Vito D'Andrea
- Department of Surgical Sciences, Sapienza University, Rome, Italy
| | - Roberto Cirocchi
- Department of General Surgery, Hospital of Terni, University of Perugia, Terni, Italy
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13
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Rogers AP, Xu Y, Lidor AO. Healthcare Resource Utilization in Inguinal Hernia Repair: A Three-Year Cost Evaluation of Truven Health Marketscan Research Databases. J Surg Res 2021; 264:408-417. [PMID: 33848840 DOI: 10.1016/j.jss.2021.02.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/11/2021] [Accepted: 02/27/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Inguinal hernia repair is the most commonly performed elective operation in the United States, with over 800,000 cases annually. While clinical outcomes comparing laparoscopic versus open techniques have been well documented, there is little data comparing costs associated with these techniques. This study evaluates the cost of healthcare resources during the 90-d postoperative period following inguinal hernia repair. METHODS We analyzed data from the Truven Health MarketScan Research Databases. Adult patients with an ICD-9 or CPT code for inguinal hernia repair from 2012 to 2014 were included. Patients with continuous enrollment for 6 mo prior to surgery and 6 mo after surgery were analyzed. Related healthcare service costs (readmission and/or ER visit and/or outpatient visit) were calculated by clinical classification software and generalized linear modeling was used to compare healthcare utilization between groups. RESULTS 124,582 cases were identified (open = 84,535; lap = 40,047). Index surgery cost was 41% higher in laparoscopic cases. The cost for readmission was close to $25,000 and similar between both groups, but the laparoscopic group were 12% less likely to be readmitted for surgical complications within 90-d when compared to the open group. Cost of bilateral laparoscopic repair is less than that of serial unilateral open repairs. CONCLUSION Laparoscopic inguinal hernia repair carries a higher index surgery cost than open repair. However, open repair has an increased rate of readmission. To maximize value, efforts should be directed at minimizing readmissions and improving identification of bilateral hernias at the time of initial presentation.
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Affiliation(s)
- Andrew P Rogers
- Department of Surgery, University of Wisconsin, 600 Highland Avenue MC 7375, Madison, WI 53792.
| | - Yiwei Xu
- Department of Surgery, University of Wisconsin, 600 Highland Avenue MC 7375, Madison, WI 53792
| | - Anne O Lidor
- Department of Surgery, University of Wisconsin, 600 Highland Avenue MC 7375, Madison, WI 53792
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14
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Sartori A, De Luca M, Noaro G, Piatto G, Pignata G, Di Leo A, Lauro E, Andreuccetti J. Rare Intraoperative and Postoperative Complications After Transabdominal Laparoscopic Hernia Repair: Results from the Multicenter Wall Hernia Group Registry. J Laparoendosc Adv Surg Tech A 2020; 31:290-295. [PMID: 32808863 DOI: 10.1089/lap.2020.0459] [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] [Indexed: 11/12/2022] Open
Abstract
Background: Inguinal hernioplasty is the most frequently performed operation in the Western world today. Although the laparoscopic approach for inguinal hernia repair has shown excellent results in terms of complications and recurrences, the anterior approach is still the most used. Postoperative pain and recurrences are the most widely studied complications in both approaches, but there is little information about the often more troublesome rare complications of laparoscopic surgery and their treatment. Methods: In the period from January 1, 2014 to December 31, 2019, 1874 hernioplasty operations were performed with the transabdominal approach and recorded prospectively in the Wall Hernia Group database. The mean follow-up was 47 months (range 3-64 months). All less frequent complications were analyzed and a literature review was carried out to assess the presence of similar cases and their treatment in other series. Results: Eight cases of rare complications were identified and subdivided according to the Clavien-Dindo classification. They included a bowel perforation, 4 cases of bleeding, 2 bowel obstructions, and an injury to the motor branch of the obturator nerve. The postoperative course in these patients was significantly longer than in patients with a regular postoperative course. In 2 cases the complication occurred during the first admission, while the remaining 6 patients had to be readmitted within 30 days after discharge. Conclusions: Although serious postoperative complications in laparoscopic inguinal hernioplasty are rare, all surgeons, also those who have completed the learning curve, should be aware of their possible occurrence.
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Affiliation(s)
- Alberto Sartori
- Department of General Surgery, San Valentino Hospital, Montebelluna, Italy
| | - Maurizio De Luca
- Department of General Surgery, San Valentino Hospital, Montebelluna, Italy
| | - Giulia Noaro
- Department of General Surgery, San Valentino Hospital, Montebelluna, Italy
| | - Giacomo Piatto
- Department of General Surgery, San Valentino Hospital, Montebelluna, Italy
| | - Giusto Pignata
- Department of General Surgery II, Spedali Civili, Brescia, Italy
| | - Alberto Di Leo
- Department of General and Minimally Invasive Surgery, San Camillo Hospital, Trento, Italy
| | - Enrico Lauro
- Department of General Surgery, St. Maria Del Carmine Hospital, Rovereto, Italy
| | - Jacopo Andreuccetti
- Department of General and Minimally Invasive Surgery, San Camillo Hospital, Trento, Italy
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15
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Wakasugi M, Yoshikawa Y, Furukawa H, Sueda T, Matsumura T, Koga C, Miyagaki H, Tei M, Kawabata R, Tsujie M, Hasegawa J. Single-incision laparoscopic totally extraperitoneal repair for bilateral inguinal hernias after femoral-femoral artery bypass in a patient on antiplatelet therapy: A case report. Asian J Endosc Surg 2020; 13:444-447. [PMID: 31430041 DOI: 10.1111/ases.12749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 11/26/2022]
Abstract
A 77-year-old man visited our hospital due to bilateral painful inguinal swellings. He had a history of femoral-femoral artery bypass surgery for peripheral artery disease and took ethyl icosapentate. Additionally, he had a previous history of open left colectomy for descending colon cancer and had a median incision reaching the lower abdomen. With a diagnosis of bilateral direct inguinal hernias after femoral-femoral artery bypass surgery, he underwent single-incision laparoscopic surgery for totally extraperitoneal repair, continuing on ethyl icosapentate. During surgery, the preperitoneal space was safely and easily dissected, avoiding a subcutaneous vascular graft. No perioperative complications or hernia recurrence have been observed at 3 months follow-up.
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Affiliation(s)
| | | | | | | | - Tae Matsumura
- Department of Surgery, Osaka Rosai Hospital, Sakai, Japan
| | - Chikato Koga
- Department of Surgery, Osaka Rosai Hospital, Sakai, Japan
| | | | - Mitsuyoshi Tei
- Department of Surgery, Osaka Rosai Hospital, Sakai, Japan
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16
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Kohga A, Kawabe A, Yajima K, Okumura T, Yamashita K, Isogaki J, Suzuki K. Emergency surgery versus elective surgery after reduction for patients with incarcerated groin hernias. ANZ J Surg 2020; 90:1086-1091. [DOI: 10.1111/ans.15877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/05/2020] [Accepted: 03/13/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Atsushi Kohga
- Division of SurgeryFujinomiya City General Hospital Shizuoka Japan
| | - Akihiro Kawabe
- Division of SurgeryFujinomiya City General Hospital Shizuoka Japan
| | - Kiyoshige Yajima
- Division of SurgeryFujinomiya City General Hospital Shizuoka Japan
| | - Takuya Okumura
- Division of SurgeryFujinomiya City General Hospital Shizuoka Japan
| | | | - Jun Isogaki
- Division of SurgeryFujinomiya City General Hospital Shizuoka Japan
| | - Kenji Suzuki
- Division of SurgeryFujinomiya City General Hospital Shizuoka Japan
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17
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Continuation of antithrombotic therapy increases minor bleeding but does not increase the risk other morbidities in open inguinal hernia repair: A propensity score-matched analysis. Hernia 2020; 24:857-865. [PMID: 32162110 DOI: 10.1007/s10029-020-02169-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE An aging population has led to an increased number of patients with cardiovascular comorbidities requiring antithrombotic therapy. Perioperatively, surgeons should consider the increased risk of bleeding and thrombotic events in patients continuing or discontinuing these medications. We aimed to analyze the safety of continued antithrombotic therapy during open inguinal hernia repair. METHODS In this single-center, retrospective study, 4870 adult patients who underwent open inguinal hernia repair surgery by the same surgeon from 2008 January to 2019 March were included. Patients who underwent surgery while continuing antithrombotic therapy were included in the antithrombin group (n = 523) while those who were not under any antithrombotic therapy during the surgery were included in the control group (n = 4333). Using propensity score-matching, we then selected patients from each group with similar backgrounds. Surgery time, anesthesia time, postoperative bleeding, reoperation, and thrombotic event data were compared between the groups. Subgroup analysis based on the type of medications used was performed within the antithrombin group. RESULTS Ten patients in the antithrombin group and seven patients in the control group experienced postoperative bleeding (p < 0.001). The rate of postoperative bleeding was the highest in patients taking multiple medications. However, most were managed conservatively. Three patients from the antithrombin group experienced thrombotic events postoperatively (p = 0.001). CONCLUSIONS Patients receiving continued antithrombotic therapy had an increased risk of minor postoperative bleeding; however, they are a high-risk group for thrombotic events.
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18
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Mita K, Fujino K, Asakawa H, Matsuyama T, Hayashi T, Ito H. Postoperative bleeding complications after endoscopic inguinal hernia repair in patients receiving anticoagulation agents, antiplatelet agents, or both. Asian J Endosc Surg 2020; 13:71-76. [PMID: 30931549 DOI: 10.1111/ases.12698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 02/05/2019] [Accepted: 02/11/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In patients receiving chronic anticoagulation agents, antiplatelet agents, or both, perioperative antithrombotic therapy for inguinal hernia repair requires an understanding of potential side-effects-specifically, the postoperative bleeding risks. In the present study, we evaluated postoperative bleeding complications after transabdominal preperitoneal patch plasty (TAPP) in patients undergoing antithrombotic therapy. METHODS We retrospectively reviewed 413 patients who had undergone TAPP between February 2013 and June 2017. Individuals in the antithrombotic group received one of three regimens of perioperative antithrombotic therapy. The clinical indications for chronic anticoagulation agents (ie bridging therapy with unfractionated heparin), antiplatelet agents (ie continuation of aspirin), or both were followed. The antithrombotic group was compared to the control group in terms of surgical outcomes. We primarily focused on the incidence of postoperative bleeding complications. RESULTS A total of 83 patients received antithrombotic therapy. We observed significant differences between the groups in terms of mean age, ASA physical status, and length of postoperative stay. In contrast, postoperative complications were not significantly different between the antithrombotic and control groups (4.8% vs 5.5%, P = 0.818). In addition, a significantly greater postoperative bleeding rate was not observed in the antithrombotic group than in the control group (1.2% vs 0.6%, P = 0.566). Likewise, other complications were similar in both groups. CONCLUSIONS Antithrombotic therapy is not a risk factor for postoperative bleeding complications in patients who have undergone TAPP, suggesting its safety and efficacy in this patient population. Indeed, this group has the same incidence rates of morbidity and postoperative bleeding complications as patients who have not undergone antithrombotic therapy.
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Affiliation(s)
- Kazuhito Mita
- Department of Surgery, New Tokyo Hospital, Matsudo, Japan
| | - Keiichi Fujino
- Department of Surgery, New Tokyo Hospital, Matsudo, Japan
| | - Hideki Asakawa
- Department of Surgery, New Tokyo Hospital, Matsudo, Japan
| | | | | | - Hideto Ito
- Department of Surgery, New Tokyo Hospital, Matsudo, Japan
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19
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Köckerling F, Sheen AJ, Berrevoet F, Campanelli G, Cuccurullo D, Fortelny R, Friis-Andersen H, Gillion JF, Gorjanc J, Kopelman D, Lopez-Cano M, Morales-Conde S, Österberg J, Reinpold W, Simmermacher RKJ, Smietanski M, Weyhe D, Simons MP. The reality of general surgery training and increased complexity of abdominal wall hernia surgery. Hernia 2019; 23:1081-1091. [PMID: 31754953 PMCID: PMC6938469 DOI: 10.1007/s10029-019-02062-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/27/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The Accreditation and Certification of Hernia Centers and Surgeons (ACCESS) Group of the European Hernia Society (EHS) recognizes that there is a growing need to train specialist abdominal wall surgeons. The most important and relevant argument for this proposal and statement is the growing acceptance of the increasing complexity of abdominal wall surgery due to newer techniques, more challenging cases and the required 'tailored' approach to such surgery. There is now also an increasing public awareness with social media, whereby optimal treatment results are demanded by patients. However, to date the complexity of abdominal wall surgery has not been properly or adequately defined in the current literature. METHODS A systematic search of the available literature was performed in May 2019 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library, with 75 publications identified as relevant. In addition, an analysis of data from the Herniamed Hernia Registry was performed. The percentage of patients with hernia- or patient-related characteristics which unfavorably impacted the outcome of inguinal and incisional hernia repair was also calculated. RESULTS All present guidelines for abdominal wall surgery recommend the utilization of a 'tailored' approach. This relies on the prerequisite that any surgical technique used has already been mastered, as well as the recognized learning curves for each of the several techniques that can be used for both inguinal hernia (Lichtenstein, TEP, TAPP, Shouldice) and incisional hernia repairs (laparoscopic IPOM, open sublay, open IPOM, open onlay, open or endoscopic component separation technique). Other hernia- and patient-related characteristics that have recognized complexity include emergency surgery, obesity, recurrent hernias, bilateral inguinal hernias, groin hernia in women, scrotal hernias, large defects, high ASA scores, > 80 years of age, increased medical risk factors and previous lower abdominal surgery. The proportion of patients with at least one of these characteristics in the Herniamed Hernia Registry in the case of both inguinal and incisional hernia is noted to be relatively high at around 70%. In general surgery training approximately 50-100 hernia repairs on average are performed by each trainee, with around only 25 laparo-endoscopic procedures. CONCLUSION A tailored approach is now employed and seen more so in hernia surgery and this fact is referred to and highlighted in the contemporaneous hernia guidelines published to date. In addition, with the increasing complexity of abdominal wall surgery, the number of procedures actually performed by trainees is no longer considered adequate to overcome any recognized learning curve. Therefore, to supplement general surgery training young surgeons should be offered a clinical fellowship to obtain an additional qualification as an abdominal wall surgeon and thus improve their clinical and operative experience under supervision in this field. Practicing general surgeons with a special interest in hernia surgery can undertake intensive further training in this area by participating in clinical work shadowing in hernia centers, workshops and congresses.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - A J Sheen
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester, M13 9WL, UK
| | - F Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Universitair Ziekenhuis Gent, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - G Campanelli
- General and Day Surgery Unit, Center of Research and High Specialization for the Pathologies of Abdominal Wall and Surgical Treatment and Repair of Abdominal Hernia, Milano Hernia Center, Instituto Clinico Sant'Ambrogio, University of Insurbria, Milan, Italy
| | - D Cuccurullo
- Department of General, Laparoscopic and Robotic Surgery, Chief Week Surgery Departmental Unit, A.O. dei Colli Monaldi Hospital Naples, Naples, Italy
| | - R Fortelny
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital, 1160, Vienna, Austria
- Medical Faculty of Sigmund Freud University, 1020, Vienna, Austria
| | - H Friis-Andersen
- Surgical Department, Horsens Regional Hospital, Aarhus University, Sundvey 30, 8700, Horsens, Denmark
| | - J F Gillion
- Unité de Chirurgie Viscérale, Hôpital Privé d'Antony, 1, Rue Velpeau, 92160, Antony, France
| | - J Gorjanc
- Department of Surgery, Krankenhaus der Barmherzigen Brüder, Spitalgasse 26, 9300, St. Veit an der Glan, Austria
| | - D Kopelman
- Department of Surgery Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - M Lopez-Cano
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, University Hospital Virgen del Rocío, Av. Manuel Siurot, s/n, 41013, Seville, Spain
| | - J Österberg
- Department of Surgery, Mora Hospital, 79285, Mora, Sweden
| | - W Reinpold
- Wilhelmsburger Krankenhaus Gross-Sand, Gross-Sand 3, 21107, Hamburg, Germany
| | - R K J Simmermacher
- Department of Surgery, University Medical Center Utrecht, Heidelbergglaan 100, Utrecht, The Netherlands
| | - M Smietanski
- Department of General Surgery and Hernia Centre, Hospital in Puck, Medical University of Gdansk, Gdansk, Poland
| | - D Weyhe
- School of Medicine and Health Sciences, University Hospital for Visceral Surgery, Pius Hospital Oldenburg, Medical Campus University of Oldenburg, Georgstr. 12, 26121, Oldenburg, Germany
| | - M P Simons
- Department of Surgery, OLVG Hospital, Amsterdam, The Netherlands
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Continuation of low-dose acetylsalicylic acid during perioperative period of laparoscopic inguinal hernia repair is safe: results of a prospective clinical trial. Hernia 2019; 23:1141-1148. [DOI: 10.1007/s10029-019-02040-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 08/22/2019] [Indexed: 10/26/2022]
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21
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Li J, Wang M, Cheng T. The safe and risk assessment of perioperative antiplatelet and anticoagulation therapy in inguinal hernia repair, a systematic review. Surg Endosc 2019; 33:3165-3176. [DOI: 10.1007/s00464-019-06956-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/01/2019] [Indexed: 01/30/2023]
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22
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Ho CH, Wu CC, Wu CC, Tsai YC. Laparoscopic total extraperitoneal inguinal hernia repair is safe and feasible in patients with continuation of antithrombotics. J Minim Access Surg 2019; 15:299-304. [PMID: 30106020 PMCID: PMC6839354 DOI: 10.4103/jmas.jmas_128_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aims We aimed to evaluate the safety and feasibility of laparoscopic total extraperitoneal (TEP) inguinal hernia repair in patients with the continuation of their antithrombotic agents. Settings and Design This was prospective cohort study. Materials and Methods A total of 115 patients who underwent TEP inguinal hernia repair between January 2015 and September 2016 were included in the analysis. Seventeen patients continued their antithrombotics (antithrombotic group); the other 98 had not been on antithrombotics (control group). Statistical Analysis Used The analysis was performed by using Mann-Whitney U-test, Chi-square or Fisher's exact test. Results The antithrombotic group had a greater mean age (65.9 ± 8.0 vs. 57.7 ± 13.6,P= 0.002) and higher prevalence of hypertension (64.7% vs. 33.7%,P= 0.015), cardiovascular diseases (64.7% vs. 7.1%,P < 0.001), atrial fibrillation (23.5% vs. 0,P < 0.001), ischaemic heart disease (35.3% vs. 0,P < 0.001) and the American Society of Anaesthesiologists ≥2 (94.1% vs. 81.6%,P= 0.005). The operation time for the antithrombotic group was longer than that of the control group (92.06 ± 32.81 min vs. 72.33 ± 20.99 min,P= 0.015). None experienced conversion to open surgery in either group. There was no difference in the post-operative complications (29.4% vs. 28.6%) and sero-haematoma formation (23.5% vs. 11.1%). The analgesic requirement, hospital stays (23.72 ± 7.74 vs. 22.35 ± 10.33 h) and the time for return to normal daily activity (3.56 ± 1.74 vs. 3.63 ± 1.90) were not statistically different between the two groups. None in either group experienced major cardiovascular events within 30 days. Conclusions Laparoscopic TEP inguinal hernia repair can be safely performed in patients with the continuation of their antithrombotic agents in experienced hands.
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Affiliation(s)
- Chen-Hsun Ho
- Department of Urology, School of Medicine, College of Medicine; Department of Urology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chia-Chang Wu
- Department of Urology, School of Medicine, College of Medicine; Department of Urology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chao-Chuan Wu
- Department of Surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Yao-Chou Tsai
- Department of Surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, Taipei; Department of Urology, Medical College, Tzu Chi University, Hualien, Taiwan
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Wirth U, Saller ML, von Ahnen T, Köckerling F, Schardey HM, Schopf S. [Inguinal hernia repair in TAPP technique in a day-case surgery setting - at what price?]. Chirurg 2018; 88:792-798. [PMID: 28451730 DOI: 10.1007/s00104-017-0429-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND TAPP surgery can be considered as a gold standard in inguinal hernia repair. Patients benefit of a faster reconvalescence and less pain compared to other techniques. TAPP surgery in Germany is performed in an in-patient setting routinely. However, according to European guidelines, inguinal hernia surgery should be considered as day-case surgery whenever possible. OBJECTIVES The safety of day-case surgery was examined in relation to postoperative pain, complications, comorbidities, recurrent inguinal hernia and bilateral procedures. MATERIAL AND METHODS In a retrospective, monocentric study we analyzed 522 elective inguinal hernia repairs using TAPP technique in a specialized hernia center. Supplemental data from Herniamed registry is analyzed. RESULTS Parts of the procedures should be performed in an in-patient setting, whereas a much larger number of cases should be carried out as day-case surgeries. Logistic regression analyses show that "age", "bilateral procedures" and "comorbidities" affect the complication rate. "Age" and "recurrent inguinal hernia" are risk factors for an increased need for analgetic medication. Furthermore, we present an actual distribution of day-case vs. in-patient surgeries in inguinal hernia repair based on data from the Herniamed registry. CONCLUSION A much larger part of procedures could safely be carried out as day-case surgeries. Based on a false incentive there is an incorrect steering in the German health system. These procedures cannot be carried out covering the costs as day-surgery cases. If there is no reevaluation of the proceeds of these procedures in a day-case surgery setting, the reasonable quality in treatment is compromised especially in inguinal hernia surgery.
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Affiliation(s)
- U Wirth
- Klinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland. .,Institut für Chirurgische Forschung Oberbayern e. V., Hausham, Deutschland.
| | - M-L Saller
- Institut für Chirurgische Forschung Oberbayern e. V., Hausham, Deutschland.,Klinik für Rehabilitation und Innere Medizin, International Medical Center, Schön Klinik Vogtareuth, Vogtareuth, Deutschland
| | - T von Ahnen
- Institut für Chirurgische Forschung Oberbayern e. V., Hausham, Deutschland.,Abteilung für Allgemein-, Viszeral- und Gefäßchirurgie, Krankenhaus Agatharied, Hausham, Deutschland
| | - F Köckerling
- Klinik für Chirurgie-, Viszeral- und Gefäßchirurgie, Vivantes-Klinikum Spandau, Berlin, Deutschland
| | - H M Schardey
- Institut für Chirurgische Forschung Oberbayern e. V., Hausham, Deutschland.,Abteilung für Allgemein-, Viszeral- und Gefäßchirurgie, Krankenhaus Agatharied, Hausham, Deutschland
| | - S Schopf
- Institut für Chirurgische Forschung Oberbayern e. V., Hausham, Deutschland.,Abteilung für Allgemein-, Viszeral- und Gefäßchirurgie, Krankenhaus Agatharied, Hausham, Deutschland
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Staerkle RF, Hoffmann H, Köckerling F, Adolf D, Bittner R, Kirchhoff P. Does coagulopathy, anticoagulant or antithrombotic therapy matter in incisional hernia repair? Data from the Herniamed Registry. Surg Endosc 2018; 32:3881-3889. [PMID: 29492708 PMCID: PMC6096530 DOI: 10.1007/s00464-018-6127-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 02/23/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND A considerable number of patients undergoing incisional hernia repair are on anticoagulant or antiplatelet therapy or have existing coagulopathy which may put them at higher risk for postoperative bleeding complications. Data about the optimal treatment of these patients are sparse. This analysis attempts to determine the rate of postoperative bleeding complications following incisional hernia repair and the consecutive rate of reoperation among patients with coagulopathy or receiving antiplatelet and anticoagulant therapy (higher risk group) compared to patients who do not have a higher risk (normal risk group). METHODS Out of the 43,101 patients documented in the Herniamed Registry who had an incisional hernia repair, 6668 (15.5%) were on anticoagulant or antithrombotic therapy or had existing coagulopathy. The implication of that higher risk profile for onset of postoperative bleeding was investigated in multivariable analysis. Hence, other influential variables were identified. RESULTS The rate of postoperative bleeding in the higher risk group was 3.9% (n = 261) and significantly higher compared to the normal risk group at 1.6% (n = 564) (OR 2.001 [1.699; 2.356]; p < 0.001). Additionally, male gender, use of drains, larger defect size, open incisional hernia repair, lower BMI, and higher ASA score significantly increased the risk of postoperative bleeding. The rate of reoperations due to postoperative bleeding was significantly increased in the higher risk group compared to the normal risk group (2.4 vs. 1.0%; OR 1.217 [1.071; 1.382]; p = 0.003). Likewise, the postoperative general complication rate (6.04 vs. 3.66%; p < 0.001) as well as the mortality rate (0.46 vs. 0.17%; p < 0.001) were significantly higher in the higher risk group. CONCLUSIONS Patients with anticoagulant or antiplatelet therapy or existing coagulopathy who undergo incisional hernia repair have a significantly higher risk for onset of postoperative bleeding. The risk of bleeding complications and complication-related reoperations seems to be lower after laparoscopic intraperitoneal onlay mesh.
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Affiliation(s)
- Ralph F Staerkle
- Department of Surgery, Clinic for Visceral Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Henry Hoffmann
- Department of Surgery, Clinic for Visceral Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Ferdinand Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany
| | - Daniela Adolf
- StatConsult GmbH, Halberstädter Straße 40 a, 39112, Magdeburg, Germany
| | - Reinhard Bittner
- Winghofer Medicum Hernia Center, Winghofer Strasse 42, 72108, Rottenburg am Neckar, Germany
| | - Philipp Kirchhoff
- Department of Surgery, Clinic for Visceral Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
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25
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Abstract
The guidelines of all international hernia societies recommend as procedures of choice the laparoendoscopic techniques total extraperitoneal patch plasty (TEP) and transabdominal preperitoneal patch plasty (TAPP) as well as the open Lichtenstein operation for elective inguinal hernia repair. The learning curve associated with the laparoendoscopic techniques, in particular TEP, is longer than that for the open Lichtenstein technique due to the complexity of the procedures. Accordingly, for laparoendoscopic techniques it is particularly important that the operations are conducted in a standardized manner in compliance with the evidence-based recommendations given for the technical details. When procedures are carried out in strict compliance with the guidelines of the international hernia societies, low rates of perioperative complications, complication-related reoperations, recurrences and chronic pain can be expected for TEP. Compliance with the guidelines can also positively impact mastery of the learning curve for TEP. The technical guidelines on TEP are based on study results and on the experiences of numerous experts; therefore, it is imperative that they are implemented in routine surgical practice.
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Affiliation(s)
- F Köckerling
- Klinik für Chirurgie - Viszeral- und Gefäßchirurgie, Zentrum für Minimal Invasive Chirurgie, Zertifiziertes Zentrum für Hernienchirurgie, Zertifiziertes Zentrum für Adipositaschirurgie, Vivantes Klinikum Spandau, Neue Bergstraße 6, 13585, Berlin, Deutschland.
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26
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Laparoscopic repair is a treatment of choice for selected patients with incarcerated obturator hernia. Hernia 2018; 22:887-895. [DOI: 10.1007/s10029-018-1747-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 01/25/2018] [Indexed: 02/07/2023]
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Abstract
INTRODUCTION Worldwide, more than 20 million patients undergo groin hernia repair annually. The many different approaches, treatment indications and a significant array of techniques for groin hernia repair warrant guidelines to standardize care, minimize complications, and improve results. The main goal of these guidelines is to improve patient outcomes, specifically to decrease recurrence rates and reduce chronic pain, the most frequent problems following groin hernia repair. They have been endorsed by all five continental hernia societies, the International Endo Hernia Society and the European Association for Endoscopic Surgery. METHODS An expert group of international surgeons (the HerniaSurge Group) and one anesthesiologist pain expert was formed. The group consisted of members from all continents with specific experience in hernia-related research. Care was taken to include surgeons who perform different types of repair and had preferably performed research on groin hernia surgery. During the Group's first meeting, evidence-based medicine (EBM) training occurred and 166 key questions (KQ) were formulated. EBM rules were followed in complete literature searches (including a complete search by The Dutch Cochrane database) to January 1, 2015 and to July 1, 2015 for level 1 publications. The articles were scored by teams of two or three according to Oxford, SIGN and Grade methodologies. During five 2-day meetings, results were discussed with the working group members leading to 136 statements and 88 recommendations. Recommendations were graded as "strong" (recommendations) or "weak" (suggestions) and by consensus in some cases upgraded. In the Results and summary section below, the term "should" refers to a recommendation. The AGREE II instrument was used to validate the guidelines. An external review was performed by three international experts. They recommended the guidelines with high scores. The risk factors for inguinal hernia (IH) include: family history, previous contra-lateral hernia, male gender, age, abnormal collagen metabolism, prostatectomy, and low body mass index. Peri-operative risk factors for recurrence include poor surgical techniques, low surgical volumes, surgical inexperience and local anesthesia. These should be considered when treating IH patients. IH diagnosis can be confirmed by physical examination alone in the vast majority of patients with appropriate signs and symptoms. Rarely, ultrasound is necessary. Less commonly still, a dynamic MRI or CT scan or herniography may be needed. The EHS classification system is suggested to stratify IH patients for tailored treatment, research and audit. Symptomatic groin hernias should be treated surgically. Asymptomatic or minimally symptomatic male IH patients may be managed with "watchful waiting" since their risk of hernia-related emergencies is low. The majority of these individuals will eventually require surgery; therefore, surgical risks and the watchful waiting strategy should be discussed with patients. Surgical treatment should be tailored to the surgeon's expertise, patient- and hernia-related characteristics and local/national resources. Furthermore, patient health-related, life style and social factors should all influence the shared decision-making process leading up to hernia management. Mesh repair is recommended as first choice, either by an open procedure or a laparo-endoscopic repair technique. One standard repair technique for all groin hernias does not exist. It is recommended that surgeons/surgical services provide both anterior and posterior approach options. Lichtenstein and laparo-endoscopic repair are best evaluated. Many other techniques need further evaluation. Provided that resources and expertise are available, laparo-endoscopic techniques have faster recovery times, lower chronic pain risk and are cost effective. There is discussion concerning laparo-endoscopic management of potential bilateral hernias (occult hernia issue). After patient consent, during TAPP, the contra-lateral side should be inspected. This is not suggested during unilateral TEP repair. After appropriate discussions with patients concerning results tissue repair (first choice is the Shouldice technique) can be offered. Day surgery is recommended for the majority of groin hernia repair provided aftercare is organized. Surgeons should be aware of the intrinsic characteristics of the meshes they use. Use of so-called low-weight mesh may have slight short-term benefits like reduced postoperative pain and shorter convalescence, but are not associated with better longer-term outcomes like recurrence and chronic pain. Mesh selection on weight alone is not recommended. The incidence of erosion seems higher with plug versus flat mesh. It is suggested not to use plug repair techniques. The use of other implants to replace the standard flat mesh in the Lichtenstein technique is currently not recommended. In almost all cases, mesh fixation in TEP is unnecessary. In both TEP and TAPP it is recommended to fix mesh in M3 hernias (large medial) to reduce recurrence risk. Antibiotic prophylaxis in average-risk patients in low-risk environments is not recommended in open surgery. In laparo-endoscopic repair it is never recommended. Local anesthesia in open repair has many advantages, and its use is recommended provided the surgeon is experienced in this technique. General anesthesia is suggested over regional in patients aged 65 and older as it might be associated with fewer complications like myocardial infarction, pneumonia and thromboembolism. Perioperative field blocks and/or subfascial/subcutaneous infiltrations are recommended in all cases of open repair. Patients are recommended to resume normal activities without restrictions as soon as they feel comfortable. Provided expertise is available, it is suggested that women with groin hernias undergo laparo-endoscopic repair in order to decrease the risk of chronic pain and avoid missing a femoral hernia. Watchful waiting is suggested in pregnant women as groin swelling most often consists of self-limited round ligament varicosities. Timely mesh repair by a laparo-endoscopic approach is suggested for femoral hernias provided expertise is available. All complications of groin hernia management are discussed in an extensive chapter on the topic. Overall, the incidence of clinically significant chronic pain is in the 10-12% range, decreasing over time. Debilitating chronic pain affecting normal daily activities or work ranges from 0.5 to 6%. Chronic postoperative inguinal pain (CPIP) is defined as bothersome moderate pain impacting daily activities lasting at least 3 months postoperatively and decreasing over time. CPIP risk factors include: young age, female gender, high preoperative pain, early high postoperative pain, recurrent hernia and open repair. For CPIP the focus should be on nerve recognition in open surgery and, in selected cases, prophylactic pragmatic nerve resection (planned resection is not suggested). It is suggested that CPIP management be performed by multi-disciplinary teams. It is also suggested that CPIP be managed by a combination of pharmacological and interventional measures and, if this is unsuccessful, followed by, in selected cases (triple) neurectomy and (in selected cases) mesh removal. For recurrent hernia after anterior repair, posterior repair is recommended. If recurrence occurs after a posterior repair, an anterior repair is recommended. After a failed anterior and posterior approach, management by a specialist hernia surgeon is recommended. Risk factors for hernia incarceration/strangulation include: female gender, femoral hernia and a history of hospitalization related to groin hernia. It is suggested that treatment of emergencies be tailored according to patient- and hernia-related factors, local expertise and resources. Learning curves vary between different techniques. Probably about 100 supervised laparo-endoscopic repairs are needed to achieve the same results as open mesh surgery like Lichtenstein. It is suggested that case load per surgeon is more important than center volume. It is recommended that minimum requirements be developed to certify individuals as expert hernia surgeon. The same is true for the designation "Hernia Center". From a cost-effectiveness perspective, day-case laparoscopic IH repair with minimal use of disposables is recommended. The development and implementation of national groin hernia registries in every country (or region, in the case of small country populations) is suggested. They should include patient follow-up data and account for local healthcare structures. A dissemination and implementation plan of the guidelines will be developed by global (HerniaSurge), regional (international societies) and local (national chapters) initiatives through internet websites, social media and smartphone apps. An overarching plan to improve access to safe IH surgery in low-resource settings (LRSs) is needed. It is suggested that this plan contains simple guidelines and a sustainability strategy, independent of international aid. It is suggested that in LRSs the focus be on performing high-volume Lichtenstein repair under local anesthesia using low-cost mesh. Three chapters discuss future research, guidelines for general practitioners and guidelines for patients. CONCLUSIONS The HerniaSurge Group has developed these extensive and inclusive guidelines for the management of adult groin hernia patients. It is hoped that they will lead to better outcomes for groin hernia patients wherever they live. More knowledge, better training, national audit and specialization in groin hernia management will standardize care for these patients, lead to more effective and efficient healthcare and provide direction for future research.
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Kohga A, Kawabe A, Cao Y, Yajima K, Okumura T, Yamashita K, Isogaki J, Suzuki K. Elective laparoscopic repair after reduction might be useful strategy for incarcerated obturator hernia: a case report. J Surg Case Rep 2017; 2017:rjx180. [PMID: 28959429 PMCID: PMC5610579 DOI: 10.1093/jscr/rjx180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 08/14/2017] [Accepted: 08/24/2017] [Indexed: 01/09/2023] Open
Abstract
Obturator hernia is a rare clinical condition that causes intestinal obstruction. Recent reports have suggested that laparoscopic repair may be useful for incarcerated obturator hernia in select patients. The patient was a 64-year-old female who presented to our emergency department with a chief complaint of abdominal pain. Computed tomography (CT) imaging revealed an incarcerated obturator hernia on her right side, without apparent findings of irreversible ischaemic change or perforation. She had a previous history of cardiovascular surgery and was taking an anticoagulant medication. We performed a reduction of the incarcerated intestine. After heparin displacement, laparoscopic repair was electively performed. During laparoscopy, an occult obturator hernia was found on the left side. We repaired the bilateral obturator hernia using a mesh prosthesis. Elective laparoscopic repair after reduction might be a useful procedure for incarcerated obturator hernias in those patients without findings of irreversible ischaemic change or perforation.
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Affiliation(s)
- Atsushi Kohga
- Division of Surgery, Fujinomiya City General Hospital, 3-1, Nishiki-cho, Fujinomiya, Shizuoka, Japan
| | - Akihiro Kawabe
- Division of Surgery, Fujinomiya City General Hospital, 3-1, Nishiki-cho, Fujinomiya, Shizuoka, Japan
| | - Yuchen Cao
- Division of Surgery, Fujinomiya City General Hospital, 3-1, Nishiki-cho, Fujinomiya, Shizuoka, Japan
| | - Kiyoshige Yajima
- Division of Surgery, Fujinomiya City General Hospital, 3-1, Nishiki-cho, Fujinomiya, Shizuoka, Japan
| | - Takuya Okumura
- Division of Surgery, Fujinomiya City General Hospital, 3-1, Nishiki-cho, Fujinomiya, Shizuoka, Japan
| | - Kimihiro Yamashita
- Division of Surgery, Fujinomiya City General Hospital, 3-1, Nishiki-cho, Fujinomiya, Shizuoka, Japan
| | - Jun Isogaki
- Division of Surgery, Fujinomiya City General Hospital, 3-1, Nishiki-cho, Fujinomiya, Shizuoka, Japan
| | - Kenji Suzuki
- Division of Surgery, Fujinomiya City General Hospital, 3-1, Nishiki-cho, Fujinomiya, Shizuoka, Japan
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29
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Wakasugi M, Tei M, Suzuki Y, Furukawa K, Masuzawa T, Kishi K, Tanemura M, Akamatsu H. Single-incision totally extraperitoneal inguinal hernia repair is feasible and safe in patients on antithrombotic therapy: A single-center experience of 92 procedures. Asian J Endosc Surg 2017; 10:301-307. [PMID: 28516514 DOI: 10.1111/ases.12368] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/12/2016] [Accepted: 01/29/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the feasibility and safety of SILS for totally extraperitoneal inguinal hernia repair for patients on antithrombotic therapy. METHODS A total of 365 patients who underwent SILS for totally extraperitoneal inguinal hernia repair between January 2011 and November 2015 were analyzed retrospectively. Antithrombotic drugs were stopped preoperatively, and bridging intravenous heparin therapy was given according to the operative risk of each patient. Data on the patients' characteristics and perioperative outcomes were collected from their medical records. RESULTS Ninety-two patients (25%, 92/365) were treated with antithrombotic drugs preoperatively. The mean operative times for unilateral and bilateral hernia repairs were 96 min and 94 min (P = 0.5), respectively, in the antithrombotic therapy group and 140 min and 130 min (P = 0.2), respectively, in the control group. Bleeding volume was minimal in all patients. There was no significant difference in the conversion rate. The mean postoperative hospital stay was 2.5 days in the antithrombotic therapy group and 2.1 days in the control group (P = 0.1). Postoperative complications were seen in 16% (15/92) of patients in the antithrombotic therapy group and in 11% (29/273) of patients in the control group (P = 0.2). Pulmonary embolism was seen in one patient (0.4%, 1/273) in the control group. CONCLUSIONS SILS for totally extraperitoneal inguinal hernia repair with bridging heparin therapy can be performed safely for patients on antithrombotic therapy.
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Affiliation(s)
| | - Mitsuyoshi Tei
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Yozo Suzuki
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Kenta Furukawa
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Toru Masuzawa
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Kentaro Kishi
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
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Weyhe D, Tabriz N, Sahlmann B, Uslar VN. Risk factors for perioperative complications in inguinal hernia repair - a systematic review. Innov Surg Sci 2017; 2:47-52. [PMID: 31579736 PMCID: PMC6754002 DOI: 10.1515/iss-2017-0008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 02/09/2017] [Indexed: 11/15/2022] Open
Abstract
The current literature suggests that perioperative complications occur in 8%–10% of all inguinal hernia repairs. However, the clinical relevance of these complications is currently unknown. In our review, based on 571,445 hernia repairs reported in 39 publications, we identified the following potential risk factors: patient age, ASA score, diabetes, smoking, mode of admission (emergency vs. elective surgery), surgery in low resource settings, type of anesthesia, and (in men) bilateral and sliding hernias. The most commonly reported complications are bleeding (0.9%), wound infection (0.5%), and pulmonary and cardiovascular complications (0.2%). In 3.9% of the included publications, a reliable grading of the reported complications according to Clavien-Dindo classification was possible. Using this classification retrospectively, we could show that, in patients with complications, these are clinically relevant for about 22% of these patients (Clavien-Dindo grade ≥IIIa). About 78% of all patients suffered from complications needing only minor (meaning mostly medical) intervention (Clavien-Dindo grade <III). Especially with regard to the low incidence of complications in inguinal hernia repair, future studies should use the Clavien-Dindo classification to achieve better comparability between studies, thus enabling better correlation with potential risk factors.
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Affiliation(s)
- Dirk Weyhe
- Medical Campus University of Oldenburg, School of Medicine and Health Sciences, University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Georgstr. 12, 26121 Oldenburg, Germany
| | - Navid Tabriz
- Medical Campus University of Oldenburg, School of Medicine and Health Sciences, University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Georgstr. 12, 26121 Oldenburg, Germany
| | - Bianca Sahlmann
- Medical Campus University of Oldenburg, School of Medicine and Health Sciences, University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Georgstr. 12, 26121 Oldenburg, Germany
| | - Verena-Nicole Uslar
- Medical Campus University of Oldenburg, School of Medicine and Health Sciences, University Hospital for Visceral Surgery, Pius-Hospital Oldenburg, Georgstr. 12, 26121 Oldenburg, Germany
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Köckerling F. Data and outcome of inguinal hernia repair in hernia registers - a review of the literature. Innov Surg Sci 2017; 2:69-79. [PMID: 31579739 PMCID: PMC6754003 DOI: 10.1515/iss-2016-0206] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 12/29/2016] [Indexed: 01/29/2023] Open
Abstract
Register-based observational studies in inguinal hernia repair deliver real-world data from very large patient populations and give answers to important clinical questions never evaluated in randomized controlled trials. Data from hernia registers can provide evidence of effectiveness of therapies in the general population. Hernia registers with high case load have existed in Sweden since 1992, in Denmark since 1998, and in Germany/Austria/Switzerland since 2009. In this review, the most important findings of register-based observational studies in inguinal hernia repair are presented. After an intensive literature search, 85 articles are relevant for this review. Numerous findings from these register-based studies have been incorporated into the various guidelines on inguinal hernia repair. These highlight the particular importance of hernia registers in answering key scientific and clinical questions in hernia surgery. The myriad of surgical techniques described – spanning more than 100 and with ongoing new additions – as well as the large number of associated medical devices call for, more than in other surgical disciplines, meticulous documentation of the methods used for the treatment of inguinal hernias.
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Affiliation(s)
- Ferdinand Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, D-13585 Berlin, Germany
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