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da Silveira CAB, Rasador AC, Lima DL, Kasmirski J, Kasakewitch JPG, Nogueira R, Malcher F, Sreeramoju P. The impact of smoking on ventral and inguinal hernia repair: a systematic review and meta-analysis. Hernia 2024:10.1007/s10029-024-03122-9. [PMID: 39085514 DOI: 10.1007/s10029-024-03122-9] [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: 04/09/2024] [Accepted: 07/23/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE Individual studies indicate poorer outcomes for smokers after hernia repair. Previous meta-analyses have examined the impact of smoking on specific outcomes such as recurrence and surgical site infection, but there has been a lack of comprehensive consensus or systematic review on this subject. Addressing this gap, our study undertakes a systematic review and meta-analysis to assess the impact of smoking on the outcomes of ventral hernia repair (VHR) and inguinal hernia repair. SOURCE A thorough search of Cochrane Central, Scopus, SciELO, and PubMed/MEDLINE, focusing on studies that examined the effect of smoking on inguinal and VHR outcomes was conducted. Key outcomes evaluated included recurrence, reoperation, surgical site occurrences (SSO), surgical site infection (SSI), and seroma. PRINCIPAL FINDINGS Out of 3296 screened studies, 42 met the inclusion criteria. These comprised 25 studies (69,295 patients) on VHR and 17 studies (204,337 patients) on inguinal hernia repair. The analysis revealed that smokers had significantly higher rates of recurrence (10.4% vs. 9.1%; RR 1.48; 95% CI [1.15; 1.90]; P < 0.01), SSO (13.6% vs. 12.7%; RR 1.44; 95% CI [1.12; 1.86]; P < 0.01) and SSI (6.6% vs. 4.2%; RR 1.64; 95% CI [1.38; 1.94]; P < 0.01) following VHR. Additionally, smokers undergoing inguinal hernia repair showed higher recurrence (9% vs. 8.7%; RR 1.91; 95% CI [1.21; 3.01]; P < 0.01), SSI (0.6% vs. 0.3%; RR 1.6; 95% CI [1.21; 2.0]; P < 0.001), and chronic pain (9.9% vs. 10%; RR 1.24; 95% CI [1.06; 1.45]; P < 0.01) rates. No significant differences were observed in seroma (RR 2.63; 95% CI [0.88; 7.91]; P = 0.084) and reoperation rates (RR 1.48; 95% CI [0.77; 2.85]; P = 0.236) for VHR, and in reoperation rates (RR 0.99; 95% CI [0.51; 1.91]; P = 0.978) for inguinal hernias between smokers and non-smokers. Analysis using funnel plots and Egger's test showed the absence of publication bias in the study outcomes. CONCLUSION This comprehensive meta-analysis found statistically significant increases in recurrence rates, and immediate postoperative complications, such as SSO and SSI following inguinal and VHR. Also, our subgroup analysis suggests that the MIS approach seems to be protective of adverse outcomes in the smokers group. However, our findings suggest that these findings are not of clinical relevance, so our data do not support the necessity of smoking cessation before hernia surgery. More studies are needed to elucidate the specific consequences of smoking in both inguinal and ventral hernia repair. PROSPERO REGISTRATION ID CRD42024517640.
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Affiliation(s)
| | | | - Diego L Lima
- Department of Surgery, Montefiore Medical Center, Bronx, NY, USA.
| | | | - João P G Kasakewitch
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Flavio Malcher
- Division of General Surgery, NYU Langone, New York, NY, USA
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Lau Young J, Poynter D, Moss D, Singh PP, Weaver A, Poole G. Quality of life following laparoscopic inguinal hernia surgery with self-adhesive mesh in 552 patients: a two surgeon experience. ANZ J Surg 2022; 92:2487-2491. [PMID: 35748499 DOI: 10.1111/ans.17860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/02/2022] [Accepted: 06/08/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Given negative publicity surrounding surgical mesh in the media, the aim of this study was to assess post-operative morbidity and quality of life (QoL) following laparoscopic inguinal hernia surgery with self-adhesive ProgripTM mesh. METHODS This study is a retrospective analysis of ProgripTM mesh for laparoscopic inguinal hernia repairs by two experienced surgeons in the public and private sectors. Data were collected by screening electronic clinical records. A sample of participants were contacted directly for QoL assessment using the Carolinas Comfort Scale (CCS). Descriptive statistical analysis was performed in Microsoft Excel. RESULTS Five hundred and fifty-two patients had 648 hernia repairs using ProgripTM mesh from 2013 to 2019. The rate of hernia recurrence was 0.2% (n = 1). The rate of reoperation was 0.5% (n = 3). There were no mesh explant procedures, no adhesion-related readmissions and no perioperative deaths. Haematoma was the most common post-operative complication, occurring in 3.1% of participants (n = 17). The CCS assessment had a response rate of 55.8%. A total of 93% of CCS questions were answered with no sensation of mesh, 92% with no pain and 98% with no movement limitation. No participants reported severe or disabling symptoms. CONCLUSION In this cohort, laparoscopic inguinal hernia repair with ProgripTM has shown a low recurrence rate and excellent post-operative QoL. The QoL data shows that the public perception of mesh based on media reports of complications may not be relevant for this operation. The knowledge gained from this study reinforces the potential value of a national mesh registry such as those seen overseas.
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Affiliation(s)
- Jade Lau Young
- Department of General Surgery, Counties Manukau DHB, Auckland, New Zealand
| | - Demi Poynter
- Department of General Surgery, Counties Manukau DHB, Auckland, New Zealand
| | - David Moss
- Department of General Surgery, Counties Manukau DHB, Auckland, New Zealand.,General Surgery, Ormiston Private Hospital & Eastcare Specialist Centre, Auckland, New Zealand
| | - Parry Primal Singh
- Department of General Surgery, Counties Manukau DHB, Auckland, New Zealand
| | - Abi Weaver
- Department of General Surgery, Counties Manukau DHB, Auckland, New Zealand
| | - Garth Poole
- Department of General Surgery, Counties Manukau DHB, Auckland, New Zealand
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Effect of carbon dioxide pneumoperitoneum on acid-base balance during laparoscopic inguinal hernia repair: a prospective randomized controlled study. Hernia 2020; 25:1271-1277. [PMID: 32886256 DOI: 10.1007/s10029-020-02292-6] [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: 07/08/2020] [Accepted: 08/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND In this study, we aimed to compare the effects of CO2 pneumoperitoneum on acid-base balance during transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) procedures for repair of inguinal hernias. METHODS The study cohort comprised 100 patients who underwent repair of primary inguinal hernias from 1 June to 30 November 2019. The patients were randomly allocated to TAPP and TEP groups. Their acid-base balance was analyzed by comparing the results of blood gas analysis before and after the operative procedures and dynamic transcutaneous CO2 (TcCO2) changes during the procedures. RESULTS There were no statistically significant differences among groups in demographics, including sex, age, and hernia type. There were also no significant differences between the two groups in anesthesia time, incidence of perioperative complications, or type of management of the hernia sac (all P > 0.05). The operation time was shorter for the TEP than the TAPP group (P < 0.01). In terms of CO2 metabolism and acid-base balance, the following differences between the two groups were statistically significant: changes in PaCO2 (7.54 ± 3.36 vs. 20.36 ± 7.60 mmHg, P < 0.01), changes in TcCO2 (8.86 ± 3.57 vs. 17.40 ± 8.03 mmHg, P < 0.01), rate of change in TcCO2 (0.22 ± 0.11 vs. 1.03 ± 0.56, P < 0.01), and changes in pH (- 0.05 ± 0.28 vs. - 0.15 ± 0.76, P < 0.01). CONCLUSION TAPP and TEP can achieve good results in the treatment of inguinal hernia. Although no serious complications occurred, TEP procedures may cause more serious CO2 accumulation and quicker acidosis than TAPP procedures.
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Denham M, Johnson B, Leong M, Kuchta K, Conaty E, Ujiki MB, Denham W, Haggerty SP, Butt Z, Carbray J, Gitelis M, Linn JG. An analysis of results in a single-blinded, prospective randomized controlled trial comparing non-fixating versus self-fixating mesh for laparoscopic inguinal hernia repair. Surg Endosc 2019; 33:2670-2679. [PMID: 30627841 DOI: 10.1007/s00464-018-6555-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 10/17/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND It remains unclear whether use of self-fixating mesh during laparoscopic inguinal hernia repair (LIHR) impacts postoperative quality of life (QoL). We hypothesize patients receiving self-fixating mesh during totally extraperitoneal (TEP) LIHR will report less pain and improved QoL compared to those receiving non-fixating mesh. METHODS An IRB-approved, single-blinded randomized controlled trial was conducted. Patients with primary, unilateral inguinal hernias were randomized to receive either non-fixating (control) or self-fixating mesh. Clinical visits were conducted 3 weeks and 1 year after LIHR. A validated Surgical Outcomes Measurement System (SOMS) instrument was used to assess patients' QoL preoperatively and postoperatively along with Carolinas Comfort Scale (CCS) at 3 weeks and 1 year after surgery. Comparisons between self-fixating and non-fixating mesh groups were made using Chi-square, Wilcoxon rank-sum or independent samples t tests. RESULTS Two hundred and seventy patients were enrolled (137 non-fixating vs 133 self-fixating). Preoperatively, there was no difference in mean age, BMI, or median hernia duration between groups (57.9 vs 56.6 years, p = 0.550; 26.1 vs 26.8, p = 0.534; 3.0 vs 3.0 months, p = 0.846). Median operative times (34 vs 34 min, p = 0.545) and LOS were similar. More patients in the non-fixating group received tacks (43 vs 19, p = 0.001). Patients receiving non-fixating mesh recorded better mean SOMS scores for the first 3 days following surgery (Day 1: p = 0.005; Day 2: p = 0.002; Day 3: p = 0.024, Table 1) indicating less pain. No differences in pain were seen 3 weeks or 1 year postoperatively. There were zero recurrences found during clinical follow-up in either of the groups. CONCLUSIONS Patients receiving self-fixating mesh report worse postoperative pain in the first 2-3 days than those receiving non-fixating mesh. The groups showed no differences across QoL metrics (SOMS and CCS) at 3 weeks or 1 year postoperatively. Self-fixating mesh does not appear to positively impact QoL after TEP LIHR.
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Affiliation(s)
- Merritt Denham
- Section of Minimally Invasive Surgery, Department of Surgery, NorthShore Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Brandon Johnson
- Section of Minimally Invasive Surgery, Department of Surgery, NorthShore Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Michelle Leong
- Section of Minimally Invasive Surgery, Department of Surgery, NorthShore Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Kristine Kuchta
- Section of Minimally Invasive Surgery, Department of Surgery, NorthShore Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Eliza Conaty
- Section of Minimally Invasive Surgery, Department of Surgery, NorthShore Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Michael B Ujiki
- Section of Minimally Invasive Surgery, Department of Surgery, NorthShore Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Woody Denham
- Section of Minimally Invasive Surgery, Department of Surgery, NorthShore Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Stephen P Haggerty
- Section of Minimally Invasive Surgery, Department of Surgery, NorthShore Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Zeeshan Butt
- Northwestern University Feinberg School of Medicine, Evanston, IL, 60201, USA
| | - JoAnn Carbray
- Section of Minimally Invasive Surgery, Department of Surgery, NorthShore Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Matt Gitelis
- Section of Minimally Invasive Surgery, Department of Surgery, NorthShore Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - John G Linn
- Section of Minimally Invasive Surgery, Department of Surgery, NorthShore Center for Simulation and Innovation, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA.
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Hall T, Warnes N, Kuchta K, Novak S, Hedberg H, Linn JG, Haggerty S, Denham W, Joehl RJ, Ujiki M. Patient-Centered Outcomes after Laparoscopic Paraesophageal Hernia Repair. J Am Coll Surg 2018; 227:106-114. [DOI: 10.1016/j.jamcollsurg.2017.12.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 12/12/2017] [Accepted: 12/13/2017] [Indexed: 01/20/2023]
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Is a Technically Challenging Procedure More Likely to Fail? A Prospective Single-Center Study on the Short- and Long-Term Outcomes of Inguinal Hernia Repair. Surg Res Pract 2018; 2018:7850671. [PMID: 29808170 PMCID: PMC5901827 DOI: 10.1155/2018/7850671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/18/2018] [Indexed: 11/17/2022] Open
Abstract
Background and Aims The aim of this prospective single-center study was to evaluate the outcome of inguinal hernia repair. Materials and Methods A total of 485 inguinal hernias (452 patients and 33 patients with bilateral hernias) were operated between January 2004 and December 2010. Mean age was 56 years, and 93% were male. Patient demographics and operative data were collected, and the operating surgeon assessed the technical difficulty of the operation. Five years after surgery, a questionnaire evaluated recurrence and chronic discomfort according to the Cunningham scale. 372 responded (82%), and mean follow-up was 5.5 years. Results There were 390 repairs for a primary and 62 for a recurrent hernia. Totally extraperitoneal (TEP) operation was most frequently performed (56%), transabdominal preperitoneal (TAPP) operation in 31%, and Lichtenstein and Shouldice in 12% and 2%, respectively. At 5-year follow-up, the primary outcome of chronic discomfort was 19.5%. The independent positive predictors were young age and operation for a recurrent hernia (OR: 3.7), with TEP operation reducing the risk of chronic discomfort (OR: 0.5). The secondary outcome was the recurrence rate of 2.5%. Risk factors were strenuous work (OR: 13.7), technically difficult repairs (OR: 7.2), and chronic discomfort (OR: 6.7). Conclusions Every fifth patient had chronic discomfort in long-term follow-up. The recurrence rate was 2.5%, and a technically difficult procedure was a risk factor.
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Hedberg HM, Hall T, Gitelis M, Lapin B, Butt Z, Linn JG, Haggerty S, Denham W, Carbray J, Ujiki MB. Quality of life after laparoscopic totally extraperitoneal repair of an asymptomatic inguinal hernia. Surg Endosc 2017; 32:813-819. [PMID: 28779250 DOI: 10.1007/s00464-017-5748-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 07/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND When considering an asymptomatic inguinal hernia, surgeons must weigh the risks of watchful waiting against the risk of operative complications. Laparoscopy offers the benefit of reduced postoperative pain, which, for appropriate surgical candidates, may strengthen the case for repair. This study compares general and disease-specific quality of life following totally extraperitoneal (TEP) laparoscopic inguinal hernia repair (LIHR) of asymptomatic and symptomatic hernias. METHODS We summarize prospective data from 387 patients who underwent TEP LIHR between 2009 and 2015 by four surgeons at a single institution. Asymptomatic individuals were identified by pain scores of zero at preoperative clinic visits. Validated quality of life (QOL) measurements were administered preoperatively and at 3 weeks, 6 months, and 1-year postop. Comparisons were made using Chi-square test, t test, or Mann-Whitney U test. Changes over time were assessed using longitudinal mixed effects models. RESULTS A cohort of 79 asymptomatic cases were compared to 308 symptomatic individuals. The asymptomatic cohort had larger median hernia defects (2.5 vs 2 cm, p < 0.01), was older (mean 63.0 vs 58.9 years, p = 0.03), included fewer indirect hernias (57.7 vs 74.9%, p < 0.01), took pain medication for fewer days (mean 1.2 ± 1.5 vs 2.2 ± 3.0 days, p = 0.02), returned to baseline activities of daily living earlier (median 3 vs 5 days, p < 0.01), and reported decreased postoperative pain (p = 0.02). There was no significant difference in general QOL. There was one recurrence in the asymptomatic group and were two in the symptomatic cohort. CONCLUSIONS Asymptomatic individuals undergoing TEP LIHR reported less postoperative pain, returned to baseline activities, and discontinued pain medication sooner than symptomatic patients. These results are encouraging and may inform patient-centered discussions about asymptomatic hernia repair.
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Affiliation(s)
- H Mason Hedberg
- Department of Surgery, University of Chicago Medical Center, Chicago, USA. .,Department of Surgery, NorthShore University HealthSystems, 2650 Ridge Ave, Evanston, IL, 60201, USA.
| | - Tyler Hall
- Department of Surgery, NorthShore University HealthSystems, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | | | - Brittany Lapin
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, USA
| | - Zeeshan Butt
- Departments of Medical Social Sciences, Surgery (Division of Organ Transplantation), and Psychiatry and Behavioral Sciences, Northwestern University, Chicago, USA
| | - John G Linn
- Department of Surgery, NorthShore University HealthSystems, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Stephen Haggerty
- Department of Surgery, NorthShore University HealthSystems, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Woody Denham
- Department of Surgery, NorthShore University HealthSystems, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - JoAnn Carbray
- Department of Surgery, NorthShore University HealthSystems, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Michael B Ujiki
- Department of Surgery, NorthShore University HealthSystems, 2650 Ridge Ave, Evanston, IL, 60201, USA
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Langenbach MR, Berengolts A. Chronic Pain after Laparoscopic Inguinal Hernia Repair Depends on Mesh Implant Features: A Clinical Randomised Trial. ACTA ACUST UNITED AC 2017. [DOI: 10.17352/ojpm.000004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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