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Yang G, Tung KLM, Tumtavitikul S, Li MKW. A new groin hernia classification with clinical relevance. Hernia 2024:10.1007/s10029-024-03000-4. [PMID: 38662243 DOI: 10.1007/s10029-024-03000-4] [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: 10/24/2023] [Accepted: 02/20/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Groin hernia is one of the most commonly managed surgical diseases around the world. The typical question asked by patients is "Does my hernia require urgent surgery?". The currently available classifications are insufficient to stratify patients into different groups. We propose a new classification that incorporates diverse clinical elements together with anatomical and other vital information, which allows us to stratify patients into different groups. METHOD A task force was formed by the Hong Kong Hernia Society, working with international expert hernia surgeons. The framework of the classification system was formulated. Clinical elements that are important in groin disease stratification were identified. A comprehensive literature review was conducted using PubMed. Those which dictate the severity of the disease were selected and compiled to form the new proposed classification. Application of this classification model to a single hernia surgeon's registry in The Hong Kong Adventist Hospital Hernia Centre was done for initial evaluation. RESULT This new classification incorporates important clinical characteristics forming a total of nine grades of differentiation, together with the anatomical details and special information. This comprehensive system allows the stratification of patients into different groups based on disease severity. It also enables more accurate data collection for future audits, comparisons of disease progression over time, and the effect of different management strategies for different-stage patients. CONCLUSION This is the first classification system which incorporates essential clinical parameters, which allows the stratification of groin hernia into different stages. Further studies and validation should be performed to evaluate the usefulness and value of this classification in groin hernia management.
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Affiliation(s)
- George Yang
- Hong Kong Adventist Hospital, Stubbs Road, Hong Kong, China.
| | | | | | - M K W Li
- Hong Kong Sanatorium & Hospital, 2 Village Road, Happy valley, Hong Kong, China
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Spencer Netto FAC, Mainprize M, Yilbas A, Degani C, Svendrovski A, Szasz P. Surgical aspects and early morbidity of patients undergoing open recurrent inguinal hernia repair. Hernia 2023; 27:1225-1233. [PMID: 37140758 DOI: 10.1007/s10029-023-02801-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/25/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE This study aims to characterize the patterns of recurrence associated with specific types of primary inguinal hernia repair techniques used for and their respective correlations with early morbidity, in patients undergoing open repair for their first hernia recurrence. METHODS After ethics approval was obtained, a retrospective review of charts from patients who underwent open surgery for repair of a first recurrence after a previous inguinal hernia repair during 2013-2017 was completed. Statistical analyses were performed and p-values < .05 are reported as statistically significant. RESULTS 1393 patients underwent 1453 surgeries for recurrent inguinal hernias at this institution. Operations for recurrence were longer (61.9 ± 21.1 vs. 49.3 ± 11.9; p < .001), required more frequent intra-operative surgical consultation (1% vs. 0.2%; p < .001) and had a higher incidence of surgical-site infections (0.8% vs. 0.4%; p = .03) than primary inguinal hernia repairs. When comparing the patterns of recurrence among different techniques of primary repairs, patients undergoing laparoscopic hernia repair presented with a higher incidence of indirect recurrences. Reoperations after a Shouldice repair and open mesh repair represented markers for higher surgical difficulty in the recurrent operation (longer operative time, higher identification of heavy scarring, less nerve identification, and higher frequency of intra-operative consultation), but not higher rates of complications when compared with other techniques. CONCLUSIONS Open reoperations for inguinal hernia first recurrences are more complex, with noticeable differences according to the index operation, and associated with higher morbidity when compared with primary hernia repairs. This complexity varies according to the type of primary surgery, with a previous Shouldice repair and open hernia repair with mesh presenting higher surgical difficulties although this did not translate to higher incidence of early complications. This information may allow adequate allocation of surgeons with an expertise in recurrent hernias and choice of recurrent repair method (laparoscopic or open) based on the primary surgery.
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Affiliation(s)
- F A C Spencer Netto
- Department of Surgery, Shouldice Hospital, 7750 Bayview Ave, Thornhill, ON, L3T 4A3, Canada
| | - M Mainprize
- Department of Surgery, Shouldice Hospital, 7750 Bayview Ave, Thornhill, ON, L3T 4A3, Canada.
| | - A Yilbas
- Department of Surgery, Shouldice Hospital, 7750 Bayview Ave, Thornhill, ON, L3T 4A3, Canada
| | - C Degani
- Department of Surgery, Shouldice Hospital, 7750 Bayview Ave, Thornhill, ON, L3T 4A3, Canada
| | | | - P Szasz
- Department of Surgery, Queen's University, Kingston Health Sciences Center, Kingston, ON, Canada
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Zhao Y, Xu Z, Wang T, Zhou D, Tang N, Zhang S, Chen C. The impact of laparoscopic versus open inguinal hernia repair for inguinal hernia treatment: A retrospective cohort study. Health Sci Rep 2023; 6:e1194. [PMID: 37056467 PMCID: PMC10089615 DOI: 10.1002/hsr2.1194] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/31/2023] [Indexed: 04/15/2023] Open
Abstract
Objectives Although laparoscopic inguinal hernia repair (LIHR) has been widely accepted for treating inguinal hernia, the procedure remains very technical and challenging. The present study aimed to assess the effect of LIHR in relation to operation time, intraoperative hemorrhage and postoperative hospitalization. Methods A total of 503 patients with inguinal hernia admitted at the Wuxi Rehabilitation Hospital between June 2019 and July 2021 were included in this retrospective cohort study. Binary logistic and linear regressions were used for categorical and continuous outcomes, respectively. The learning curve was drawn by cumulative sum analysis. Results Multivariate logistic regression analysis identified LIHR as an independent factor associated with prolonging operation time (odd ratio [OR] = 1.750, 95% confidence interval [CI]: 1.215-2.520, p = 0.003) and decreasing intraoperative hemorrhage levels (OR = 0.079, 95 CI: 0.044-0.142, p < 0.001). Multivariate linear regression identified LIHR (Coefficient = -0.702, 95% CI: [-1.050] to [-0.354], p < 0.001) as an independent factor for shortening postoperative hospitalization time. After learning curve, LIHR (OR = 1.409, 95% CI: 0.948 to 2.094, p = 0.090) no longer resulted as a risk factor prolonging operation time. Conclusions LIHR is an important independent predictive factor for decreasing intraoperative hemorrhage levels and shortening postoperative hospitalization time. Additionally, LIHR does not prolong operation time after the learning curve.
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Affiliation(s)
- Yong Zhao
- Department of General SurgeryWuxi Rehabilitation HospitalWuxiChina
| | - Zipeng Xu
- Department of General SurgeryXishan People's Hospital of Wuxi CityWuxiChina
| | - Tao Wang
- Department of General SurgeryWuxi Rehabilitation HospitalWuxiChina
| | - Dingxing Zhou
- Department of Emergency SurgeryWuxi Second Hospital of Traditional Chinese MedicineWuxiChina
| | - Neng Tang
- Department of Hepatic‐Biliary‐Pancreatic Surgerythe Affiliated Drum Tower Hospital of Nanjing University Medical schoolNanjingChina
| | - Shuo Zhang
- Department of Hepatic‐Biliary‐Pancreatic Surgerythe Affiliated Drum Tower Hospital of Nanjing University Medical schoolNanjingChina
| | - Chaobo Chen
- Department of General SurgeryXishan People's Hospital of Wuxi CityWuxiChina
- Department of Hepatic‐Biliary‐Pancreatic Surgerythe Affiliated Drum Tower Hospital of Nanjing University Medical schoolNanjingChina
- Department of Immunology, Ophthalmology & ORLComplutense University School of MedicineMadridSpain
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Piltcher-DA-Silva R, Hütten DO, Trapp AG, Soares PSM, Castro TL, Bohnenberger S, Kroth EC, Pinto JAR, Grehs C, Tomasi DC, Cavazzola LT. Inguinal hernia in southern Brazil - challenges in follow-up and recurrence rates. Rev Col Bras Cir 2022; 49:e20223238. [PMID: 36074391 PMCID: PMC10578802 DOI: 10.1590/0100-6991e-20223238-en] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 06/27/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION recurrence rates for primary hernia repair range from 0.5 to 15 percent depending upon the hernia site, type of repair, and clinical circumstances. Many risk factors are known and they must be considered before the procedure. In developing countries, follow up and maintenance of databases are critical to understand the real numbers. METHODS a retrospective cohort study analyzed adult patients who have undergone inguinal hernia repair at Hospital de Clínicas de Porto Alegre, a tertiary care government public hospital, between 2013 and 2015. Medical records, telephone, and letter contact have been reviewed in order to complete the minimum period of 5 years of follow-up. The analyzed data focused on the surgeon's experience and the recurrence rate in 5 years of follow-up. RESULTS a total of 1094 medical records were selected and a complete five years follow-up were possible in 454 patients - 538 inguinal hernia repairs due to bilateral approach in 84 patients. These 454 patients answered, in a validated questionnaire about symptoms of recurrence. The total recurrence rate was 9.29%. For the patients who had Nyhus IV, recurrence rate was 24.1% against 9.9% after primary hernia repair, with a 2.4 higher risk. There was no difference in recurrence between surgeons and training surgeons. CONCLUSION our data reveal an acceptable recurrence rate in a tertiary care hospital with residents, and to our knowledge is the first Brazilian report with long term follow up. An increased re-recurrent hernia was found when compared with primary hernia repair.
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Affiliation(s)
| | - Debora Oliveira Hütten
- - Hospital de Clínicas de Porto Alegre, General Surgery Service - Porto Alegre - RS - Brasil
| | - Artur Gehres Trapp
- - Hospital de Clínicas de Porto Alegre, General Surgery Service - Porto Alegre - RS - Brasil
| | | | - Tiago Lima Castro
- - Hospital de Clínicas de Porto Alegre, General Surgery Service - Porto Alegre - RS - Brasil
| | - Simoni Bohnenberger
- - Hospital de Clínicas de Porto Alegre, General Surgery Service - Porto Alegre - RS - Brasil
| | - Eduardo Castelli Kroth
- - Hospital de Clínicas de Porto Alegre, General Surgery Service - Porto Alegre - RS - Brasil
| | | | - Caroline Grehs
- - Hospital de Clínicas de Porto Alegre, General Surgery Service - Porto Alegre - RS - Brasil
| | | | - Leandro Totti Cavazzola
- - Hospital de Clínicas de Porto Alegre, General Surgery Service - Porto Alegre - RS - Brasil
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de la Garza MA, Hegge SR, Bakker J. Inguinal Hernia in Nonhuman Primates: From Asymptomatic to Life-Threatening Events. Vet Sci 2022; 9:vetsci9060280. [PMID: 35737332 PMCID: PMC9228773 DOI: 10.3390/vetsci9060280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 05/24/2022] [Accepted: 06/02/2022] [Indexed: 11/18/2022] Open
Abstract
In this study, a review of available data and literature on the epidemiology and anamnesis of inguinal hernias in nonhuman primates, as well as on their clinical evaluation and surgical management, was conducted. Inguinal hernias are assumed to be relatively common in male nonhuman primates. Clinical signs are usually limited to a visible or palpable mass in the groin region without pain or systemic illness. Most hernias contain omentum. Careful monitoring is an acceptable treatment option for those animals. Size, the danger of incarceration, and the presence of strangulation are important factors when considering surgical repair. A strangulated inguinal hernia is an emergency, requiring prompt surgery to avoid tissue necrosis and death. Imaging techniques, as well as computed tomography (CT), ultrasonography, and magnetic resonance imaging (MRI), provide information about the anatomical characteristics of the suspected region, allowing for a diagnosis and treatment. An inguinal hernia repair can be performed with either open surgery or laparoscopic surgery. The hernia repair can be achieved by mesh or suture. Decisions regarding which repair technique to use depend on the surgeon′s skill level and preference. Complication and recurrence rates are generally low. The most common postsurgical complication is a recurrence of the hernia. Contraceptive measures are not indicated in breeders, as there is no known hereditary component, and the presence of hernia does not appear to affect fertility, nor does it predispose to occurrence, recurrence, or incarceration.
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Affiliation(s)
| | | | - Jaco Bakker
- Animal Science Department (ASD), Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands
- Correspondence: ; Tel.: +31-15-284 2579
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Lozada-Martinez ID, Covaleda-Vargas JE, Gallo-Tafur YA, Mejía-Osorio DA, González-Pinilla AM, Florez-Fajardo MA, Benavides-Trucco FE, Santodomingo-Rojas JC, Julieth Bueno-Prato NK, Narvaez-Rojas AR. Pre-operative factors associated with short- and long-term outcomes in the patient with inguinal hernia: What does the current evidence say? Ann Med Surg (Lond) 2022; 78:103953. [PMID: 35734704 PMCID: PMC9207143 DOI: 10.1016/j.amsu.2022.103953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 11/24/2022] Open
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Ali MA, Hagbevor I, Maalman RSE, Donkor YO, Dedey F, Abedi E. HIV patient with prolonged infection after hemicolectomy and repair of complicated hernia. Mini-review of a rare successful surgical outcome. Int J Surg Case Rep 2022; 90:106726. [PMID: 34979426 PMCID: PMC8732747 DOI: 10.1016/j.ijscr.2021.106726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction and importance Surgical site infection (SSI) is an inevitable occurrence in bowel perforation with faecal soiled hernia wound(s) especially in retroviral patients. Unfortunately, the increased antibiotics and wound care demands do not prevent delayed healing, increased risk of hernia recurrence, or multiple surgeries to control the infection. The standard open or endo-laparoscopic Mesh repairs are either deferred or avoided with alternative tissue-based hernia repairs after bowel surgery. The reported success of open tissue-based repairs remains mixed. Nylon monofilament that have been used in infected wounds was chosen for the patient in anticipation of wound infection. Case presentation A 48-year-old man presented with a 7-days complicated hernia at the emergency unit, Margaret Marquart Catholic Hospital. Clinical examination revealed signs of shock, intestinal obstruction, and peritonism, laboratory investigation was remarkable of anaemia, septicaemia, deranged renal function, and positive retroviral test. He had concurrent right hemicolectomy and nylon darn after optimisation. The outcome we evaluated after surgery included postoperative pain, scrotal collection, anastomotic breakdown, postoperative analgesic use, wounds infection, prolonged hospital stays, recurrence, and the need for a second surgery. Though he developed prolonged deep SSI, he has intact hernia repair after 6-years. Clinical discussion The postoperative critical clinical events presented in this case were unexpected but might have been precipitated by his retroviral status. Thus, a weight loss of over 13 kg within 2 weeks was highly unusual. Furthermore, the positive retroviral status couple with the perforated caecum and soiled peritoneum was the cause of the surgical site infection. Conclusion Nylon darning in a retro-positive patient developing prolonged SSI appeared beneficial. It should be considered in patients with anticipated long period wound infection. Surgical site infection is a challenge in hernias with perforated viscus after repair. Current standard modalities of hernia repairs are used in such patient's infection are not anticipated. Patient with retroviral infection and wound contamination requires a different approach to ensure the intact repair. Nylon darn, one of the methods was used with success. Our patient with a prolonged infection after surgery and a 5-year post-repair success are a first of the kind reported.
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Affiliation(s)
- Mahamudu Ayamba Ali
- Departments of Surgery and Basic Medical Science, School of Medicine, University of Health and Allied Science, Ho, Ghana.
| | - Israel Hagbevor
- Surgical unit, Margaret Marquart Catholic Hospital, Kpando, Volta Region, Ghana
| | - Raymond Saa-Eru Maalman
- Departments of Surgery and Basic Medical Science, School of Medicine, University of Health and Allied Science, Ho, Ghana
| | - Yaw Otchere Donkor
- Departments of Surgery and Basic Medical Science, School of Medicine, University of Health and Allied Science, Ho, Ghana
| | - Florence Dedey
- Department of Surgery, University of Ghana Medical School, Korle-Bu - Accra, Ghana
| | - Emmanuel Abedi
- Surgical unit, Margaret Marquart Catholic Hospital, Kpando, Volta Region, Ghana
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PILTCHER-DA-SILVA RODRIGO, HÜTTEN DEBORAOLIVEIRA, TRAPP ARTURGEHRES, SOARES PEDROSANMARTIN, CASTRO TIAGOLIMA, BOHNENBERGER SIMONI, KROTH EDUARDOCASTELLI, PINTO JORGEARMANDOREYES, GREHS CAROLINE, TOMASI DANIELLECRISTINA, CAVAZZOLA LEANDROTOTTI. Hérnia inguinal no Sul do Brasil - desafios no seguimento e taxas de recorrência. Rev Col Bras Cir 2022. [DOI: 10.1590/0100-6991e-20223238] [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] Open
Abstract
RESUMO Introdução: a recorrência da hérnia inguinal após hernioplastia varia de 0,5 a 15 por cento, dependendo do local da hérnia, tipo de reparo e circunstâncias clínicas. Muitos fatores de risco são conhecidos e devem ser considerados antes do procedimento. Acompanhamento e adequado bancos de dados são fundamentais para entender a incidência de recidiva. Métodos: estudo de coorte retrospectivo analisou hernioplastias inguinais realizados no Hospital de Clínicas de Porto Alegre entre 2013 e 2015. Para concluir 5 anos de seguimento, analisamos o prontuário e fizemos contato telefônico e por correio. Resultados: o total de 1094 registros médicos foram selecionados e um seguimento de pelo menos 5 anos foi possível em 454 pacientes - 538 reparos de hérnia inguinal devido à abordagem bilateral em 84 pacientes. Os pacientes responderam um questionário validado sobre sintomas de recorrência. A taxa total de recorrência foi de 9,29%. No grupo masculino, a recorrência foi de 10% contra 4% no grupo feminino. Para os pacientes com hérnia Nyhus IV, a recidiva foi de 24% contra 8% após o reparo da hérnia primária, com um risco de 2,8 maior. Não houve diferença na recorrência entre cirurgiões experientes e em treinamento. Conclusão: nossos dados revelam uma taxa de recorrência aceitável em um hospital de ensino, e para o nosso conhecimento é o primeiro artigo com acompanhamento de longo prazo no sul do Brasil. A re-recidiva da hérnia foi maior quando comparada com o reparo da hérnia primária.
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Al Riyees L, Al Madani W, Firwana N, Balkhy HH, Ferwana M, Alkhudhayri A. Antibiotic Prophylaxis against Surgical Site Infection after Open Hernia Surgery: A Systematic Review and Meta-Analysis. Eur Surg Res 2021; 62:121-133. [PMID: 34404046 DOI: 10.1159/000517404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 05/21/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The role of antibiotic prophylaxis (AP) in the prevention of surgical site infection (SSI) after hernia repair is debated. We conducted this systematic review and meta-analysis to assess the evidence on the value of prophylactic antibiotics in reducing the risks of SSI after open hernia surgery. METHODS We ran an online and manual search to identify relevant randomized controlled trials that compared prophylactic antibiotics to nonantibiotic controls in patients undergoing open surgical hernia repair. Data on SSI risk were extracted and pooled as risk ratios (RRs) with 95% confidence intervals (95% CIs), using RevMan software. We further used the Cochrane risk of bias tool and GRADE assessment to evaluate the quality of generated evidence. RESULTS Twenty-nine studies (N = 8,616 patients) were included in the current analysis. Antibiotic prophylaxis reduced the risk of SSI in open hernia repair patients (RR = 0.65, 95% CI = 0.53, 0.79). Subgroup analysis showed a significant benefit for antibiotics in mesh repair patients (RR = 0.60, 95% CI = 0.48, 0.76) yet no significant difference in SSI risk after herniorrhaphy (RR = 0.86, 95% CI = 0.54, 1.36). In addition, AP was associated with a significant reduction in superficial SSI risk (RR = 0.56, 95% CI = 0.43, 0.72) but not deep SSI (RR = 0.70, 95% CI = 0.30, 1.62). Further analysis showed a significant reduction in SSI risk with amoxicillin/clavulanic acid and cefazolin but not with cefuroxime. CONCLUSION The present meta-analysis suggests that AP is beneficial prior to open mesh hernia repair. However, the quality of evidence was low, and further well-designed trials are needed.
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Affiliation(s)
- Lolwah Al Riyees
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Consultant of General Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Wedad Al Madani
- Senior Epidemiologist, National Center for Evidence-Based Health Practice, Saudi Health Council, Riyadh, Saudi Arabia
| | - Nistren Firwana
- Executive Master of Health Informatics, University of Toronto, Toronto, Ontario, Canada
| | | | - Mazen Ferwana
- Professor of Family Medicine, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Co-director, National and Gulf Center for Evidence- Based Health Practice, Riyadh, Saudi Arabia.,Consultant, Family Medicine and Primary Healthcare Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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10
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Martín Duce A, Lozano O, Galván M, Muriel A, Villeta S, Gómez J. Results of Shouldice hernia repair after 18 years of follow-up in all the patients. Hernia 2021; 25:1215-1222. [PMID: 34009507 DOI: 10.1007/s10029-021-02422-8] [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: 02/16/2021] [Accepted: 04/30/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Evaluate the long-term efficacy of the Shouldice technique performed by non-specialized surgeons and also to reflex on the quality parameters necessary to safely assess hernia recurrence rates. METHODS During 3 years, a prospective study was conducted in 243 adult men who underwent surgery for primary inguinal hernias by 13 junior surgeons with an interest in hernia surgery. Using local anesthesia, a classic 4 step Shouldice repair, with polypropylene or polyester, was performed. All patients were followed for 18 years. The follow-up met the nine quality criteria proposed by the authors. RESULTS At 18 years, 80.2% of patients were followed and only 6.5% were lost. There were 7 recurrences in the first 10 years, 5 of them secondary to a direct hernia, and the same after 18 years. The recurrence rate was 2.88%. Tolerance of the local anesthesia was excellent in 91.4%of patients and, after 3 years, the pain was considered moderate or severe in 4 patients (1.8%). CONCLUSIONS It is necessary to incorporate more demanding criteria in the assessment of recurrence, to give more valid results. The Shouldice technique remains a useful technique today not only in patients under 30 years of age, and in the absence of risk factors, but also in cases of intolerance, patient rejection or absence of mesh. In addition, it provides the clinical and economic advantages of being possible to perform it under local anesthesia.
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Affiliation(s)
- A Martín Duce
- Faculty of Medicine and Health Sciences, Alcalá University, Plaza de San Diego s/n, 28801, Alcalá de Henares, Madrid, Spain. .,Department of General Surgery, Príncipe de Asturias University Hospital, Madrid, Spain.
| | - O Lozano
- Department of General Surgery, Los Arcos del Mar Menor University Hospital, San Javier, Spain
| | - M Galván
- Department of General Surgery, Los Arcos del Mar Menor University Hospital, San Javier, Spain
| | - A Muriel
- Faculty of Medicine and Health Sciences, Alcalá University, Plaza de San Diego s/n, 28801, Alcalá de Henares, Madrid, Spain.,Biostatistics Department, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, CIBERESP, Ramón y Cajal University Hospital, Madrid, Spain
| | - S Villeta
- Faculty of Medicine and Health Sciences, Alcalá University, Plaza de San Diego s/n, 28801, Alcalá de Henares, Madrid, Spain
| | - J Gómez
- Faculty of Medicine and Health Sciences, Alcalá University, Plaza de San Diego s/n, 28801, Alcalá de Henares, Madrid, Spain
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Kykalos S, Machairas N, Ntikoudi E, Dorovinis P, Molmenti EP, Sotiropoulos GC. Inguinal Hernias in Cirrhotic Patients: From Diagnosis to Treatment. Surg Innov 2021; 28:620-627. [PMID: 33599535 DOI: 10.1177/1553350621995058] [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] [Indexed: 11/16/2022]
Abstract
Cirrhosis has a strong association with abdominal wall hernias, especially in the presence of concomitant ascites. Major predisposing factors for hernia formation in this particular group of patients include increased intra-abdominal pressure and decreased muscle mass due to poor nutrition. Management of these patients is highly challenging and requires an experienced multidisciplinary surgical and medical approach. The aim of our review is to clarify crucial diagnostic and management approaches. Crucial medical and technical issues on this topic are widely discussed with special focus on indication, timing, and type of surgical repair, with an additional reference to the actual role of laparoscopy.
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Affiliation(s)
- Stylianos Kykalos
- Department of Propaedeutic Surgery, 68993National and Kapodistrian University of Athens, Medical School Athens, Laiko General Hospital, Greece
| | - Nikolaos Machairas
- Department of Propaedeutic Surgery, 68993National and Kapodistrian University of Athens, Medical School Athens, Laiko General Hospital, Greece
| | | | - Panagiotis Dorovinis
- Department of Propaedeutic Surgery, 68993National and Kapodistrian University of Athens, Medical School Athens, Laiko General Hospital, Greece
| | - Ernesto P Molmenti
- Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Georgios C Sotiropoulos
- Department of Propaedeutic Surgery, 68993National and Kapodistrian University of Athens, Medical School Athens, Laiko General Hospital, Greece
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Kulacoglu H, Celasin H, Karaca AS. Return to outdoor walking, car driving, and sexual activity following elective inguinal hernia repair: surgeons' perspective versus patients' reality. Hernia 2020; 24:985-993. [PMID: 32592152 DOI: 10.1007/s10029-020-02255-x] [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: 01/28/2020] [Accepted: 06/19/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE To determine the time to resumption of outdoor walking, car driving, sports, and sexual activity following elective inguinal hernia repair, and to reveal if there are differences between surgeons' recommendations and patients' real return times. METHODS A questionnaire including questions about recommendations to hernia patients for times to resume outdoor walking ability without assistance, driving and sexual intercourse after an elective inguinal hernia repair was sent to surgeons. Also, a short questionnaire was sent to patients who had undergone elective inguinal hernia repair to search the exact times for resuming these physical activities. RESULTS Surgeons' thoughts and recommendations to their patients varied significantly. The range of recommendations were same day to 20 days for outdoor walking, and same day to 3 months both for driving and sexual intercourse. Patients' actual resumption of postoperative activities were 1-14 days for outdoor walking, 1 day to 3 months for driving, and 1 day to 2 months for sexual intercourse. When the answers from the two questionnaires were compared, it was observed that the mean times for resumption of outdoor walking and sexual intercourse were significantly longer in the patients' lives than recommended by the surgeons. Patients ≥ 60 years were able to walk outside, drive, and participate in sexual activity earlier than the younger patients. Bilateral and recurrent hernia repairs caused slower resumption of different activities in comparison to primary hernias. CONCLUSIONS Patients reported that times for resumption of outdoor walking, driving, and sexual activity were significantly longer than those recommended by surgeons. Age, BMI, bilateral repair, and recurrent hernias were found to be factors affecting return time to different activities.
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Affiliation(s)
- H Kulacoglu
- Ankara Hernia Center, AFM Cerrahi Merkezi, Cukurambar mahallesi, Budapeste caddesi, 33/A, Cankaya, 06520, Ankara, Turkey.
| | - H Celasin
- Lokman Hekim Akay Hospital, Ankara, Turkey
| | - A S Karaca
- Baskent University School of Medicine Istanbul Hospital, Istanbul, Turkey
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13
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Hernia research in developing countries-are we looking for needles in haystacks? Hernia 2020; 24:683-684. [PMID: 32495054 DOI: 10.1007/s10029-020-02235-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/25/2020] [Indexed: 12/21/2022]
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Köckerling F, Krüger C, Gagarkin I, Kuthe A, Adolf D, Stechemesser B, Niebuhr H, Jacob D, Riediger H. What is the outcome of re-recurrent vs recurrent inguinal hernia repairs? An analysis of 16,206 patients from the Herniamed Registry. Hernia 2020; 24:811-819. [PMID: 32086633 PMCID: PMC7395905 DOI: 10.1007/s10029-020-02138-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/06/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The proportion of recurrent repairs in the total collective of inguinal hernia repairs among men is 11.3-14.3% and among women 7.0-7.4%. The rate of re-recurrences is reported to be 2.9-9.2%. To date, no case series has been published on second and ≥ third recurrences and their treatment outcomes. Only case reports are available. MATERIALS AND METHODS In an analysis of data from the Herniamed Registry the perioperative and 1-year follow-up outcomes of 16,206 distinct patients who had undergone first recurrent (n = 14,172; 87.4%), second recurrent (n = 1,583; 9.8%) or ≥ third recurrent (n = 451; 2.8%) inguinal hernia repair between September 1, 2009 and July 1, 2017 were compared. RESULTS The intraoperative complication rate for all recurrent repairs was between 1-2%. In the postoperative complications a continuous increase was observed (first recurrence: 3.97% vs second recurrence: 5.75% vs ≥ third recurrence 8.65%; p < 0.001). That applied equally to the complication-related reoperation rates (first recurrence: 1.50% vs second recurrence: 2.21% vs ≥ third recurrence 2.66; p = 0.020). Likewise, the re-recurrence rate rose significantly (first recurrence: 1.95% vs second recurrence: 2.72% vs ≥ third recurrence 3.77; p = 0.005). Similarly, the rate of pain requiring treatment rose highly significantly with an increasing number of recurrences (first recurrence: 5.21% vs second recurrence: 6.70% vs ≥ third recurrence 10.86; p = < 0.001). CONCLUSION The repair of re-recurrences in inguinal hernia is associated with increasingly more unfavorable outcomes. For the first recurrence the guidelines should definitely be noted. For a second and ≥ third recurrence diagnostic laparoscopy may help to select the best possible surgical technique.
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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.
| | - C Krüger
- Immanuel Hospital Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf, Germany
| | - I Gagarkin
- Spital Riggisberg, Inselgruppe,, Eyweg 2, 3132, Riggisberg, Switzerland
| | - A Kuthe
- DRK-Krankenhaus Clementinenhaus, Lützerodestr. 1, 30161, Hannover, Germany
| | - D Adolf
- StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany
| | - B Stechemesser
- Pan Hospital, Hernia Center, Zeppelinstraße 1, 50667, Köln, Germany
| | - H Niebuhr
- Hansechirurgie, Niebuhr, Marleschki & Partner, Alte Holstenstr. 16, 21031, Hamburg, Germany
| | - D Jacob
- COPV-Hernia Center, Kaiser-Wilhelm-Str. 24-26, 12247, Berlin, Germany
| | - H Riediger
- Vivantes Humboldt Hospital, Am Nordgraben 2, 13509, Berlin, Germany
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15
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Wong J, Jones J, Ananthapadmanabhan S, Meagher AP. Abdominal wall closure with prophylactic mesh in colorectal operations. ANZ J Surg 2020; 90:564-568. [PMID: 31970887 DOI: 10.1111/ans.15692] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/27/2019] [Accepted: 12/28/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Prospective studies demonstrate that over one-third of patients undergoing standard suture closure of laparotomy wounds will develop incisional hernias (IHs). Whilst prophylactic mesh has been demonstrated to decrease IH rates in clean laparotomy wounds, mesh has been associated with high rates of seroma formation (>30%), infection (>10%) and pain, discouraging many surgeons from using mesh, especially combined with intestinal surgery. The aim of this study is to review the experience of a single colorectal surgeon who, after noting high IH rates in his own patients, started placing prophylactic mesh routinely in patients judged to be at high risk of IH. METHODS The records of all patients undergoing bowel resections and ileostomy closure by one surgeon from 2008 to 2018 were independently retrospectively analysed. RESULTS Of the 935 procedures identified, 662 patients underwent midline laparotomy with bowel resection and 273 patients underwent closure of loop ileostomy. Mesh was placed prophylactically in 221 (23.6%) of 935 procedures. Comparing the mesh and non-mesh groups, wound infections occurred in nine (4.1%) versus 23 (3.2%) (P = 0.53), seromas occurred in nine (4.1%) versus six (0.8%) (P = 0.003) and chronic pain was noted in 12 (5.4%) versus 17 (2.4%) (P = 0.04). The mean follow-up was 33 months in both the mesh and non-mesh groups. IHs have occurred in three (1.3%) of the mesh group compared to 95 (13.3%) of the non-mesh group procedures (P = 0.0001). CONCLUSION In colorectal operations, prophylactic mesh decreases the risk of IH without prohibitive complications.
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Affiliation(s)
- Jean Wong
- Department of Colorectal Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Julia Jones
- Department of Colorectal Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia
| | | | - Alan P Meagher
- Department of Colorectal Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia
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16
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Idiz C, Cakir C. Nutritional status and constipation scoring of inguinal hernia patients: a case–control study. Hernia 2019; 24:1107-1112. [DOI: 10.1007/s10029-019-02075-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 10/19/2019] [Indexed: 01/06/2023]
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17
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Hung KC, Sun CK, Chen JY, Wang HC, Kao CH. Association between abdominal hernia and the risk of subsequent dementia. Brain Behav 2019; 9:e01434. [PMID: 31588690 PMCID: PMC6851817 DOI: 10.1002/brb3.1434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/03/2019] [Accepted: 09/14/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Matrix metalloproteinases (MMPs) may play a role in the pathophysiology of neurodegenerative disease and hernia formation. This retrospective cohort study was designed to assess whether there is an association between hernia and the risk of dementia. MATERIALS AND METHODS Patients (≥45 years) with hernias were identified between 2000 and 2008 from a longitudinal claims data of one million beneficiaries from Taiwan's National Health Insurance program. A control group of patients with comparable distributions of sex, age, socioeconomic status, urbanization, and medical comorbidities without hernia were chosen for matching in a ratio of 1:1. Patients previously diagnosed with dementia were excluded. Follow-up ended on December 31, 2013. Incidence rate of dementia was compared between patients with hernias and those without. Cox proportional hazards models were used to estimate hazards relative to those of the control group. RESULTS After matching, there were 4,784 hernia and 4,784 nonhernia patients. Hernia patients showed a higher incidence rate and hazard ratio of dementia than those in nonhernia group (8.82 vs. 7.19/1,000 person-years; adjusted hazard ratio [aHR], 1.24; 95% CI, 1.07 to 1.45; p < .01). Advanced age (p < .0001), hypertension (p = .0139), head injury (p = .0003), and stroke (p = .041) were found to be risk factors for dementia, while patients with high socioeconomic status (p < .01) and history of coronary artery disease (p = .0292) were unlikely to develop dementia in our cohort study. CONCLUSION Patients with hernias were associated with a higher incidence of dementia than those without. Our finding should be validated in further prospective studies with larger samples.
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Affiliation(s)
- Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, School of Medicine for International Students, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Jen-Yin Chen
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan.,Department of Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Hsiang-Chi Wang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Nuclear Medicine and PET Center, Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung, Taiwan.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
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18
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Baltic A, Laback C, Auer T, Leithner A, Bernhardt GA. Incarcerated hernia after internal hemipelvectomy for G2 chondrosarcoma: a preventable complication? ANZ J Surg 2019; 90:381-383. [PMID: 30828966 PMCID: PMC7079183 DOI: 10.1111/ans.15148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 12/19/2018] [Accepted: 02/12/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Andrea Baltic
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Christian Laback
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Thomas Auer
- Division of General Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Gerwin A Bernhardt
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
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