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Al-Mansour MR, Ding DD, Yergin CG, Tamer R, Huang LC. The association of hernia-specific and procedural risk factors with early complications in ventral hernia repair: ACHQC analysis. Am J Surg 2024; 233:100-107. [PMID: 38494357 DOI: 10.1016/j.amjsurg.2024.02.028] [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: 10/02/2023] [Revised: 01/29/2024] [Accepted: 02/15/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Many surgical risk assessment tools emphasize patient-specific risk factors. Our objective was to use a hernia-specific database to assess risk factors of complications in ventral hernia repair (VHR) focusing on hernia-specific and procedural factors. METHODS The ACHQC database was queried for elective VHR in adults from 2012 to 2023. Primary outcome was overall 30-day complications. Multivariable logistic regression was used for analysis. RESULTS 41,526 VHR were included. The rate of 30-day complications was 18%, surgical site infection 3%, surgical site occurrence requiring procedural intervention 4%, readmission 4%, reoperation 2%, and mortality 0.2%. Multivariable analysis demonstrated that BMI, ASA, frailty, COPD, anticoagulants, defect width, incisional and recurrent hernias, presence of stoma or prior mesh, prior abdominal wall infection, non-clean wound, operative time, open approach and myofascial release were associated with 30-day complications (OR = 1.01-1.66). Preoperative chlorhexidine, bowel preparation and fascial closure were associated with lower complication risk (OR = 0.70-0.89). CONCLUSION Hernia and procedural risk factors are associated with early complications following elective VHR. These factors need to be included in surgical risk assessment tools, to supplement patient-specific factors.
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Affiliation(s)
| | - Delaney D Ding
- University of Florida College of Medicine, Gainesville, FL, USA
| | | | - Robert Tamer
- Center for Surgical Health Assessment, Research and Policy, The Ohio State University, Columbus, OH, USA
| | - Li-Ching Huang
- Vanderbilt University Medical Center, Nashville, TN, USA
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2
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Fabregó B, Miralpeix E, Sole-Sedeno JM, Pereira JA, Mancebo G. Prophylactic mesh to prevent incisional hernia in laparotomy for ovarian tumors. Int J Gynecol Cancer 2024:ijgc-2024-005427. [PMID: 38909993 DOI: 10.1136/ijgc-2024-005427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024] Open
Abstract
OBJECTIVE Incisional hernias are a common complication of midline laparotomies. The aim of this study was to determine the impact of prophylactic mesh placement after midline laparotomy for ovarian tumors on the incidence of incisional hernia. METHODS We collected retrospective data from patients undergoing midline laparotomy for borderline or ovarian cancer with at least 12 months of follow-up, including those with and without mesh. Patient demographics, preoperative characteristics and risk factors for hernia were reported and grouped according to prophylactic mesh placement. A multivariate analysis was conducted to identify independent risk factors for incisional hernia. Kaplan-Meier curves illustrating the cumulative incidence of incisional hernia based on mesh placement were performed. RESULTS A total of 139 consecutive patients with available data were included, 58 in the non-mesh group and 81 in the mesh group, with high body mass index (BMI) as the most common reason for mesh placement. The mean (SD)) age was 60 years (13.97). A total of 11 patients (7.9%) had borderline tumors while 128 (92.1%) had invasive cancer. After clinical and radiological examination, 18.7% (26/139) of patients developed incisional hernia at a median follow-up of 35.8 months (IQR) 43.8): 31% (18/58) were detected in the non-mesh group, and 9.9% (8/81) in the mesh group (p<0.002). Multivariate analysis showed no-mesh placement (OR) 10; 95% CI) 2.8 to 35.919; p<0.001) as a significant risk factor for incisional hernia. Age ≥70 (OR 4.3; 95% CI 1.24 to 15; p=0.02) and BMI ≥29 (OR 4.4; 95% CI 1.27 to 14.93; p=0.019) were also identified as independent risk factors for hernia development. According to Kaplan-Meier curves, the cumulative incidence of incisional hernia was higher in the non-mesh group (p=0.002). CONCLUSION The incidence of incisional hernia was high in patients undergoing midline laparotomy for ovarian tumors. The addition of a prophylactic mesh may reduce this incidence, therefore there is a need to consider it as an option for high-risk patients, particularly those aged over 70 years or with a BMI ≥29 kg/m2.
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Affiliation(s)
- Berta Fabregó
- Department of Obstetrics and Gynecology, Hospital del Mar, Hospital del Mar, Barcelona, Catalunya, Spain
| | - Ester Miralpeix
- Department of Obstetrics and Gynecology, Hospital del Mar, Hospital del Mar, Barcelona, Catalunya, Spain
| | - Josep-Maria Sole-Sedeno
- Department of Obstetrics and Gynecology, Hospital del Mar, Hospital del Mar, Barcelona, Catalunya, Spain
| | - José-Antonio Pereira
- Department of Surgery, Hospital del Mar, Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
| | - Gemma Mancebo
- Department of Obstetrics and Gynecology, Hospital del Mar, Hospital del Mar, Barcelona, Catalunya, Spain
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Turcotte JJ, Chang YWW, Park AE. Patients Engaged in Losing Weight Preoperatively Experience Improved Outcomes After Hiatal Hernia Repair. Surg Innov 2024:15533506241264371. [PMID: 38907732 DOI: 10.1177/15533506241264371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2024]
Abstract
BACKGROUND Adherence to preoperative weight loss recommendations may serve as a surrogate for the level of engagement in hiatal hernia (HH) patients. This study aims to evaluate the relationship between achieving preoperative weight loss goals and outcomes after HH repair. METHODS A retrospective review of 235 patients undergoing laparoscopic HH repair at a single institution was performed. Patients were grouped based on the percentage of weight loss goal achieved. Low achievement was defined as the bottom quartile of goal achievement (≤75%); high achievement was defined as the top quartile (≥140%). Baseline characteristics, clinical outcomes, and patient reported outcomes (PROMs) were compared between groups. RESULTS 131/235 (55.7%) achieved their weight loss goal. No differences in baseline characteristics or clinical outcomes were observed between the low and high achievement groups. While both groups experienced improvements in PROMs postoperatively, patients in the high achievement group demonstrated significantly lower symptom burden at one-month postoperatively. Further, high-achievement patients were more likely to experience complete resolution of common HH symptoms at one-month postoperatively, including no difficulty swallowing food, no breathing difficulties or choking episodes, no choking when eating food, no choking when drinking liquid, and no regurgitation of food or liquid. CONCLUSIONS In patients undergoing laparoscopic HH repair, patients achieving their preoperative weight loss goals experienced less overall symptom burden and lower prevalence of common symptoms one-month postoperatively than those with low levels of goal achievement. These results demonstrate that patients can take an active role in improving their own surgical outcomes and health status.
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Affiliation(s)
- Justin J Turcotte
- Department of Surgery, Luminis Health Anne Arundel Medical Center, Annapolis, MD, USA
| | - Yu-Wei W Chang
- Department of Surgery, Penn State Health, Enola, PA, USA
| | - Adrian E Park
- Department of Surgery, Meritus Health, Hagerstown, MD, USA
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Omar I, Townsend A, Hadfield O, Zaimis T, Ismaiel M, Wilson J, Magee C. Outcomes of elective and emergency surgical repair of incisional hernia: a comparative observational study. Hernia 2024:10.1007/s10029-024-02975-4. [PMID: 38446277 DOI: 10.1007/s10029-024-02975-4] [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: 10/12/2023] [Accepted: 01/25/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE Incisional hernia (IH) is a common complication following abdominal surgery. Surgical repair of IH is associated with the alleviation of symptoms and improvement of quality of life. Operative intervention can pose a significant burden to the patient and healthcare facilities. This study aims to describe and compare outcomes of elective and emergency surgical repair of IH. METHODS This study is a single-centre comparative retrospective study including patients who had repair of IH. Patients were divided into Group I (Emergency) and Group II (Elective), and a comparison was conducted between them. RESULTS Two hundred sixty-two patients were identified with a mean age of 61.8 ± 14.2 years, of which 152 (58%) were females. The mean BMI was 31.6 ± 7.2 kg/m2. More than 58% had at least one comorbidity. 169 (64.5%) patients had an elective repair, and 93 (35.5%) had an emergency repair. Patients undergoing emergency repair were significantly older and had higher BMI, p = 0.031 and p = 0.002, respectively. The significant complication rate (Clavien-Dindo III and IV) was 9.54%. 30 and 90-day mortality rates were 2.3% (n = 6) and 2.68% (n = 7), respectively. In the emergency group, the overall complications, 30-day and 90-day mortality rates were significantly higher than in the elective group, p ≤ 0.001, 0.002 and 0.001, respectively. Overall, 42 (16.1%) developed wound complications, 25 (9.6%) experienced a recurrence, and 41 (15.71%) were readmitted within 90 days, without significant differences between the two groups. CONCLUSION Patients who underwent emergency repair were significantly older and had a higher BMI than the elective cases. Emergency IH repair is associated with higher complication rates and mortality than elective repair.
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Affiliation(s)
- I Omar
- Department of General Surgery, The Hillingdon Hospitals NHS Foundation Trust, Pield Heath Road, Uxbridge Middlesex, UB8 3NN, UK.
| | - A Townsend
- Department of General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - O Hadfield
- Department of General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - T Zaimis
- Department of General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - M Ismaiel
- Department of General Surgery, Altnagelvin Area Hospital, Londonderry, UK
| | - J Wilson
- Department of General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - C Magee
- Department of General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
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5
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Omar I, Anany A, Ismaiel M, Townsend A, Wilson J, Magee C. Outcomes of Surgical Repair of Incisional Hernia in Patients With Severe and Morbid Obesity: A Comparative Study. Cureus 2024; 16:e55782. [PMID: 38586736 PMCID: PMC10999117 DOI: 10.7759/cureus.55782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Incisional hernia (IH) is a common complication after open and minimal access abdominal surgery. The current practice guidelines recommend weight reduction to achieve a body mass index (BMI) < 35 kg/m2 before surgical repair of ventral hernias. However, this could be challenging to achieve, especially in emergency presentations. This study aims to assess the safety of surgical repair of IH in patients with BMI ≥35 kg/m2. Methods A retrospective comparative study has been conducted to include all patients who had surgical repair of IH on an elective and emergency basis in a UK District General Hospital. The patients were divided into two groups. Group I BMI < 35 kg/m2 and Group II with BMI ≥35 kg/m2. A comparison was made between the two groups according to demographics, comorbidities, hernia characteristics, operative data, and outcomes. Results The study included 239 patients, 181 in Group I and 58 in Group II. Morbid obesity was associated with male patients, and they were younger than Group I, p= 0.001 and 0.013, respectively. 13.8% of Group I had DM compared to 29.3% in Group II, p= 0.007. There were no significant differences in hernia characteristics or mode of surgery between the two groups. However, Group II had more overall and wound-related complications, p= <0.001 each. There were no significant differences in 30-day and 90-day mortality, recurrence rate, or 90-day readmissions. Conclusions Surgical repair of IH in patients with severe and morbid obesity is associated with more overall and wound-related complications.
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Affiliation(s)
- Islam Omar
- Department of General Surgery, The Hillingdon Hospitals National Health Service (NHS) Foundation Trust, Uxbridge, GBR
| | - Amr Anany
- Department of General Surgery, Charing Cross Hospital, Imperial College National Health Service (NHS) Trust, London, GBR
| | - Mohamed Ismaiel
- Department of General Surgery, Altnagelvin Hospital, Londonderry, GBR
| | - Abby Townsend
- Department of General Surgery, Wirral University Teaching Hospital National Health Service (NHS) Foundation Trust, Wirral, GBR
| | - Jeremy Wilson
- Department of General Surgery, Wirral University Teaching Hospital National Health Service (NHS) Foundation Trust, Wirral, GBR
| | - Conor Magee
- Department of General Surgery, Wirral University Teaching Hospital National Health Service (NHS) Foundation Trust, Wirral, GBR
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Lozada Hernández EE, Maldonado Barrios IL, Amador Ramírez S, Rodríguez Casillas JL, Hinojosa Ugarte D, Smolinski Kurek RL, Crocco Quirós B, Cethorth Fonseca RK, Sánchez Téran A, Macias Grageda M. Surgical site occurrence after prophylactic use of mesh for prevention of incisional hernia in midline laparotomy: systematic review and meta-analysis of randomized clinical trials. Surg Endosc 2024; 38:942-956. [PMID: 37932603 DOI: 10.1007/s00464-023-10509-9] [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: 04/16/2023] [Accepted: 09/24/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND The use of mesh is the standard for the prevention of incisional hernia (IH). However, the effect of surgical site occurrence (SSO) has never been compared. The aim of this meta-analysis was to evaluate the prevalence of SSO and measure its negative effect through the calculation of the number needed to treat for net effect (NNT net). METHODS A meta-analysis was performed according to the PRISMA guidelines. The primary objective was to determine the prevalence of SSO and IH, and the secondary objective was to determine the NNT net as a metric to measure the combined benefits and harms. Only published clinical trials were included. The risk of bias was analyzed, and the random effects model was used to determine statistical significance. RESULTS A total of 15 studies comparing 2344 patients were included. The incidence of IH was significantly lower in the mesh group than in the control group, with an OR of 0.29 (95% CI 0.16-0.49, p = 0.0001). The incidence of SSO was higher in the mesh group than in the control group, with an OR of 1.21 (95% CI 0.85-1.72, p = 0.0001) but without statistical significance. Therefore, the way to compare the benefits and risks of each of the studies was done with the calculation of the NNT net, which is the average number of patients who need to be treated to see the benefit exceeding the harm by one event, and the result was 5, which is the average number of patients who need to be treated to see the benefit exceeding the harm by one event. CONCLUSION The use of mesh reduces the prevalence of IH and it does not increases the prevalence of SSO, the NNT net determined that the use of mesh continues to be beneficial for the patient.
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Affiliation(s)
- Edgard Efrén Lozada Hernández
- Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajio, Circuito Quinta los Naranjos # 145 B. Colonia Quinta los Naranjos, León, Guanajuato, Mexico.
| | | | | | | | - Diego Hinojosa Ugarte
- Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajio, Circuito Quinta los Naranjos # 145 B. Colonia Quinta los Naranjos, León, Guanajuato, Mexico
| | - Rafal Ludwik Smolinski Kurek
- Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajio, Circuito Quinta los Naranjos # 145 B. Colonia Quinta los Naranjos, León, Guanajuato, Mexico
| | - Bruno Crocco Quirós
- Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajio, Circuito Quinta los Naranjos # 145 B. Colonia Quinta los Naranjos, León, Guanajuato, Mexico
| | - Roland Kevin Cethorth Fonseca
- Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajio, Circuito Quinta los Naranjos # 145 B. Colonia Quinta los Naranjos, León, Guanajuato, Mexico
| | - Alfonso Sánchez Téran
- Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajio, Circuito Quinta los Naranjos # 145 B. Colonia Quinta los Naranjos, León, Guanajuato, Mexico
| | - Michelle Macias Grageda
- Department of Diseases of the Digestive Tract, Regional Hospital of High Specialty of Bajio, Circuito Quinta los Naranjos # 145 B. Colonia Quinta los Naranjos, León, Guanajuato, Mexico
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Omar I, Zaimis T, Townsend A, Ismaiel M, Wilson J, Magee C. Incisional Hernia: A Surgical Complication or Medical Disease? Cureus 2023; 15:e50568. [PMID: 38222215 PMCID: PMC10788045 DOI: 10.7759/cureus.50568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/16/2024] Open
Abstract
Incisional hernia (IH) is a frequent complication following abdominal surgery. The development of IH could be more sophisticated than a simple anatomical failure of the abdominal wall. Reported IH incidence varies among studies. This review presented an overview of definitions, molecular basis, risk factors, incidence, clinical presentation, surgical techniques, postoperative care, cost, risk prediction tools, and proposed preventative measures. A literature search of PubMed was conducted to include high-quality studies on IH. The incidence of IH depends on the primary surgical pathology, incision site and extent, associated medical comorbidities, and risk factors. The review highlighted inherent and modifiable risk factors. The disorganisation of the extracellular matrix, defective fibroblast functions, and ratio variations of different collagen types are implicated in molecular mechanisms. Elective repair of IH alleviates symptoms, prevents complications, and improves the quality of life (QOL). Recent studies introduced risk prediction tools to implement preventative measures, including suture line reinforcement or prophylactic mesh application in high-risk groups. Elective repair improves QOL and prevents sinister outcomes associated with emergency IH repair. The watchful wait strategy should be reviewed, and options should be discussed thoroughly during patients' counselling. Risk stratification tools for predicting IH would help adopt prophylactic measures.
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Affiliation(s)
- Islam Omar
- General Surgery, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, GBR
| | - Tilemachos Zaimis
- General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, GBR
| | - Abby Townsend
- General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, GBR
| | - Mohamed Ismaiel
- General Surgery, Altnagelvin Area Hospital, Londonderry, GBR
| | - Jeremy Wilson
- General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, GBR
| | - Conor Magee
- General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, GBR
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Alansari AH, Almalawi AM, Alghamdi A, Alghamdi MS, Hazazi HA, Aljabri AA, Alsulami RA, Alkhoshi AM, Khinaifis F. Body Mass Index Within Multifactor Predictors of Ventral Hernia Recurrence: A Retrospective Cohort Study. Cureus 2023; 15:e41148. [PMID: 37519520 PMCID: PMC10386881 DOI: 10.7759/cureus.41148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 08/01/2023] Open
Abstract
Background A ventral hernia is a protrusion of the peritoneum through the defective abdominal wall. Several risk factors increase the likelihood of hernial recurrence. One of the most common risk factors is obesity, defined by the World Health Organization (WHO) as increased body mass index (BMI). Few studies have explored the effects of BMI and other factors on hernia recurrence. Hence, we aimed to investigate the role of increased BMI in hernia recurrence in conjunction with various risk factors such as age, sex, type of hernia, the time elapsed between the occurrence and recurrence, complications of hernia, and procedure. Methods This retrospective cohort study was conducted at King Abdulaziz University Hospital (KAUH). All the patients were admitted between 2015-2022. A total of 1676 medical records were obtained from all patients who underwent hernia repair more than once or were diagnosed with a recurrent hernia during the study period. Results Our study revealed an insignificant correlation between a BMI of more than 25 kg/m2 and the recurrence of inguinal hernias, predominantly indirect hernias. Furthermore, overweight and obese patients experience a longer interval between the first and second hernia repairs. Interestingly, all the patients with inguinal and umbilical hernias had the same diagnosis at the second presentation. However, the findings also included a significant increase in umbilical hernias in individuals with a high BMI and higher recurrence rates among male patients with inguinal hernias. Conclusion BMI higher than 25 kg/m2 increases recurrence rates for umbilical hernias but decreases the recurrence of inguinal hernias.
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Affiliation(s)
| | - Asim M Almalawi
- Infectious Diseases, King Abdulaziz University Hospital, Jeddah, SAU
| | - Abdullah Alghamdi
- Infectious Diseases, King Abdulaziz University Hospital, Jeddah, SAU
| | | | - Hassan A Hazazi
- Infectious Diseases, King Abdulaziz University Hospital, Jeddah, SAU
| | | | - Raed A Alsulami
- Internal Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | | | - Fatma Khinaifis
- Surgical Oncology, King Abdulaziz University Hospital, Jeddah, SAU
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9
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Smith L, Coxon-Meggy A, Shinkwin M, Cornish J, Watkins A, Fegan G, Torkington J. "Happy to close?" The relationship between surgical experience and incisional hernia rates following abdominal wall closure in colorectal surgery. Colorectal Dis 2023. [PMID: 36965056 DOI: 10.1111/codi.16537] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/01/2023] [Accepted: 02/09/2023] [Indexed: 03/27/2023]
Abstract
AIM Incisional hernia (IH) is a common complication of colorectal surgery, affecting up to 30% of patients at 2 years. Given the associated morbidity and high recurrence rates after attempted repair of IH, emphasis should be placed on prevention. There is an association between surgeon volume and outcomes in hernia surgery, yet there is little evidence regarding impact of the seniority of the surgeon performing abdominal wall closure on IH rate. The aim of our study was to assess the rates of IH at 1 year following abdominal wall closure between junior and senior surgeons in patients undergoing elective colorectal surgery. METHODS This was an exploratory analysis of patients who underwent elective surgery for colorectal cancer between 2014-2018 as part of the Hughes Abdominal Repair Trial (HART), a prospective, multicentre randomised control trial comparing abdominal wall closure methods. Grade of surgeon performing abdominal closure was categorised into "trainee" and "consultant" and compared to IH rate at one year. RESULTS A total of 663 patients were included in this retrospective analysis of patients in the HART trial. The rate of IH in patients closed by trainees was 20%, compared to 12% in those closed by consultants (p = <0.001). When comparing closure methods, IH rates were significantly higher in the Hughes closure arm between trainees and consultants (20% vs. 12%, p = 0.032), but not high enough in the mass closure arm to reach statistical significance (21% vs. 13%, p = 0.058). On multivariate analysis, age (p = 0.036, OR: 1.02, 95% CI: 1.00-1.04), Male sex (p = 0.049, OR: 1.61, 95% CI: 1.00-2.59) and closure by a trainee (p = 0.006, OR: 1.85, 95% CI: 1.20-2.85) were identified as risk factors for developing IH. CONCLUSION Patients who undergo abdominal wall closure by a surgeon in training have an increased risk of developing IH when compared to those closed by a consultant. Further work is needed to determine the impact of supervised and unsupervised trainees on IH rates, but abdominal wall closure should be regarded as a training opportunity in its own right.
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Affiliation(s)
- Laurie Smith
- Department of Colorectal Surgery, University Hospital of Wales, Cardiff, UK
- Cardiff University, Cardiff, UK
| | - Alexandra Coxon-Meggy
- Department of Colorectal Surgery, University Hospital of Wales, Cardiff, UK
- Cardiff University, Cardiff, UK
| | - Michael Shinkwin
- Department of Colorectal Surgery, University Hospital of Wales, Cardiff, UK
| | - Julie Cornish
- Department of Colorectal Surgery, University Hospital of Wales, Cardiff, UK
| | - Alan Watkins
- Swansea Trials Unit, Swansea University Medical School, Swansea, UK
| | - Greg Fegan
- Swansea Trials Unit, Swansea University Medical School, Swansea, UK
| | - Jared Torkington
- Department of Colorectal Surgery, University Hospital of Wales, Cardiff, UK
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10
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Risk factors of venous thromboembolism after incisional ventral hernia repair. Hernia 2022:10.1007/s10029-022-02726-3. [PMID: 36471032 DOI: 10.1007/s10029-022-02726-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/20/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The problem of venous thromboembolic events (VTE) after incisional hernia repair remains relevant. According to the literature the frequency of VTE ranges from 0.2 to 4.2%. The data on risk factors of VTE in this cohort of patients are scarce. Aim of our study is to find frequency and risk factors for VTE development in patients who underwent surgery for incisional ventral hernia. MATERIALS AND METHODS There were 240 patients enrolled in our retrospective study. We included patients, who were operated for incisional hernia in Saveljev University Surgery Clinic from January 2018 to December 2019. Compression duplex ultrasound of lower extremity veins was performed within median 3 days (min 1 day, max 7 days) after surgery for all participants. The primary endpoint was the occurrence of the VTE event, including deep venous thrombosis (DVT) and pulmonary embolism (PE). RESULTS VTE was detected in 19 patients, which accounted for 7.9% in analyzed cohort. All patients received standard pharmacological prophylaxis. There were 3 (1.3%) proximal, 16 (6.7%) distal DVT, in one patient (0.4%) distal thrombosis was complicated by symptomatic pulmonary embolism. In multivariate Cox proportional hazard model was found that component separation (HR 3.99, 95% CI 1.14-14.0, p = 0.03), duration of operation in hours (HR 1.67. 95% CI 1.13-2.5, p = 0.011) and body mass index (HR 1.13, 95% CI 1.02-1.2, p = 0.02) were statistically significant risk factors. CONCLUSION The incidence of postoperative VTE in patients after incisional hernia repair is high with a predominant distal DVT as a thrombotic event. Component separation, duration of operation and body mass index are statistically significant factors of VTE in patients undergoing surgery for incisional hernia.
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Li Z, Xia L, Li X, Guan Y, He H, Jin L. Body mass index and the risk of abdominal hernia: a Mendelian randomization study. Hernia 2022; 27:423-429. [PMID: 36441335 DOI: 10.1007/s10029-022-02703-w] [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: 08/07/2022] [Accepted: 10/21/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Abdominal hernia (AH) is one of the most common clinical diseases. A large number of observational studies have found that obesity is an important risk factor for AH. However, the causal relationship between obesity and AH cannot be determined because of the clinical studies on AH induced by obesity are relatively few and only have some small- or medium-scale observational studies. Observational studies have so many confounding factors and reverse causality due to their shortcomings. From an evidence-based medicine perspective, they are not sufficiently convincing. Therefore, there is still a lack of high-quality, evidence-based medical evidence supporting a causal relationship between obesity and AH. A causal relationship between obesity and AH is also almost impossible to confirm by randomized controlled trials (RCTs). Our study based on Mendelian randomization (MR) may provide a higher level of evidence-based medical support for the relationship between obesity and AH. Body mass index (BMI) is the most common measure used for defining obesity. Finally, we employed two-sample Mendelian randomization (TSMR) to explore the causal relationship between BMI and AH. METHODS AH-related single nucleotide polymorphisms (SNPs) data were obtained from the FinnGen Biobank (FB), and BMI-related single nucleotide polymorphisms (SNPs) data were obtained from the UK Biobank (UKB). Genetic loci are used as instrumental variables (IVs), methods such as inverse variance weighted (IVW) were used for two-sample Mendelian randomization analysis, and the odds ratio (OR) value was used to evaluate the causal relationship between BMI and AH. RESULTS The results of the horizontal pleiotropy test were calculated by Egger-intercept method: p = 0.34 > 0.05. The Cochran Q test of MR-Egger method and IVW method showed heterogeneity P = 0.03 < 0.05, so the IVW random effect model was used as the gold standard. We found a genetically determined 1-standard deviation (SD) increment of BMI causally increased a 66.0% risk of AH (N = 371 SNPs, OR = 1.66, 95% CI 1.46-1.89, p = 1.55E-14) based on the IVW random effect model which was almost consistent with the results of other seven methods. CONCLUSIONS Our MR found genetic evidence for BMI and AH. The risk of developing AH increases with the number of BMI. This finding provides further evidence that maintaining a healthy BMI can prevent the development of AH. In addition, clinicians may need to focus on the potential risk of AH on some high-BMI patients.
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Affiliation(s)
- Z Li
- School of Clinical Medicine, Dali University, Dali, 671000, China
| | - L Xia
- School of Clinical Medicine, Dali University, Dali, 671000, China
| | - X Li
- College of Life Science, Shaanxi Normal University, Xi'an, 710000, China
| | - Y Guan
- The First Affiliated Hospital of Dali University, Dali, 671000, China
| | - H He
- The First Affiliated Hospital of Dali University, Dali, 671000, China
| | - L Jin
- The First Affiliated Hospital of Dali University, Dali, 671000, China.
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Wehrle CJ, Shukla P, Miller BT, Blake KE, Prabhu AS, Petro CC, Krpata DM, Beffa LR, Tu C, Rosen MJ. Incisional hernia rates following midline laparotomy in the obese patient: a retrospective review. Hernia 2022; 27:557-563. [DOI: 10.1007/s10029-022-02688-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022]
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Sebastián-Tomás JC, Díez-Ares JÁ, Peris-Tomás N, Navarro-Martínez S, Periañez-Gómez D, Pérez-Rubio Á, Martínez-Mas E, Trullenque-Juan R. Simultaneous Complex Incisional Hernia Repair and Bariatric Surgery for Obese Patients: a Case Series of a Single-Center Early Experience. JOURNAL OF METABOLIC AND BARIATRIC SURGERY 2021; 10:55-65. [PMID: 36683670 PMCID: PMC9847639 DOI: 10.17476/jmbs.2021.10.2.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 01/25/2023]
Abstract
Purpose Obesity is associated with recurrence of complex incisional hernia repair (CIHR). Bariatric procedure during CIHR can improve recurrence rates without increasing morbidity. This study aimed to describe our results after CIHR in patients with obesity, in which a simultaneous bariatric procedure was performed. Materials and Methods We performed a retrospective observational study including patients who underwent surgery between January 2014 and December 2018, with a complex incisional hernia (CIH) according to the Slater classification and body mass index (BMI) ≥35. CIHR was the main indication for surgery. We collected demographic data, comorbidities, CIH classification according to the European Hernia Society, type of bariatric procedure, postoperative morbidity using the Dindo-Clavien classification, and short-term results. Computed tomography (CT) is performed preoperatively. Results Ten patients were included in the study (7 women). The mean BMI was 43.63±4.91 kg/m2. The size of the abdominal wall defect on CT was 8.86±3.93 cm. According to the European Hernia Society classification, all CIHs were W2 or higher. Prosthetic repair of the CIH was selected. Onlay, sublay, preperitoneal, and inlay mesh placement were performed twice each, as well as one modified component separation technique and one transversus abdominis release. Gastric leak after sleeve gastrectomy was the only major complication. Short-term outcomes included one recurrence, and % total weight loss was 24.04±8.03 after 1-year follow-up. Conclusion The association of bariatric procedures during CIHR seems to be feasible, safe, and could be an option for surgical treatment in selected patients.
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Affiliation(s)
| | - José Ángel Díez-Ares
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Nuria Peris-Tomás
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Sergio Navarro-Martínez
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Dolores Periañez-Gómez
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Álvaro Pérez-Rubio
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Ezequiel Martínez-Mas
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Ramón Trullenque-Juan
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
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