1
|
Rodrigues-Gonçalves V, Verdaguer M, Bravo-Salva A, Moratal M, Blanco R, Ochoa-Segarra F, Pereira-Rodríguez JA, López-Cano M. Open preperitoneal vs. open anterior repair for the treatment of emergency femoral hernia: a bicentric retrospective study. Hernia 2023; 27:127-138. [PMID: 36083415 DOI: 10.1007/s10029-022-02673-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/30/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE The aim of this study is to compare the postoperative results, in terms of complications and recurrence, between the anterior and open preperitoneal approaches in emergency femoral hernia. METHODS This bi-centric retrospective cohort study included patients who underwent emergency femoral hernia repair between January 2010 and December 2018. Postoperative complications and recurrence were analyzed comparing anterior and open preperitoneal approaches. The predictors of complications, mortality and recurrence were investigated using multivariate logistic regression. RESULTS A total of 204 patients met the inclusion criteria. Open anterior approach was performed in 128 (62.7%) patients and open preperitoneal was performed in 76 (37.3%). Open preperitoneal approach was associated with lower rates of recurrence (P = 0.033) and associated midline laparotomies (P = 0.006). Multivariable analysis identified patients with chronic nephropathy (OR, 3.801; 95%CI, 1.034-13.974; P = 0.044), preoperative bowel obstruction (OR, 2.376; 95%CI, 1.118-5.047; P = 0.024) and required midline laparotomy (OR, 12.467; 95%CI, 11.392-102.372; P = 0.030) as risk factors for complications and ASA ≥ III (OR, 7.820; 95%CI, 1.279-47.804; P = 0.026), COPD (OR, 5.064; 95%CI, 1.188-21.585; P = 0.028), necrotic contents (OR, 36.968; 95%CI, 4.640-294.543; P = 0.001), and required midline laparotomy (OR, 11.047; 95%CI, 1.943-62.809; P = 0.007). as risk factors for 90-day mortality. Male gender (OR, 4.718; 95%CI, 1.668-13.347; P = 0.003) and anterior approach (OR, 5.292; 95%CI, 1.114-25.149; P = 0.036) were risk factors for recurrence. CONCLUSION Open preperitoneal approach may be superior to anterior approach in the emergency setting because it can avoid the morbidity of associated midline laparotomies, with a lower long-term recurrence rate.
Collapse
Affiliation(s)
- V Rodrigues-Gonçalves
- General Surgery Department, Abdominal Wall Surgery Unit, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Paseo Vall d`Hebron 119-129, 08035, Barcelona, Spain.
| | - M Verdaguer
- General Surgery Department, Abdominal Wall Surgery Unit, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Paseo Vall d`Hebron 119-129, 08035, Barcelona, Spain
| | - A Bravo-Salva
- Servei de Cirurgia General, Hospital del Mar, Parc de Salut Mar, Department de Ciències, Experimentals I de La Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - M Moratal
- General Surgery Department, Abdominal Wall Surgery Unit, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Paseo Vall d`Hebron 119-129, 08035, Barcelona, Spain
| | - R Blanco
- General Surgery Department, Abdominal Wall Surgery Unit, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Paseo Vall d`Hebron 119-129, 08035, Barcelona, Spain
| | - F Ochoa-Segarra
- Servei de Cirurgia General, Hospital del Mar, Parc de Salut Mar, Department de Ciències, Experimentals I de La Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - J A Pereira-Rodríguez
- Servei de Cirurgia General, Hospital del Mar, Parc de Salut Mar, Department de Ciències, Experimentals I de La Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - M López-Cano
- General Surgery Department, Abdominal Wall Surgery Unit, Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Paseo Vall d`Hebron 119-129, 08035, Barcelona, Spain
| |
Collapse
|
2
|
Comparison of mesh repair and suture repair for the treatment of incarcerated femoral hernia: a retrospective, single-center study. Surg Endosc 2023; 37:466-470. [PMID: 35999313 DOI: 10.1007/s00464-022-09488-0] [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: 03/16/2022] [Accepted: 07/16/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Femoral hernias often present with incarceration or strangulation that requires emergency surgery. However, recommendations vary regarding optimal approaches for incarcerated femoral hernia. The aim of this study is to compare clinical efficacy between mesh repair and suture repair for the treatment of incarcerated femoral hernia. METHODS Retrospective, single-center analysis of the clinical data from 48 patients with incarcerated femoral hernia, including 16 patients who underwent mesh repair (mesh repair group) and 32 patients who underwent traditional suture repair (suture repair group). RESULTS The mean age, body mass index, incarceration duration, hernia sac size, operation duration, and the rates of postoperative incision infection, recurrence, chronic pain, and mortality were not significantly different between the suture repair and mesh repair groups (P > 0.05 for all). In contrast, the female/male ratio; the rates of bowel obstruction, coexisting diseases, and nighttime operation; and the American Society of Anesthesiologists grade were higher and the rate of prophylactic antibiotic use and the mean cost of hospitalization were lower in the suture repair group than in the mesh repair group (P < 0.05 for all). CONCLUSION The surgical approach should be chosen based on the patient's condition. Mesh repair for the emergency treatment of incarcerated femoral hernia is safe and effective, whereas suture repair is suitable for elderly patients, those with more coexisting diseases, and those with limited life expectancy.
Collapse
|
3
|
CAKCAK İE, KAPTAN M. COVID-19 pandemisinin inguinal herni cerrahi tedavisi üzerindeki etkisi: Tek bir merkezde retrospektif bir çalışma. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2022. [DOI: 10.25000/acem.1104456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: In this study, we aimed to examine the effect of the COVID 19 pandemic on the number, complication rates and epidemic characteristics of patients operated with the diagnosis of inguinal hernia in our institute.
Methods: We analyzed all patients who underwent inguinal hernia operation in Trakya University Faculty of Medicine, Dept of General Surgery, between March 11, 2019, and March 11, 2020, and compared them with the cases between March 11, 2020, and March 11, 2021, retrospectively. Percentages, mean, standard deviation, median and interquartile range were used as the descriptive statistics. Mann-Whitney U test was used for the variations which are contrary to the normal distribution range in the comparison of two groups. The relations between qualitative variations were studied by the Pearson Chi-Square test and Fisher's Exact test. Significant value was determined as 0.05 for all statistical analyses.
Results: Between March 11, 2019, and 2020, 65 patients were operated on (Group 1), and 26 patients between March 11, 2020, and 2021 (Group 2). The percentage of female patients was significantly higher in Group 2 (4.6% in Group 1, 23.1% in Group 2, p=0.008) and there was a statistically significant increase in the rate of incarceration and strangulation in Group 2 (44.6% in Group 1, 84.6% in Group 2, p=0.001).
Conclusions: During the COVID-19 pandemic the incarceration and strangulation rate was higher. The increase in complication rates can be attributed to the relative decrease in elective surgeries or the increase in the number of female patients admitted during the COVID period.
Collapse
|
4
|
Ninomiya S, Fujita S, Ogawa T, Ueda Y, Shiraishi N, Inomata M, Shimoda K. Incarcerated femoral hernia treated with elective totally extraperitoneal repair: a case report. J Surg Case Rep 2020; 2020:rjaa158. [PMID: 32577212 PMCID: PMC7297550 DOI: 10.1093/jscr/rjaa158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 12/27/2022] Open
Abstract
Incarcerated groin hernia is a common surgical emergency. However, reports of incarcerated femoral hernia treated with elective totally extraperitoneal repair are extremely rare. A 62-year-old woman visited our hospital with lower abdominal pain and bulging from a right groin lesion. The patient was diagnosed as having right incarcerated femoral hernia containing greater omentum by computed tomography. As there were no clear findings of intestinal obstruction and peritonitis, elective surgery was performed. Intraoperatively, the hernia sac had herniated into the right femoral canal. We could release the hernia sac using laparoscopic forceps. After reduction of the hernia sac, polypropylene mesh was placed in the preperitoneal space and fixed to Cooper's ligament. The patient's postoperative course was uneventful, and she was discharged 3 days after surgery. We consider elective totally extraperitoneal repair for incarcerated femoral hernia to be an effective procedure for selected patients who have been diagnosed accurately.
Collapse
Affiliation(s)
- Shigeo Ninomiya
- Department of Surgery, Cosmos Hospital, Usuki, Japan.,Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Yufu, Japan
| | | | - Tadashi Ogawa
- Department of Surgery, Cosmos Hospital, Usuki, Japan
| | - Yoshitake Ueda
- Department of Comprehensive Surgery for Community Medicine, Oita University Faculty of Medicine, Yufu, Japan
| | - Norio Shiraishi
- Department of Comprehensive Surgery for Community Medicine, Oita University Faculty of Medicine, Yufu, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Yufu, Japan
| | | |
Collapse
|
5
|
Chen P, Yang W, Zhang J, Wang C, Yu Y, Wang Y, Yang L, Zhou Z. Analysis of risk factors associated bowel resection in patients with incarcerated groin hernia. Medicine (Baltimore) 2020; 99:e20629. [PMID: 32502042 PMCID: PMC7306359 DOI: 10.1097/md.0000000000020629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Incarcerated groin hernia (IGH) is a common surgical emergency. However, there are few accurate and applicable predictors for differentiating patients with strangulated groin hernia from those with IGH. In this study, we aimed to identify the independent risk factors for bowel resection in patients with IGH. METHODS We retrospectively collected 323 patients who underwent emergency hernia repair surgery for IGH between January 2010 and October 2019. The patients were categorized into those who received bowel resection and those who did not require bowel resection. The receiver-operating characteristic curve was used to identify the best cutoff values for continuous variables. Following this, univariate and multivariate analyses were performed to identify potential risk factors for bowel resection in these patients. RESULTS Univariate analysis identified 6 variables that were significantly associated with bowel resection among patients with IGH. On multivariate analysis, neutrophil-to-lymphocyte ratio (NLR) (odds ratio [OR] = 3.362, 95% confidence interval [CI] 1.705-6.628, P = .000) and bowel obstruction (OR = 3.191, 95% CI 1.873-5.437, P = 0.000) were identified as independent risk factors for bowel resection among patients with IGH. CONCLUSION In this study, an elevated NLR and those with bowel obstruction are associated with an increased risk of bowel resection among patients with IGH. Based on our findings, surgeons should prioritize prompt emergency surgical repair for patients who present with elevated NLR and bowel obstruction concurrent with IGH.
Collapse
Affiliation(s)
- Peng Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
| | - Wenming Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
| | - Jianhao Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
| | - Cun Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University, Chengdu
| | - Yongyang Yu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University, Chengdu
| | - Yong Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University, Chengdu
| | - Lie Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University, Chengdu
- Department of General Surgery, West China-Ziyang Hospital of Sichuan University/The First People's Hospital of Ziyang, Ziyang, Sichuan Province, China
| | - Zongguang Zhou
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University, Chengdu
| |
Collapse
|
6
|
Marciniuk P, Jagielak D, Rogowski J, Gumiela P, Bury K. Femoral hernia in the era of TAVI - a potential obstacle for transfemoral approach: a case report and literature review. BMC Surg 2020; 20:26. [PMID: 32039722 PMCID: PMC7008545 DOI: 10.1186/s12893-020-0693-3] [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: 08/28/2019] [Accepted: 02/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background Transcatheter aortic valve implantation (TAVI) via total percutaneous transfemoral approach is an increasingly common technique for aortic stenosis treatment. It is primarily indicated in elderly with serious comorbidities. The epidemiology of these patients tends to overlap with the incidence of femoral hernia (FH). The appearance of hernia sac at the approach site and insufficient preoperational examination can lead to serious complications. We present the first-ever reported case of subsequent femoral hernia repair during transfemoral TAVI. Case presentation This report presents a case of FH/TAVI coincidence and literature review of its epidemiology. Literature review was performed to analyze similarities of femoral hernia and TAVI. The case describes an 84-year old female referred for elective TAVI. Intraoperation incarcerated femoral hernia was noticed and directly repaired. Further TAVI steps were performed on regular basis. A 2-year follow-up reported no local and general complications related to procedures. Conclusions Unsuspected femoral hernia found subsequently with transfemoral TAVI may become a growing problem. The number of TAVI performed rises with indications expansion. Femoral hernia repairs constitute from 2 to 4% of all groin hernia. Both TAVI and FH are connected with elderly. Despite the fact of low FH incidence, growing number of TAVI performed and ageing of population, corresponds with higher possibility of complications. Most of these complications may end up fatal as they would involve high-risk patients. Insufficient attention is paid by cardiologists to the possible hernia appearance in the access site as this issue has been hardly ever presented in literature. Concomitant FH in TAVI patients should always be excluded in order to avoid serious complications. The case we report presents a successful subsequent FH repair during TAVI procedure. Further studies have to be conducted to provide data on how such problems ought to be managed.
Collapse
Affiliation(s)
- Piotr Marciniuk
- Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Dębinki 7, 80-952, Gdańsk, Poland.
| | - Dariusz Jagielak
- Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Dębinki 7, 80-952, Gdańsk, Poland
| | - Jan Rogowski
- Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Dębinki 7, 80-952, Gdańsk, Poland
| | - Piotr Gumiela
- Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Dębinki 7, 80-952, Gdańsk, Poland
| | - Kamil Bury
- Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Dębinki 7, 80-952, Gdańsk, Poland
| |
Collapse
|
7
|
Fukushima K, Yokoyama T, Miwa S, Motoyama H, Arai T, Kitagawa N, Shimizu A, Notake T, Kikuchi T, Kobayashi A, Miyagawa SI. Impact of age on groin hernia profiles observed during laparoscopic transabdominal preperitoneal hernia repair. Surg Endosc 2018; 33:2602-2611. [PMID: 30357524 DOI: 10.1007/s00464-018-6556-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/17/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND How increasing age affects the characteristics of groin hernia remains uncertain. This study evaluated the association between age and the type of groin hernia, especially with respect to its multiplicity, observed during laparoscopic transabdominal preperitoneal (TAPP) hernia repair. METHODS We retrospectively evaluated 634 consecutive patients with primary groin hernia who underwent laparoscopic TAPP repair between October 2000 and June 2017. Patients were stratified into 4 age groups: < 60 years, 60-69 years, 70-79 years, and 80 years or older. RESULTS The incidence of occult contralateral hernia and multiple ipsilateral hernias increased significantly with each increasing age group: 7.3%, 10.4%, 12.7%, and 20.8% for occult contralateral hernia (p = 0.005), and 5.6%, 9.2%, 16.8%, and 21.7% for multiple ipsilateral hernias (p < 0.001), respectively. Univariate analyses showed that an older age (age ≥ 70 years) was the only factor significantly associated with the presence of multiple groin hernias (odds ratio, 2.69; 95% confidence interval, 1.89-3.81; p < 0.001). In patients with multiple ipsilateral hernias, the prevalent form in men was a pantaloons hernia, with an incidence of about 70% across all age groups, whereas in women it was groin hernias, with one component being a femoral hernia, an obturator hernia, or both. CONCLUSIONS The multiple occurrence of groin hernias, either unilaterally or bilaterally, was a clinical feature in the elderly.
Collapse
Affiliation(s)
- Kentaro Fukushima
- First Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, 390-8621, Matsumoto, Nagano, Japan
| | - Takahide Yokoyama
- First Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, 390-8621, Matsumoto, Nagano, Japan
| | - Shiro Miwa
- Department of Surgery, Okaya Municipal Hospital, Okaya, Japan
| | - Hiroaki Motoyama
- First Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, 390-8621, Matsumoto, Nagano, Japan
| | - Takuma Arai
- Department of Surgery, Okaya Municipal Hospital, Okaya, Japan
| | | | - Akira Shimizu
- First Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, 390-8621, Matsumoto, Nagano, Japan
| | - Tsuyoshi Notake
- First Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, 390-8621, Matsumoto, Nagano, Japan
| | - Toshiki Kikuchi
- Department of Surgery, Showa-inan General Hospital, Komagane, Japan
| | - Akira Kobayashi
- First Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, 390-8621, Matsumoto, Nagano, Japan.
| | - Shin-Ichi Miyagawa
- First Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, 390-8621, Matsumoto, Nagano, Japan
| |
Collapse
|
8
|
Proportion of femoral hernia repairs performed for recurrence in the United States. Hernia 2018; 22:593-602. [PMID: 29411165 DOI: 10.1007/s10029-018-1743-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 01/22/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE Recurrence rates after femoral hernia repair (FHR) have not been reliably established in the USA. We sought to determine this trend over time. METHODS The proportion of primary and recurrent FHRs was determined for patients age ≥ 18 from: ACS-NSQIP (1/2005-12/2014), Premier (1/2010-09/2015), and institutional (1/2005-12/2014) data. Trends were analyzed using a one-tailed Cochran-Armitage test. RESULTS In the NSQIP database, 6649 patients underwent a FHR. In females, the proportion of FHRs performed for recurrence decreased from 14.0% in 2005 to 6.2% in 2014, p = 0.02. In males, there was no change: 16.7-16.1% 2005-2014 (p = 0.18). The Premier database included 4495 FHRs and our institution 315 FHRs. There was no difference for either gender over time in either data source, all p > 0.05. CONCLUSIONS The proportion of femoral hernia repairs performed for recurrence in the USA remained relatively constant in males in two large national databases between 2005 and 2015. In females, a decrease was seen in one of the large national databases.
Collapse
|
9
|
High incidence of recess formation at myopectineal orifice during laparoscopic surgery. Asian J Surg 2017; 41:427-430. [PMID: 28716501 DOI: 10.1016/j.asjsur.2017.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 05/12/2017] [Accepted: 06/01/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Groin hernias are frequently seen in clinical practice. The purpose of this study was to determine the rate of patients who might have latent groin hernia. METHODS During laparoscopic abdominal surgery, we observed the area around the groin lesion and attempted to evaluate the degree of recess at myopectineal orifice. The classification defining the recess was as follows: Grade 0: no recess, Grade I: slight recess with a visible bottom, Grade II: deep recess with an invisible bottom, Grade III: other organ invaginated into the recess, and Grade IV: confirmed bulging on the body surface. RESULTS From 2009 to 2011, 46 patients were enrolled. A recess around myopectineal orifice were detected in 20 patients. The lesions were as follows: 11 on the lateral side of the inferior epigastric artery (IEA), five on the internal side of the IEA, three at both sites and one found at the femoral ring. According to the grade classification of these groin hernias, 26 (57%) were Grade 0, 14 (30%) Grade I, 4 (9%) Grade II, 1 (2%) Grade III, and 1 (2%) Grade IV. CONCLUSIONS This study showed that rate of patients with asymptomatic latent groin hernias is relatively high in Japanese.
Collapse
|
10
|
Quality of life and outcomes for femoral hernia repair: does laparoscopy have an advantage? Hernia 2016; 21:79-88. [PMID: 27209631 DOI: 10.1007/s10029-016-1502-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 05/09/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Due to their relative scarcity and to limit single-center bias, multi-center data are needed to study femoral hernias. The aim of this study was to evaluate outcomes and quality of life (QOL) following laparoscopic vs. open repair of femoral hernias. METHODS The International Hernia Mesh Registry was queried for femoral hernia repairs. Laparoscopic vs. open techniques were assessed for outcomes and QOL, as quantified by the Carolinas Comfort Scale (CCS), preoperatively and at 1, 6, 12, and 24 months postoperatively. Outcomes were evaluated using the standard statistical analysis. RESULTS A total of 80 femoral hernia repairs were performed in 73 patients: 37 laparoscopic and 43 open. There was no difference in mean age (54.7 ± 14.6 years), body mass index (24.2 ± 3.8 kg/m2), gender (60.3 % female), or comorbidities (p > 0.05). The hernias were recurrent in 21 % of the cases with an average of 1.23 ± 0.6 prior repairs (p > 0.1). Preoperative CCS scores were similar for both groups and indicated that 59.7 % of patients reported pain and 46.4 % had movement limitations (p > 0.05). Operative time was equivalent (47.2 ± 21.2 vs. 45.9 ± 14.8 min, p = 0.82). There was no difference in postoperative complications, with an overall 8.2 % abdominal wall complications rate (p > 0.05). The length of stay was shorter in the laparoscopic group (0.5 ± 0.6 vs. 1.3 ± 1.6 days, p = 0.02). Follow-up was somewhat longer in the open group (23.8 ± 10.2 vs. 17.3 ± 10.9 months, p = 0.02). There was one recurrence, which was in the laparoscopic group (3.1 vs. 0 %, p = 0.4). QOL outcomes at all time points demonstrated no difference for pain, movement limitation, or mesh sensation. Postoperative QOL scores improved for both groups when compared to preoperative scores. CONCLUSION In this prospective international multi-institution study of 80 femoral hernia repairs, no difference was found for operative times, long-term outcomes, or QOL in the treatment of femoral hernias when comparing laparoscopic vs. open techniques. After repair, QOL at all time-points postoperatively improved compared to QOL scores preoperatively for laparoscopic and open femoral hernia repair. While international data supports improved outcomes with laparoscopic approach for femoral hernia repair, no data had existed prior to this study on the difference of approach impacting QOL. In the setting where recurrence and complication rates are equal after femoral hernia repair for either approach, surgeons should perform the technique with which they are most confident, as the operative approach does not appear to change QOL outcomes after femoral hernia repair.
Collapse
|
11
|
Abstract
Reports on the outcomes of emergency and elective femoral hernia surgery are scarce. Most studies do not distinguish femoral hernia from other types of groin hernia; studies of femoral hernia alone are few in number. The main objective of the present study was to identify factors affecting morbidity of femoral hernia patients. We retrospectively analyzed data on 80 patients who underwent femoral hernia surgery between June 2009 and June 2013. Patients who did and did not experience morbidity were compared in terms of age, sex, hernia location, the presence of any comorbid disease, the type of anesthesia employed, the operative technique used, the type of surgical intervention, and performance of small bowel resection. Forty-three patients (53.8%) underwent emergency surgery because of incarceration. Of these, 18 (41.9%) experienced strangulation and underwent resection. Postoperative complications developed in 11 patients (13.8%). Upon multiple logistic regression analysis, visceral organ resection (of the small bowel and/or omentum) was the only independent predictor of significant morbidity (P < 0.05; odds ratio [OR]: 14.010, 95% confidence interval [CI]: 1.001-196.143). When diagnosed, femoral hernias should be electively repaired as soon as possible. The cumulative probability of strangulation rises over time. A requirement for bowel resection seems to significantly increase morbidity.
Collapse
|
12
|
Kulacoglu H. Mini-mesh repair for femoral hernia. Int J Surg Case Rep 2014; 5:574-6. [PMID: 25105770 PMCID: PMC4201027 DOI: 10.1016/j.ijscr.2014.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 06/20/2014] [Accepted: 07/07/2014] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Femoral hernia consists only 4% of all primary groin hernias. It is described as “the Bête Noire of Hernias” because of its nature and anatomy which is difficult to understand for the surgeons and tendency to recurrence. Although there is some large series of femoral hernia in the literature, few studies prospectively comparing repair techniques especially for this type of hernia has been published. A new technique named mini-mesh repair is described here. PRESENTATION OF CASE After hernia sac is dissected completely and sent back into the preperitoneal space, femoral canal is exposed. A round or oval shaped patch is prepared in 1.5–2.5 cm in diameter according to the size of the femoral canal. Mesh is secured to the Cooper's ligament with 2/0 polypropylene suture. Eight femoral hernias in 8 patients were repaired with this new technique. Patient satisfaction is very good. One seroma and one limited ecchymosis were recorded. No recurrence was observed in a mean follow-up of 22.4 months. No chronic pain was recorded. DISCUSSION Many techniques for femoral hernia repair have been described to date with a variety of clinical outcomes. Each technique has its own advantages and disadvantages. Mesh repairs without tension seems to be better choices. When the transversalis fascia is healthy and strong in a patient with femoral hernia a large piece of mesh may be unnecessary. The simple technique described in this paper can be a good alternative. It is totally problem-oriented, and the burden of prosthetic material is very limited. CONCLUSION Mini mesh repair may be a good solution for selected patients with femoral hernia.
Collapse
Affiliation(s)
- Hakan Kulacoglu
- Diskapi Yildirim Beyazit Teaching and Research Hospital, Department of Surgery, Ankara, Turkey; Rize University School of Medicine, Department of Surgery, Rize, Turkey.
| |
Collapse
|
13
|
|
14
|
Nishiwada S, Ishikawa H, Tsuji Y, Nakamura K, Mukogawa T, Matsusaka M, Ko S, Watanabe A. Kugel patch method prevents the development of a femoral hernia after inguinal herniorrhaphy. Surg Today 2014; 45:57-62. [PMID: 24633897 DOI: 10.1007/s00595-014-0880-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 02/03/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE A femoral hernia is a relatively rare condition, and no standard surgical methods have so far been established. In this study, we investigated the development of a femoral hernia after inguinal herniorrhaphy. METHODS A total of 1,969 patients who underwent surgery for an inguinal hernia from April 1992 to March 2012 were enrolled in this study. The patients were composed of 1,934 (98.2 %) inguinal hernia and 35 (1.8 %) femoral hernia patients. Of these, we retrospectively studied the femoral hernia cases with reference to the use of inguinal herniorrhaphy. RESULTS Of all 35 femoral hernia cases, six cases (17.1 %) were femoral type recurrences after inguinal herniorrhaphy performed by the conventional or mesh plug methods. The surgical methods used for the 35 cases were mesh plug repair in 15 cases (42.9 %), the Kugel patch method in seven (20.0 %) and conventional repair in 13 patients (37.2 %). Inguinal type recurrences developed in three cases (8.6 %) that were re-repaired by mesh plug repair or sac resection. There were no femoral or inguinal type recurrences after Kugel patch repair for a femoral hernia. CONCLUSIONS The results of this study suggested the importance of repairing all hernia orifices when repairing a groin hernia. The Kugel patch repair method is available for all inguinal region hernias by the same approach, and it seems to be useful for preventing the development of recurrence after surgery.
Collapse
Affiliation(s)
- Satoshi Nishiwada
- Department of Surgery, Nara Prefectural Nara Hospital, 1-30-1 Hiramatsu, Nara, 631-0846, Japan,
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Kshirsagar DP, Savalia CV, Kalyani IH, Kumar R, Nayak DN. Disease alerts and forecasting of zoonotic diseases: an overview. Vet World 2013. [DOI: 10.14202/vetworld.2013.889-896] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
16
|
Lei W, Huang J, Luoshang C. New minimally invasive technique for repairing femoral hernias: 3-D patch device through a femoris approach. Can J Surg 2012; 55:177-80. [PMID: 22630060 DOI: 10.1503/cjs.030710] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Femoral hernias are less common than inguinal hernias. The use of preformed mesh to repair femoral hernias without tension has become increasingly common. We sought to investigate the safety and feasibility of repairing femoral hernias with a Prolene 3-dimentional (3-D) patch using a femoris approach. METHODS We identified all consecutive patients with femoral hernias treated at our centre with a Prolene 3-D patch using a femoris approach in our institution over a 5-year period (2004-2009). We assessed duration of surgery, length of stay in hospital, recurrence, postoperative pain and complications. RESULTS We repaired 73 hernias with this technique during the study period. The mean duration of surgery was 13.1 minutes, most patients were discharged in less than 24 hours, no recurrence was noted, and only minor complications occurred. CONCLUSION This technique has not only the same advantage of other tension-free repairs, but also the advantages of convenience and shorter duration of surgery.
Collapse
Affiliation(s)
- Wenzhang Lei
- Therapeutic and Training Centre of Hernia, West China Hospital, China.
| | | | | |
Collapse
|
17
|
|
18
|
Roth N, Gangl O, Havlicek W, Függer R. The impact of emergency surgery on results of femoral hernia repair. Eur Surg 2010. [DOI: 10.1007/s10353-010-0573-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
19
|
Babar M, Myers E, Matingal J, Hurley MJ. The modified Nyhus–Condon femoral hernia repair. Hernia 2010; 14:271-5. [DOI: 10.1007/s10029-009-0606-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Accepted: 12/04/2009] [Indexed: 11/24/2022]
|
20
|
Adibe OO, Hansen EN, Seifarth FG, Burnweit CA, Muensterer OJ. Laparoscopic-Assisted Repair of Femoral Hernias in Children. J Laparoendosc Adv Surg Tech A 2009; 19:691-4. [DOI: 10.1089/lap.2009.0134] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Obinna O. Adibe
- Department of Pediatric Surgery, Children's Hospital of Alabama, University of Alabama at Birmingham, Birmingham, Alabama
| | - Erik N. Hansen
- Department of Pediatric Surgery, Children's Hospital of Alabama, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Cathy A. Burnweit
- Department of Pediatric Surgery, Miami Children's Hospital, Miami, Florida
| | - Oliver J. Muensterer
- Department of Pediatric Surgery, Children's Hospital of Alabama, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
21
|
|
22
|
No SM, Cho HC. Clinical Analysis of Femoral Hernia in Adult. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2009. [DOI: 10.4174/jkss.2009.76.6.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sang-Moon No
- Department of Surgery, Hernial Center, Daegu Fatima Hospital, Daegu, Korea
| | - Hae-Chang Cho
- Department of Surgery, Hernial Center, Daegu Fatima Hospital, Daegu, Korea
| |
Collapse
|
23
|
Longterm Results of a Prospective Study of 225 Femoral Hernia Repairs: Indications for Tissue and Mesh Repair. J Am Coll Surg 2008; 207:360-7. [DOI: 10.1016/j.jamcollsurg.2008.04.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Revised: 04/08/2008] [Accepted: 04/08/2008] [Indexed: 11/15/2022]
|
24
|
Abstract
OBJECTIVE To analyze mortality following groin hernia operations. SUMMARY BACKGROUND DATA It is well known that the incidence of groin hernia in men exceeds the incidence in women by a factor of 10. However, gender differences in mortality following groin hernia surgery have not been explored in detail. METHODS The study comprises all patients 15 years or older who underwent groin hernia repair between January 1, 1992 and December 31, 2005 at units participating in the Swedish Hernia Register (SHR). Postoperative mortality was defined as standardized mortality ratio (SMR) within 30 days, ie, observed deaths of operated patients over expected deaths considering age and gender of the population in Sweden. RESULTS A total of 107,838 groin hernia repairs (103,710 operations), were recorded prospectively. Of 104,911 inguinal hernias, 5280 (5.1%) were treated emergently, as compared with 1068 (36.5%) of 2927 femoral hernias. Femoral hernia operations comprised 1.1% of groin hernia operations on men and 22.4% of operations on women. After femoral hernia operation, the mortality risk was increased 7-fold for both men and women. Mortality risk was not raised above that of the background population for elective groin hernia repair, but it was increased 7-fold after emergency operations and 20-fold if bowel resection was undertaken. Overall SMR was 1.4 (95% confidence interval, 1.2-1.6) for men and 4.2 (95% confidence interval, 3.2-5.4) for women, in accordance with a greater proportion of emergency operations among women compared with men, 17.0%, versus 5.1%. CONCLUSIONS Mortality risk following elective hernia repair is low, even at high age. An emergency operation for groin hernia carries a substantial mortality risk. After groin hernia repair, women have a higher mortality risk than men due to a greater risk for emergency procedure irrespective of hernia anatomy and a greater proportion of femoral hernia.
Collapse
Affiliation(s)
- Hanna Nilsson
- Department of Surgery, Sahlgrenska University Hospital/Ostra, Gothenburg, Sweden
| | | | | | | | | |
Collapse
|
25
|
Baldassarre E, Valenti G, Torino G. Treatment of femoral hernia: systematically or occasionally? Am J Surg 2007; 193:290-1. [PMID: 17236867 DOI: 10.1016/j.amjsurg.2005.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Accepted: 12/15/2005] [Indexed: 11/22/2022]
|
26
|
Coskun H, Demir U, Bostanci O, Mihmanli M. Necrotising soft-tissue infection at the inguinal region caused by a strangulated hernia: a case report. J Wound Care 2006; 15:88-9. [PMID: 16521600 DOI: 10.12968/jowc.2006.15.2.26884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- H Coskun
- Department of General Surgery, Sisli Etfal Teaching and Research Hospital, Istanbul, Turkey.
| | | | | | | |
Collapse
|
27
|
Alimoglu O, Kaya B, Okan I, Dasiran F, Guzey D, Bas G, Sahin M. Femoral hernia: a review of 83 cases. Hernia 2005; 10:70-3. [PMID: 16283073 DOI: 10.1007/s10029-005-0045-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2005] [Accepted: 09/08/2005] [Indexed: 11/25/2022]
Abstract
We evaluate the factors that affect morbidity and mortality in patients who underwent surgery due to femoral hernia. The medical records of 83 patients who underwent femoral hernia repair between January 1996 and June 2004 were retrospectively analyzed. The femoral hernias were repaired either with McVay or mesh plug hernioplasty. Sex, age, surgical repair technique, presence of incarceration/strangulation, incarcerated/strangulated organs, postoperative complications, duration of hospitalization, recurrence rate, and factors that affect mortality and morbidity were studied. There were 83 patients with femoral hernia in our study. Patients' age ranged from 10 to 75 years (mean age was 46.84) with a predominance of female (71%). Thirty-six patients (40%) underwent emergency surgery with the diagnosis of strangulation or incarceration of femoral hernia. Seventeen patients had strangulation and underwent resection; eleven of these patients had omentum in the hernial sac, whereas six patients had intestines. Four of these patients underwent laparotomy. The remaining 19 patients had incarceration and underwent simple reduction of hernial sac content without resection. Forty-seven (60%) patients underwent elective surgery. McVay technique was used for 79 patients, while the other four patients were treated with mesh-plug. Twelve patients (15%) developed a variety of complications (nine patients (25%) in emergency, three patients (6%) in elective group). There was one mortality. Recurrences occurred in two patients. Femoral hernia is an important surgical pathology with high rates of incarceration/strangulation and intestinal resection. Emergency surgery can increase morbidity and mortality especially in the elderly. Early elective surgery may reduce complication.
Collapse
Affiliation(s)
- O Alimoglu
- First Department of Surgery, Vakif Gureba Training Hospital, Mevlana Mah. Hekim Suyu Cad., Dostluk Sitesi D 1 Blok D:13, 34080, Kucukkoy, Istanbul, Turkey.
| | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
Many techniques have been described for the repair of femoral hernia. The technique applying the principles of the tension-free method of McVay's Cooper ligament repair by covering all potential hernia sites in the myopectineal orifice with a mesh has also been described, but no report has yet been published with large number of cases and long follow-up period. We used this technique in 28 patients (19 females and 9 males) with femoral hernia. The average operating time was 40 min (range 25-75) and average follow-up period was 40 months (range 6-75). No postoperative infection or seroma was recorded. There was no recurrence at the time of writing. This technique seems to be a good alternative for the repair of femoral hernia and also for concurrent femoral hernia with inguinal hernia.
Collapse
Affiliation(s)
- N N Gönüllü
- Department of Surgery, School of Medicine, University of Kocaeli, Izmit, Turkey.
| | | | | |
Collapse
|
29
|
Reyes-Devesa HE, Martinez-Dejesús F, Martínez-Mier G, Viñas-Dozal JC. A new open anterior tension-free onlay patch technique for inguinofemoral hernia repair. Am J Surg 2005; 190:118-22. [PMID: 15972183 DOI: 10.1016/j.amjsurg.2005.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2004] [Revised: 12/31/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND The high rate of misdiagnosed, coincident, or recurrent femoral hernias while or after mesh herniorrhaphy suggests its systematic search. We introduced a new open anterior tension-free mesh herniorrhaphy with a novel design. METHODS A description of the operative technique and patients demographics is presented. RESULTS Two hundred sixty-eight hernias were repaired with this technique in a 5-year period. Two hundred twelve patients had a primary inguinal hernia. An unsuspected femoral hernia was discovered in 39 patients with a preoperatively diagnosed inguinal hernia. Operative time was 45 minutes, most patients were discharged in less than 24 hours, no recurrence has been noted, and minor complications were present. Most patients had minimal pain and returned to their normal activities within 10 days after surgery. CONCLUSION This technique has the same advantages of open tension-free repairs, allows identification of femoral hernias, and protects a herniorrhaphy for recurrence.
Collapse
Affiliation(s)
- Hugo Enrique Reyes-Devesa
- Department of Surgery, Adolfo Ruiz Cortines National Medical Center, Cuauhtemoc S/N entre Raz y Guzman y Cerbantes y Padilla, Formando Hogar, Veracruz, Mexico 91897.
| | | | | | | |
Collapse
|
30
|
Yalamarthi S, Kumar S, Stapleton E, Nixon SJ. Laparoscopic totally extraperitoneal mesh repair for femoral hernia. J Laparoendosc Adv Surg Tech A 2005; 14:358-61. [PMID: 15684782 DOI: 10.1089/lap.2004.14.358] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The role of laparoscopic repair for femoral hernia has not been clearly defined, although the advantages of this technique for repair of inguinal hernia are well recognized. AIM The aim of this study was to assess the outcome of laparoscopic total extraperitoneal (TEP) repair of femoral hernia. METHODS Case records of patients who had laparoscopic TEP repair of femoral hernia between 1994 and 2002 were reviewed retrospectively. Patients' demographic details, presentation, operative details, and follow-up information were gathered from the clinical records. Postoperative complications, chronic pain, and recurrence of the hernia were assessed. RESULTS Fifteen patients, 10 males and 5 females, with a mean age of 55 years (range, 33-84 years) underwent laparoscopic TEP femoral hernia repair. Fourteen patients (93.3%) had a primary femoral hernia, and one had a recurrent femoral hernia. In 9 (60%) patients the hernia was irreducible but not obstructed. There were no postoperative complications or chronic pain. One patient (7%) with a small (11 x 6 cm) mesh developed an inguinal recurrence. CONCLUSION Laparoscopic TEP repair is a suitable technique for repair of femoral hernia, including irreducible but not obstructed femoral hernias.
Collapse
Affiliation(s)
- Satheesh Yalamarthi
- Department of General and Laparoscopic Surgery, Western General Hospital, Edinburgh, United Kingdom
| | | | | | | |
Collapse
|
31
|
Benouaich V. [Strangulated femoral hernia]. JOURNAL DE CHIRURGIE 2005; 142:98-101. [PMID: 15976633 DOI: 10.1016/s0021-7697(05)80858-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- V Benouaich
- Service de chirurgie digestive, Hôpital Rangueil - Toulouse
| |
Collapse
|
32
|
Alvarez-Pérez JA, Baldonedo-Cernuda RF, García-Bear I, Suárez-Solís JA, Alvarez-Martínez P, Jorge-Barreiro JI. Presentación y evolución clínica de las hernias externas incarceradas en pacientes adultos. Cir Esp 2005; 77:40-5. [PMID: 16420882 DOI: 10.1016/s0009-739x(05)70802-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine the clinical presentation and outcome of incarcerated external hernias in adults, as well as to identify the factors that might have some influence on outcome. PATIENTS AND METHOD A retrospective study of 230 adult patients who underwent emergency surgical repair of incarcerated external hernias from 1992 to 2001 was performed. The characteristics of clinical presentation, type of anesthesia, surgical procedures, complications and mortality were studied. To determine clinical factors that might have some influence on outcome, an univariate analysis was also performed. RESULTS There were 77 femoral hernias, 70 inguinal, 43 umbilical and 40 incisional hernias. Seventy-four patients (32.2%) presented after 48 h of symptom onset. Significant associated diseases were found in 135 patients (58.7%). General anesthesia was used in 140 patients (60.9%), spinal anesthesia in 86 patients and local anesthesia in four patients. The most commonly used procedures were anatomic repair and tension-free hernioplasty. Bowel resection was required in 31 patients (13.5%). Overall and major morbidity and mortality were 37.8%, 10% and 3.9%, respectively. Factors that were significantly associated with unfavorable outcome were longer duration of symptoms, late hospitalization, concomitant diseases, and a high ASA class. CONCLUSIONS External hernias produce elevated morbidity and mortality if treatment is undertaken as an emergency. Thus, early diagnosis and elective repair of uncomplicated hernias should be performed in adults.
Collapse
|
33
|
Abstract
Femoral hernia repair has a long history. In the nineteenth century, simple closure of the femoral orifice by the femoral approach was favored. Such renowned surgeons as Bassini, Marcy, and Cushing authored papers about the femoral approach to femoral hernia. The recurrence rate was so high, however, that it was replaced by the inguinal approach. The man who popularized the inguinal approach was Chester McVay, who demonstrated the precise insertion of the tranversus abdominis muscle and transversalis fascia to the Cooper's ligament. He used Cooper's ligament for the femoral hernia repair by the inguinal approach. The complication and recurrence rate after the Cooper's ligament repair for femoral hernia was not satisfactory, however, due to tension on the approximated tissues, which caused postoperative pain and inability to resume normal activities. Irving Lichtenstein first introduced the plug technique to femoral hernia repair and it was further developed by Gilbert and Rutkow. In the present series, all elective cases were repaired by the PerFix mesh plug technique without any complications. Patients were discharged from the hospital on the first postoperative day and returned to normal activities shortly thereafter. These patients had few complaints of pain in the groin. The operating time using a PerFix plug was markedly shorter when contrasted with the Cooper's ligament repair. No infection of the prosthesis occurred, even in the cases in which the small intestine was necrotic and resected. From our 7-year experience of mesh plug femoral hernia repairs, I have come to regard this operation as the first choice in elective and noninfected cases of femoral hernia. In strangulated cases in which severe infection occurs. Cooper's ligament repair should be used, because there is a risk or infection to implanted prosthesis. Finally, femoral hernia is usually thought of as requiring emergency surgical treatment. Only 30% of our cases were treated as emergency operations, however, whereas 70% were elective. Unless patients complain of severe abdominal pain or ileus, surgeons need not perform emergency operations. In summary, the PerFix mesh plug hernia repair for femoral hernia has resulted in a reduced recurrence rate, shortened hospital stay, and a low rate of postoperative complications.
Collapse
Affiliation(s)
- Takehiro Hachisuka
- Department of Surgery, Yokkaichi Municipal Hospital, 2-2-37 Shibata, Yokkaichi-shi, Mie-ken 510-8567, Japan.
| |
Collapse
|
34
|
Abstract
BACKGROUND Small case series have suggested an increased risk of femoral hernia after previous inguinal herniorrhaphy, but no large-scale data with complete follow-up are available. METHODS Data were extracted from the Danish Hernia Database covering the interval from 1 January 1998 to 1 July 2001, and included 34 849 groin hernia repairs. RESULTS Of 1297 femoral hernia repairs, 71 patients had previously had an operation for inguinal hernia within the observation period. These 71 femoral hernias represented 7.9 per cent of all reoperations for groin hernia recorded in the database. The median time to reoperation for a 'recurrent' femoral hernia after previous inguinal herniorrhaphy was 7 months, compared with 10 months for inguinal recurrences. The risk of developing a 'recurrent' femoral hernia after previous inguinal herniorrhaphy was 15 times higher than the rate of femoral hernia repair in the general population. CONCLUSION This study of 34 849 groin hernia repairs demonstrated a 15-fold greater incidence of femoral hernia after inguinal herniorrhaphy compared with the spontaneous incidence. These femoral recurrences occurred earlier than inguinal recurrences, suggesting that they were possibly femoral hernias overlooked at the primary operation.
Collapse
Affiliation(s)
- T Mikkelsen
- Department of Surgical Gastroenterology 435 and the Danish Hernia Database, Hvidovre University Hospital, Hvidovre, Denmark
| | | | | |
Collapse
|
35
|
Técnica de Kugel: abordaje preperitoneal para el tratamiento de la hernia inguinal. Resultados preliminares. Cir Esp 2002. [DOI: 10.1016/s0009-739x(02)71957-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
36
|
Kulah B, Kulacoglu IH, Oruc MT, Duzgun AP, Moran M, Ozmen MM, Coskun F. Presentation and outcome of incarcerated external hernias in adults. Am J Surg 2001; 181:101-4. [PMID: 11425048 DOI: 10.1016/s0002-9610(00)00563-8] [Citation(s) in RCA: 139] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Incarcerated external hernias are the second most common cause of small-intestinal obstructions. The purpose of this study was to examine the presentation and management of incarcerated external hernia. METHODS The records of 385 consecutive patients undergoing emergency surgical operation for incarcerated external hernias in a large volume teaching hospital between August 1996 and October 1999 were analyzed. The patients' ages ranged from 15 to 100 years (mean 55.1). There were more men than women (250 and 135, respectively), and 165 (42.9%) patients were over 60 years of age. Inguinal and umbilical hernias were encountered most frequently, in 291 (75.5%) and 48 (12.5%) patients, respectively. The intestine was resected in 53 patients, 31 of whom were over 60 years of age (58.5%). Two hundred fifty-two (84.9%) patients presented 48 hours or more from the onset of symptoms. Significant concomitant diseases were noted in 52 men and 19 women. RESULTS The overall complication rate amounted to 19.5%, major complications 15.1%. The most serious postoperative complications were pulmonary and cardiovascular. Adult respiratory distress syndrome developed in 10 patients, and congestive heart failure developed in 14 patients. Postoperative mortality was 2.9%. Nine (81.8%) of the dead patients were older than 60. Nine (81.9%) of the dead patients were admitted to hospital more than 24 hours after incarceration. Mortality was high in patients with serious coexisting diseases whereas morbidity was linked with the duration of symptoms prior to admission. CONCLUSIONS Older age, severe coexisting diseases, and late hospitalization were the main causes of unfavorable outcomes of the management of incarcerated hernias.
Collapse
Affiliation(s)
- B Kulah
- Ankara Numune Teaching and Research Hospital, 3rd Surgical Department, Bahçelievler, Turkey.
| | | | | | | | | | | | | |
Collapse
|
37
|
Sánchez Llorente F, Menchén Trujillo B, García Muñoz-Nájar A, Alcaide Matas F, Campano Cruz I, Fernández Monge C, Garrote Nieto E, Quadros Borrajo M, Sierra García A. Hernia crural. Resultados tras 10 años de tratamiento mediante plug de Lichtenstein. Cir Esp 2001. [DOI: 10.1016/s0009-739x(01)71682-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
38
|
Hernandez-Richter T, Schardey HM, Rau HG, Schildberg FW, Meyer G. The femoral hernia: an ideal approach for the transabdominal preperitoneal technique (TAPP). Surg Endosc 2000; 14:736-40. [PMID: 10954820 DOI: 10.1007/s004640000108] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND We designed a study to determine the rate of intra- and postoperative complications as well as the rate of recurrences in elective operated femoral hernias treated via the laparoscopic technique. METHODS Between 1993 and 1998, we performed 1,097 operations in our department using the laparoscopic transabdominal preperitoneal (TAPP) technique. Femoral hernias amounted to only 4.6% (51 cases) of these patients. The male/female ratio was 1:2. The data concerning the operations and pre- and postoperative treatment were recorded prospectively. The patients were followed up at 2 weeks and 1 year after the operation. RESULTS We encountered one intraoperative bladder lesion, one subcutaneous port site infection, two postoperative hematomas that required reoperation, and two nerve irritation syndromes, which disappeared spontaneously after 6 months. Two patients developed an ileus; one required laparoscopic reintervention, and the other was treated with conventional open reoperation and intestinal resection. There were no recurrences. CONCLUSIONS The application of the laparoscopic approach to the treatment of femoral hernias using the TAPP technique in nonemergency situations is highly effective. To date, we have seen no recurrences. Although the rate of major complications is low, current surgical techniques need to be perfected to avoid the type of complication recognized in this study.
Collapse
Affiliation(s)
- T Hernandez-Richter
- Department of Surgery, University Hospital Grosshadern, Ludwig Maximilians University, Marchioninistrasse 15, D-81377 Munich, Germany
| | | | | | | | | |
Collapse
|
39
|
|