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Knewitz DK, Kirkpatrick SL, Jenkins PD, Al-Mansour M, Rosenthal MD, Efron PA, Loftus TJ. Preoperative computed tomography for acutely incarcerated ventral or inguinal hernia. Surgery 2022; 172:193-197. [PMID: 35304009 DOI: 10.1016/j.surg.2022.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/29/2021] [Accepted: 01/15/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The utility of preoperative computed tomography for urgent abdominal wall hernia repair is unclear. This study tests the hypothesis that there is no difference in patient outcomes for acutely incarcerated ventral or inguinal hernias diagnosed by preoperative computed tomography versus clinical assessment alone. METHODS This retrospective cohort analysis included 270 adult patients undergoing urgent repair of ventral or inguinal hernia. Demographics, risk factors for complications, operative management strategies, and 1-year outcomes were compared between patients with (n = 179) versus without (n = 91) preoperative computed tomography. RESULTS Among 179 preoperative computed tomography scans, 15 (8.4%) were ordered by surgeons, and all others were ordered by referring providers. The computed tomography and no computed tomography groups had similar age (58 vs 58 years, P = .77), body mass index (30.7 vs 30.6 kg/m2, P = .30), American Society of Anesthesiologists class (3.0 vs 3.0, P = .39), incidence of the systemic inflammatory response syndrome (19.0% vs 20.9%, P = .75), and incidence of recurrent hernia (16.8% vs 19.8%, P = .61). The interval between admission and incision was longer in the computed tomography group (11.2 hours vs 6.6 hours, P < .001). The computed tomography and no computed tomography groups had similar duration of surgery (125 minutes in both groups, P = .88), proportions of patients with biologic mesh (21.2% vs 17.6%, P = .52) and synthetic mesh (35.2% vs 46.2%, P = .09) placement, and 1-year outcomes including incidence of superficial (8.4% vs 6.6%, P = .81) and deep or organ/space surgical site infection (5.0% vs 6.6%, P = .59), mesh explant for infection (2.2% vs 3.3%, P = .69), reoperation for recurrent hernia (3.9% vs 1.1%, P = .27), and mortality (7.8% vs 4.4%, P = .44). CONCLUSION The performance of preoperative computed tomography was associated with a longer interval between admission and incision and no differences in mesh placement, mesh type, or 1-year patient outcomes. These results support the safety of performing urgent repair of acutely incarcerated ventral or inguinal hernias based on clinical assessment alone.
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Affiliation(s)
| | | | | | - Mazen Al-Mansour
- Department of Surgery, University of Florida Health, Gainesville, FL
| | | | - Philip A Efron
- Department of Surgery, University of Florida Health, Gainesville, FL
| | - Tyler J Loftus
- Department of Surgery, University of Florida Health, Gainesville, FL.
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2
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Ali MA, Hagbevor I, Maalman RSE, Donkor YO, Dedey F, Abedi E. HIV patient with prolonged infection after hemicolectomy and repair of complicated hernia. Mini-review of a rare successful surgical outcome. Int J Surg Case Rep 2022; 90:106726. [PMID: 34979426 PMCID: PMC8732747 DOI: 10.1016/j.ijscr.2021.106726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction and importance Surgical site infection (SSI) is an inevitable occurrence in bowel perforation with faecal soiled hernia wound(s) especially in retroviral patients. Unfortunately, the increased antibiotics and wound care demands do not prevent delayed healing, increased risk of hernia recurrence, or multiple surgeries to control the infection. The standard open or endo-laparoscopic Mesh repairs are either deferred or avoided with alternative tissue-based hernia repairs after bowel surgery. The reported success of open tissue-based repairs remains mixed. Nylon monofilament that have been used in infected wounds was chosen for the patient in anticipation of wound infection. Case presentation A 48-year-old man presented with a 7-days complicated hernia at the emergency unit, Margaret Marquart Catholic Hospital. Clinical examination revealed signs of shock, intestinal obstruction, and peritonism, laboratory investigation was remarkable of anaemia, septicaemia, deranged renal function, and positive retroviral test. He had concurrent right hemicolectomy and nylon darn after optimisation. The outcome we evaluated after surgery included postoperative pain, scrotal collection, anastomotic breakdown, postoperative analgesic use, wounds infection, prolonged hospital stays, recurrence, and the need for a second surgery. Though he developed prolonged deep SSI, he has intact hernia repair after 6-years. Clinical discussion The postoperative critical clinical events presented in this case were unexpected but might have been precipitated by his retroviral status. Thus, a weight loss of over 13 kg within 2 weeks was highly unusual. Furthermore, the positive retroviral status couple with the perforated caecum and soiled peritoneum was the cause of the surgical site infection. Conclusion Nylon darning in a retro-positive patient developing prolonged SSI appeared beneficial. It should be considered in patients with anticipated long period wound infection. Surgical site infection is a challenge in hernias with perforated viscus after repair. Current standard modalities of hernia repairs are used in such patient's infection are not anticipated. Patient with retroviral infection and wound contamination requires a different approach to ensure the intact repair. Nylon darn, one of the methods was used with success. Our patient with a prolonged infection after surgery and a 5-year post-repair success are a first of the kind reported.
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Affiliation(s)
- Mahamudu Ayamba Ali
- Departments of Surgery and Basic Medical Science, School of Medicine, University of Health and Allied Science, Ho, Ghana.
| | - Israel Hagbevor
- Surgical unit, Margaret Marquart Catholic Hospital, Kpando, Volta Region, Ghana
| | - Raymond Saa-Eru Maalman
- Departments of Surgery and Basic Medical Science, School of Medicine, University of Health and Allied Science, Ho, Ghana
| | - Yaw Otchere Donkor
- Departments of Surgery and Basic Medical Science, School of Medicine, University of Health and Allied Science, Ho, Ghana
| | - Florence Dedey
- Department of Surgery, University of Ghana Medical School, Korle-Bu - Accra, Ghana
| | - Emmanuel Abedi
- Surgical unit, Margaret Marquart Catholic Hospital, Kpando, Volta Region, Ghana
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Fernandez-Moure JS, Van Eps JL, Scherba JC, Haddix S, Livingston M, Bryan NS, Cantu C, Valson C, Taraballi F, Kaplan LJ, Olsen R, Tasciotti E. Polyester Mesh Functionalization with Nitric Oxide-Releasing Silica Nanoparticles Reduces Early Methicillin-Resistant Staphylococcus aureus Contamination. Surg Infect (Larchmt) 2021; 22:910-922. [PMID: 33944615 DOI: 10.1089/sur.2020.288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Infected hernia mesh is a cause of post-operative morbidity. Nitric oxide (NO) plays a key role in the endogenous immune response to infection. We sought to study the efficacy of a NO-releasing mesh against methicillin-resistant Staphylococcus aureus (MRSA). We hypothesized that a NO-releasing polyester mesh would decrease MRSA colonization and proliferation. Materials and Methods: A composite polyester mesh functionalized with N-diazeniumdiolate silica nanoparticles was synthesized and characterized. N-diazeniumdiolate silica parietex composite (NOSi) was inoculated with 104,106, or 108 colony forming units (CFUs) of MRSA and a dose response was quantified in a soy tryptic broth assay. Utilizing a rat model of contaminated hernia repair, implanted mesh was inoculated with MRSA, recovered, and CFUs were quantified. Clinical metrics of erythema, mesh contracture, and adhesion severity were then characterized. Results: Methicillin-resistant Staphylococcus aureus CFUs demonstrated a dose-dependent response to NOSi in vitro. In vivo, quantified CFUs showed a dose-dependent response to NOSi-PCO. Treated rats had fewer severe adhesions, less erythema, and reduced mesh contracture. Conclusions: We demonstrate the efficacy of a NO-releasing mesh to treat MRSA in vitro and in vivo. Creation of a novel class of antimicrobial prosthetics offers new strategies for reconstructing contaminated abdominal wall defects and other procedures that benefit from deploying synthetic prostheses in contaminated environments.
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Affiliation(s)
| | - Jeffrey L Van Eps
- Department of Surgery, Section of Colon and Rectal Surgery UT Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - Jacob C Scherba
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Seth Haddix
- Houston Methodist Research Institute, Houston, Texas, USA
| | | | | | | | - Chandni Valson
- Houston Methodist Research Institute, Houston, Texas, USA
| | | | - Lewis J Kaplan
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Randall Olsen
- Houston Methodist Research Institute, Houston, Texas, USA.,Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
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4
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Zhuo Y, Cai D, Chen J, Zhang Q, Li X. Pre-surgical peripheral blood inflammation markers predict surgical site infection following mesh repair of groin hernia. Medicine (Baltimore) 2021; 100:e25007. [PMID: 33655970 PMCID: PMC7939215 DOI: 10.1097/md.0000000000025007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 12/28/2020] [Accepted: 02/05/2021] [Indexed: 02/05/2023] Open
Abstract
Surgical site infection (SSI) is a costly postoperative complication with a decrease in the quality of life. We aimed to probe the predictive role of peripheral blood inflammation markers for SSI following mesh repair of groin hernia (GH).This retrospective study assessed the data of 1177 patients undergoing elective mesh repair of GH (open/laparoscopy) in the absence of antibiotic prophylaxis. The relation between demographics, surgical factors, pre-surgical laboratory results and the occurrence of SSI were investigated by univariate and multivariate analyses. Receiver operating characteristic analysis was performed to determine the optimal threshold of parameters and compare their veracity.The overall SSI rate was 3.2% with 1-year follow-up (38 superficial and 1 deep SSI). Patients with SSI had significant higher pre-surgical neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) than those without (P = .029 and P = .045, respectively); their NLR and PLR correlated positively with postoperative total days of antibiotic treatment for SSI (r = .689, P = .000; r = .493, P = .001; respectively). NLR and PLR had larger areas under the receiver operating characteristics curves than neutrophil (.875 vs. .601; P = .000; .726 vs. .601; P = .017). The combination of PLR and neutrophil/NLR raised the predictive sensitivity of PLR for SSI (sensitivity: PLR: 74.36%; PLR + neutrophil: 82.05%; PLR + NLR: 83.57%). On multivariate analyses, higher preoperative NLR (cut-off 2.44) and PLR (cut-off 125.42) were independent predictors for SSI.Higher pre-surgical NLR and PLR may be valuable predictors for SSI following elective mesh repair of GH.
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Affiliation(s)
| | - De Cai
- Department of Clinical Pharmacy
| | - Juntian Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Shantou University Medical College, No. 57 Changping Rd, Shantou, China
| | | | - Xinxin Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Shantou University Medical College, No. 57 Changping Rd, Shantou, China
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5
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Charleux-Muller D, Hurel R, Fabacher T, Brigand C, Rohr S, Manfredelli S, Passot G, Ortega-Deballon P, Dubuisson V, Renard Y, Romain B. Slowly absorbable mesh in contaminated incisional hernia repair: results of a French multicenter study. Hernia 2021; 25:1051-1059. [PMID: 33492554 DOI: 10.1007/s10029-020-02366-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/29/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To analyze the postoperative morbidity and 1-year recurrence rate of incisional hernia repair using a biosynthetic long-term absorbable mesh in patients at higher risk of surgical infection in a contaminated surgical field. METHODS All patients undergoing incisional hernia repair in a contaminated surgical field with the use of a biosynthetic long-term absorbable mesh (Phasix®) between May 2016 and September 2018 at six participating university centers were included in this retrospective cohort and were followed-up until September 2019. Regarding the risk of surgical infection, patients were classified according to the modified Ventral Hernia Working Group classification. Preoperative, operative and postoperative data were collected. All patients' surgical site infections (SSIs) and occurrences (SSOs) and recurrence rates were the endpoints of the study. RESULTS Two hundred and fifteen patients were included: 170 with mVHWG grade 3 (79%) and 45 with mVHWG grade 2 (21%). The SSI and SSO rates at 12 months were 22.3% and 39.5%, respectively. According to the Dindo-Clavien classification, 43 patients (20.0%) had at least one minor complication, and 57 patients (26.5%) had at least one major complication. Among the 121 patients (56.3%) having at least 1 year of follow-up, the clinical recurrence rate was 12.4%. Multivariate analysis showed that a concomitant gastrointestinal procedure was an independent risk factor for surgical infection (OR = 2.61), and an emergency setting was an independent risk factor for major complications (OR = 11.9). CONCLUSION The use of a biosynthetic absorbable mesh (Phasix®) is safe in a contaminated surgical field, with satisfying immediate postoperative and 1-year results. TRIAL REGISTRATION The study is registered on Clinical Trial ID: NCT04132986.
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Affiliation(s)
- D Charleux-Muller
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 avenue Molière, 67200, Strasbourg, France.
| | - R Hurel
- Department of General and Digestive Surgery, Robert Debre University Hospital, University of Reims Champagne Ardenne, Reims, France
| | - T Fabacher
- Department of Public Health, Biostatistic Laboratory, Strasbourg University Hospital, 1 place de l'Hôpital BP426, 67091, Strasbourg, France
| | - C Brigand
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 avenue Molière, 67200, Strasbourg, France
| | - S Rohr
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 avenue Molière, 67200, Strasbourg, France
| | - S Manfredelli
- Department of Digestive and Oncologic Surgery, Liver Transplantation Unit, University Hospital of Besançon, Besançon, France
| | - G Passot
- Department of General, Digestive and Endocrine Surgery, Hospital Lyon Sud, Hospices Civils de Lyon, 165, Chemin du Grand Revoyet, 69495, Pierre Bénite, France.,EMR 3738, University Hospital, Claude Bernard Lyon 1, Lyon, France
| | - P Ortega-Deballon
- Department of General and Digestive Surgery, University Hospital of Dijon, Dijon, France
| | - V Dubuisson
- Department of Vascular and General Surgery, Bordeaux University Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Y Renard
- Department of General and Digestive Surgery, Robert Debre University Hospital, University of Reims Champagne Ardenne, Reims, France
| | - B Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 avenue Molière, 67200, Strasbourg, France
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Orelio CC, van Hessen C, Sanchez-Manuel FJ, Aufenacker TJ, Scholten RJ. Antibiotic prophylaxis for prevention of postoperative wound infection in adults undergoing open elective inguinal or femoral hernia repair. Cochrane Database Syst Rev 2020; 4:CD003769. [PMID: 32315460 PMCID: PMC7173733 DOI: 10.1002/14651858.cd003769.pub5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Inguinal or femoral hernia is a tissue protrusion in the groin region and has a cumulative incidence of 27% in adult men and of 3% in adult women. As most hernias become symptomatic over time, groin hernia repair is one of the most frequently performed surgical procedures worldwide. This type of surgery is considered 'clean' surgery with wound infection rates expected to be lower than 5%. For clean surgical procedures, antibiotic prophylaxis is not generally recommended. However after the introduction of mesh-based hernia repair and the publication of studies that have high wound infection rates the debate as to whether antibiotic prophylaxis is required to prevent postoperative wound infections started again. OBJECTIVES To determine the effectiveness of antibiotic prophylaxis in reducing postoperative (superficial and deep) wound infections in elective open inguinal and femoral hernia repair. SEARCH METHODS We searched several electronic databases: Cochrane Registry of Studies Online, MEDLINE Ovid, Embase Ovid, Scopus and Science Citation Index (search performed on 12 November 2019). We also searched two trial registers and the reference list of included studies. SELECTION CRITERIA We included randomised controlled trials comparing any type of antibiotic prophylaxis versus placebo or no treatment for preventing postoperative wound infections in adults undergoing inguinal or femoral open hernia repair surgery (tissue repair and mesh repair). DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data and assessed risk of bias. We separately analysed results for two different surgical methods (herniorrhaphy and hernioplasty). Several studies revealed infection rates that were higher than the expected 5% for clean surgery and we therefore divided studies into two subgroups: high infection risk environments (≥ 5% infection rate); and low infection risk environments (< 5% infection rate). We performed meta-analyses with random-effects models. We analysed three outcomes: superficial surgical site infections (SSSI); deep surgical site infections (DSSI); and all postoperative wound infections (SSSI + DSSI). MAIN RESULTS In this review update we identified and included 10 new studies. In total, we included 27 studies with 8308 participants in this review. It is uncertain whether antibiotic prophylaxis as compared to placebo (or no treatment) prevents all types of postoperative wound infections after herniorrhaphy surgery (risk ratio (RR) 0.86, 95% confidence interval (CI) 0.56 to 1.33; 5 studies, 1865 participants; very low quality evidence). Subgroup analysis did not change these results. We could not perform meta-analyses for SSSI or DSSI as these outcomes were not reported separately. Twenty-two studies related to hernioplasty surgery (total of 6443 participants) and we analysed three outcomes: SSSI; DSSI; SSSI + DSSI. Within the low infection risk environment subgroup, antibiotic prophylaxis as compared to placebo probably makes little or no difference for the outcomes 'prevention of all wound infections' (RR 0.71, 95% CI 0.44 to 1.14; moderate-quality evidence) and 'prevention of SSSI' (RR 0.71, 95% CI 0.44 to 1.17, moderate-quality evidence). Within the high infection risk environment subgroup it is uncertain whether antibiotic prophylaxis reduces all types of wound infections (RR 0.58, 95% CI 0.43 to 0.77, very low quality evidence) or SSSI (RR 0.56, 95% CI 0.41 to 0.77, very low quality evidence). When combining participants from both subgroups, antibiotic prophylaxis as compared to placebo probably reduces the risk of all types of wound infections (RR 0.61, 95% CI 0.48 to 0.78) and SSSI (RR 0.60, 95% CI 0.46 to 0.78; moderate-quality evidence). Antibiotic prophylaxis as compared to placebo probably makes little or no difference in reducing the risk of postoperative DSSI (RR 0.65, 95% CI 0.26 to 1.65; moderate-quality evidence), both in a low infection risk environment (RR 0.67, 95% CI 0.11 to 4.13; moderate-quality evidence) and in the high infection risk environment (RR 0.64, 95% CI 0.22 to 1.89; low-quality evidence). AUTHORS' CONCLUSIONS Evidence of very low quality shows that it is uncertain whether antibiotic prophylaxis reduces the risk of postoperative wound infections after herniorrhaphy surgery. Evidence of moderate quality shows that antibiotic prophylaxis probably makes little or no difference in preventing wound infections (i.e. all wound infections, SSSI or DSSI) after hernioplasty surgery in a low infection risk environment. Evidence of low quality shows that antibiotic prophylaxis in a high-risk environment may reduce the risk of all wound infections and SSSI, while evidence of very low quality shows that it is uncertain whether antibiotic prophylaxis reduces DSSI after hernioplasty surgery.
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Affiliation(s)
- Claudia C Orelio
- Diakonessenhuis Utrecht, Research Support, Bosboomstraat 1, Utrecht, Netherlands, 3582 KE
| | - Coen van Hessen
- Diakonessenhuis Utrecht, Liesbreukcentrum Nederland, Bosboomstraat 1, Utrecht, Netherlands, 3582 KE
| | | | | | - Rob Jpm Scholten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Cochrane Netherlands, Room Str. 6.126, P.O. Box 85500, Utrecht, Netherlands, 3508 GA
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7
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Boukovalas S, Sisk G, Selber JC. Erratum: Addendum: Abdominal Wall Reconstruction: An Integrated Approach. Semin Plast Surg 2019; 32:199-202. [PMID: 31329738 DOI: 10.1055/s-0038-1673696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
[This corrects the article DOI: 10.1055/s-0038-1667062.].
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Affiliation(s)
- Stefanos Boukovalas
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Geoffrey Sisk
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jesse C Selber
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
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8
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Antibiotics for Groin Hernia Repair According to Evidence-Based Guidelines: Time for Action in Ghana. J Surg Res 2019; 238:90-95. [PMID: 30769249 DOI: 10.1016/j.jss.2019.01.040] [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: 10/07/2018] [Revised: 11/05/2018] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUD Groin hernia repairs (GHR), though classified as clean surgeries, are associated with varying rates of surgical site infections. We assessed the practices of surgeons in Ghana regarding antibiotic use for GHR in comparison to evidence-based international guidelines (EBIG). METHODS We interviewed surgeons trained by the Ghana College of Physicians and Surgeons (GCPS), from inception (2003) through 2016, about their use of antibiotics for GHR. We defined the outcome variable of consistently following EBIG in antibiotics use for GHR. Logistic regression was used to examine how a priori selected covariates contributed to the outcome. RESULTS Eighty-two of 117 surgeons reported performing/supervising at least one GHR per week. They performed/supervised a mean of five GHR per week. Thirty-two (40%) reported using mesh for at least 50% of GHR. For primary GHR, 75% of surgeons administered antibiotics according to EBIG, whereas for GHR with mesh only, 45% did so. Predictors of consistently following EBIG were increasing number of GHR performed per week (adjusted odds ratio 1.44, 95% CI 1.07-1.96) and increasing time spent for clinical work (adjusted odds ratio 0.95, 95% CI 0.91-0.99). Years of practice since GCPS graduation, total operations performed per week, and hospital level of practice were not predictive of the outcome variable. CONCLUSIONS Two-thirds of Ghanaian surgeons interviewed do not consistently administer antibiotics for GHR per EBIG, raising the need to improve access to evidence-based medical information overall to guide practice. Determining local surgical site infections rates to guide antibiotic use in GHR will be useful in Ghana and other LMICs.
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9
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Computed tomography evidence of fluid in the hernia sac predicts surgical site infection following mesh repair of acutely incarcerated ventral and groin hernias. J Trauma Acute Care Surg 2017; 83:170-174. [PMID: 28426559 DOI: 10.1097/ta.0000000000001503] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Mesh placement during repair of acutely incarcerated ventral and groin hernias is associated with high rates of surgical site infection (SSI). The utility of preoperative computed tomography (CT) in this setting is unclear. We hypothesized that CT evidence of bowel wall compromise would predict SSI while accounting for physiologic parameters. METHODS We performed a 4-year retrospective cohort analysis of 50 consecutive patients who underwent mesh repair of acutely incarcerated ventral or groin hernias. We analyzed chronic disease burden, acute illness severity, CT findings, operative management, and herniorrhaphy-specific outcomes within 180 days. The primary outcome was SSI by the Centers for Disease Control and Prevention criteria. Multiple logistic regression was performed to identify independent predictors of SSI. RESULTS Eighty-four percent of all patients were American Society of Anesthesiologists class III or IV, 28% were active smokers, and mean body mass index (BMI) was 35 kg/m. Fifty-four percent had ventral hernias, 40% had inguinal hernias, and 6% had femoral or combined inguinal/ femoral hernias. Seventy percent of preoperative CT scans had features suggesting bowel compromise, abdominal free fluid, or fluid in the hernia sac. Surgical site infection occurred in 32% of all patients (8% superficial, 24% deep or organ/space). The strongest predictors of SSI were CT evidence of fluid in the hernia sac (odds ratio [OR], 8.3; 95% confidence interval [CI], 1.7-41), initial heart rate 90 beats/min or greater (OR, 6.3; 95% CI, 1.1-34), and BMI 35 kg/m or greater (OR, 5.8; 95% CI, 1.2-28). Surgical site infection rates were significantly higher among patients who had CT evidence of fluid in the hernia sac (56% vs. 19%, p = 0.012). CONCLUSIONS More than half of all patients with CT scan evidence of fluid in the hernia sac developed an SSI. Computed tomography evidence of fluid in the hernia sac was the strongest predictor of SSI, followed by heart rate and BMI. Together, these parameters identify high-risk patients for whom better strategies are needed to avoid SSI without sacrificing durability. LEVEL OF EVIDENCE Prognostic study, level III; Therapeutic, level IV.
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10
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Boonchan T, Wilasrusmee C, McEvoy M, Attia J, Thakkinstian A. Network meta-analysis of antibiotic prophylaxis for prevention of surgical-site infection after groin hernia surgery. Br J Surg 2017; 104:e106-e117. [PMID: 28121028 PMCID: PMC5299528 DOI: 10.1002/bjs.10441] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/03/2016] [Accepted: 11/01/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND First-generation cephalosporins (such as cefazolin) are recommended as antibiotic prophylaxis in groin hernia repair, but other broad-spectrum antibiotics have also been prescribed in clinical practice. This was a systematic review and network meta-analysis to compare the efficacy of different antibiotic classes for prevention of surgical-site infection (SSI) after hernia repair. METHODS RCTs were identified that compared efficacy of antibiotic prophylaxis on SSI after inguinal or femoral hernia repair from PubMed and Scopus databases up to March 2016. Data were extracted independently by two reviewers. Network meta-analysis was applied to assess treatment efficacy. The probability of being the best antibiotic prophylaxis was estimated using surface under the cumulative ranking curve (SUCRA) analysis. RESULTS Fifteen RCTs (5159 patients) met the inclusion criteria. Interventions were first-generation (7 RCTs, 1237 patients) and second-generation (2 RCTs, 532) cephalosporins, β-lactam/β-lactamase inhibitors (6 RCTs, 619) and fluoroquinolones (2 RCTs, 581), with placebo as the most common comparator (14 RCTs, 2190). A network meta-analysis showed that β-lactam/β-lactamase inhibitors and first-generation cephalosporins were significantly superior to placebo, with a pooled risk ratio of 0·44 (95 per cent c.i. 0·25 to 0·75) and 0·62 (0·42 to 0·92) respectively. However, none of the antibiotic classes was significantly different from the others. SUCRA results indicated that β-lactam/β-lactamase inhibitors and first-generation cephalosporins were ranked first and second respectively for best prophylaxis. CONCLUSION β-Lactam/β-lactamase inhibitors followed by first-generation cephalosporins ranked as the most effective SSI prophylaxis for adult patients undergoing groin hernia repair.
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Affiliation(s)
- T Boonchan
- Section for Clinical Epidemiology and Biostatistics and, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - C Wilasrusmee
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - M McEvoy
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - J Attia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - A Thakkinstian
- Section for Clinical Epidemiology and Biostatistics and, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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11
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Song Z, Ma Y, Xia G, Wang Y, Kapadia W, Sun Z, Wu W, Gu H, Cui W, Huang X. In vitro and in vivo combined antibacterial effect of levofloxacin/silver co-loaded electrospun fibrous membranes. J Mater Chem B 2017; 5:7632-7643. [PMID: 32264238 DOI: 10.1039/c7tb01243h] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The Lev@MSN@Ag–PLLA fibers provided an advanced synergistic antibacterial nanoplatform of low dosage for the treatment of drug-resistant bacterial infections.
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Affiliation(s)
- Ziliang Song
- Department of General Surgery
- Sixth People's Hospital Affiliated Shanghai Jiao Tong University
- Shanghai
- P. R. China
| | - Yongjie Ma
- School of Biomedical Engineering and Med-X Research Institute
- Shanghai Jiao Tong University
- Shanghai
- P. R. China
| | - Guanggai Xia
- Department of General Surgery
- Sixth People's Hospital Affiliated Shanghai Jiao Tong University
- Shanghai
- P. R. China
| | - Yao Wang
- School of Biomedical Engineering and Med-X Research Institute
- Shanghai Jiao Tong University
- Shanghai
- P. R. China
| | - Wasim Kapadia
- Department of Orthopedics
- The First Affiliated Hospital of Soochow University
- Orthopedic Institute
- Soochow University
- Suzhou
| | - Zhiyong Sun
- Department of Orthopedics
- The First Affiliated Hospital of Soochow University
- Orthopedic Institute
- Soochow University
- Suzhou
| | - Wei Wu
- Department of Orthopedics
- The First Affiliated Hospital of Soochow University
- Orthopedic Institute
- Soochow University
- Suzhou
| | - Hongchen Gu
- School of Biomedical Engineering and Med-X Research Institute
- Shanghai Jiao Tong University
- Shanghai
- P. R. China
| | - Wenguo Cui
- Department of Orthopedics
- The First Affiliated Hospital of Soochow University
- Orthopedic Institute
- Soochow University
- Suzhou
| | - Xinyu Huang
- Department of General Surgery
- Sixth People's Hospital Affiliated Shanghai Jiao Tong University
- Shanghai
- P. R. China
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12
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Preoperative risk prediction of surgical site infection requiring hospitalization or reoperation in patients undergoing vascular surgery. J Vasc Surg 2016; 64:177-84. [PMID: 26926939 DOI: 10.1016/j.jvs.2016.01.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/11/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective of this study was to develop a surgical site infection (SSI) prediction score for risk assessment before elective vascular surgery. METHODS We conducted a nested case-control study among patients who underwent elective vascular (abdominal aortic and peripheral arterial) surgery from January 1, 2003, to December 31, 2007, at Mayo Clinic (Rochester, Minn) an academic tertiary surgical center. Cases were patients with SSI requiring hospitalization; controls (one or two per case) were matched on type of procedure and date of surgery. Clinical data were collected by chart review. A risk score based on preoperative variables was developed using multivariable logistic regression and bootstrap resampling. The C statistic, equivalent to the area under the receiver operating characteristic curve, was used to assess discrimination. Calibration was assessed by plotting percentile risk groups of model-predicted values against observed proportions of subjects with SSI. RESULTS Eighty-four cases were compared with 160 controls. Preoperative variables independently associated with SSI risk were critical limb ischemia, previous SSI, prior revascularization procedure, and chronic obstructive pulmonary disease. A prediction model containing these variables was developed (model and risk score C statistic of 0.737 and 0.727, respectively). The calibration curve did not appear to deviate appreciably from the 45-degree line of identity. CONCLUSIONS We developed an SSI risk score based on noninvasive preoperative variables with acceptable discrimination and calibration. This tool needs prospective and external validation.
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Insulin dependence as an independent predictor of perioperative morbidity after ventral hernia repair: a National Surgical Quality Improvement Program analysis of 45,759 patients. Am J Surg 2015; 211:11-7. [PMID: 26542188 DOI: 10.1016/j.amjsurg.2014.08.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 07/28/2014] [Accepted: 08/29/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Although diabetes mellitus has been identified as a predictor of perioperative morbidity after ventral hernia repair (VHR), it is unclear whether insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) confer the same degree of risk. We examined the variable effect of IDDM and NIDDM on 30-day medical and surgical complications after VHR. METHODS We performed a retrospective analysis of patients in the National Surgical Quality Improvement Program database from 2005 to 2012 undergoing VHR. After perioperative variable comparison, regression analysis was performed to determine whether IDDM and/or NIDDM independently predicted increased complications after proper risk adjustment. RESULTS A total of 45,759 patients were identified to have undergone VHR. Of these, 38,026 patients (83.1%) were not diabetic, 5,252 (11.5%) were NIDDM patients, and 2,481 (5.4%) were IDDM patients. After controlling for other risk factors, we found that IDDM independently predicted increased rates of overall, surgical, and medical complications (odds ratio, 1.284, 1.251, 1.263, respectively) in open repair. IDDM independently predicted increased overall and medical complications (odds ratio, 1.997, 1.889, respectively) but not surgical complications in laparoscopic repair. NIDDM was not significantly associated with any complication type in either procedure type. CONCLUSIONS Our present study suggests that much of the perioperative risk associated with diabetes is attributable to IDDM. The effect of IDDM on laparoscopic and open repair is subtly different. IDDM demonstrates increased overall and medical complications in laparoscopic repair and increased overall, medical, and surgical complications in open repair. Of note, IDDM does not independently predict increased risk for surgical complications in laparoscopic repair.
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Sasaki A, Takeuchi Y, Izumi K, Morimoto A, Inomata M, Kitano S. Two-stage laparoscopic treatment for strangulated inguinal, femoral and obturator hernias: totally extraperitoneal repair followed by intestinal resection assisted by intraperitoneal laparoscopic exploration. Hernia 2014; 20:483-8. [PMID: 24908448 DOI: 10.1007/s10029-014-1272-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 05/23/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Total extraperitoneal preperitoneal (TEP) repair is widely used for inguinal, femoral, or obturator hernia treatment. However, mesh repair is not often used for strangulated hernia treatment if intestinal resection is required because of the risk of postoperative mesh infection. Complete mesh repair is required for hernia treatment to prevent postoperative recurrence, particularly in patients with femoral or obturator hernia. CASES We treated four patients with inguinocrural and obturator hernias (a 72-year-old male with a right indirect inguinal hernia; an 83-year-old female with a right obturator hernia; and 86- and 82-year-old females with femoral hernias) via a two-stage laparoscopic surgery. All patients were diagnosed with intestinal obstruction due to strangulated hernia. First, the incarcerated small intestine was released and then laparoscopically resected. Further, 8-24 days after the first surgery, bilateral TEP repairs were performed in all patients; the postoperative course was uneventful in all patients, and they were discharged 5-10 days after TEP repair. At present, no hernia recurrence has been reported in any patient. CONCLUSION The two-stage laparoscopic treatment is safe for treatment of strangulated inguinal, femoral, and obturator hernias, and complete mesh repair via the TEP method can be performed in elderly patients to minimize the occurrence of mesh infection.
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Affiliation(s)
- A Sasaki
- Department of Surgery, Japan Community Health Care Organization (JCHO) Nankai Medical Center, 11-20, Saiki, Oita, 876-0857, Japan.
| | - Y Takeuchi
- Department of Surgery, Japan Community Health Care Organization (JCHO) Nankai Medical Center, 11-20, Saiki, Oita, 876-0857, Japan
| | - K Izumi
- Department of Surgery, Japan Community Health Care Organization (JCHO) Nankai Medical Center, 11-20, Saiki, Oita, 876-0857, Japan
| | - A Morimoto
- Department of Surgery, Japan Community Health Care Organization (JCHO) Nankai Medical Center, 11-20, Saiki, Oita, 876-0857, Japan
| | - M Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, 879-5593, Japan
| | - S Kitano
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, 879-5593, Japan
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Short- and long-term outcomes of open inguinal hernia repair: comparison of the Prolene Hernia System and the Mesh Plug method. Surg Today 2014; 44:2255-62. [PMID: 24554374 DOI: 10.1007/s00595-014-0867-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 11/13/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE Tension-free mesh repair of adult inguinal hernias has become a standard procedure, but there have been few comparisons of the postoperative outcome after hernia repair using the Prolene Hernia System (PHS) vs. the Mesh Plug (MP) method in a large number of patients from a single institution. METHODS We reviewed the medical records of patients to investigate the short- and long-term outcomes of the different types of hernia repair. Late symptoms were evaluated by questionnaire. A total of 1,141 repairs performed from 1999 to 2008 (PHS in 957 and MP in 184 repairs) were evaluated. RESULTS There were 93 early postoperative complications (8.2%). A subcutaneous hematoma was found more frequently after MP repair compared with after PHS repair (3.8 vs. 1.3%, P = 0.013). Seven hundred and ten patients (62.2%) could be followed up for more than 2 years. Recurrence was detected in 14 patients with PHS repair and two patients with MP repair (1.5 vs. 1.1%, P = 0.956). Wound infections occurred in three patients (0.3%) with PHS repair vs. none with MP repair (P > 0.999). Patients with PHS and MP repair showed no significant differences in the long-term wound pain. CONCLUSIONS The recurrence and wound infection rates were similar after hernia repair using the PHS and MP methods. Patients undergoing PHS repair developed fewer subcutaneous hematomas. An older age (≥65 years) was a significant independent risk factor for recurrence.
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Krpata DM, Blatnik JA, Novitsky YW, Rosen MJ. Evaluation of high-risk, comorbid patients undergoing open ventral hernia repair with synthetic mesh. Surgery 2013; 153:120-5. [DOI: 10.1016/j.surg.2012.06.003] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 06/04/2012] [Indexed: 11/30/2022]
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Kanters AE, Krpata DM, Blatnik JA, Novitsky YM, Rosen MJ. Modified Hernia Grading Scale to Stratify Surgical Site Occurrence after Open Ventral Hernia Repairs. J Am Coll Surg 2012; 215:787-93. [DOI: 10.1016/j.jamcollsurg.2012.08.012] [Citation(s) in RCA: 221] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 08/13/2012] [Accepted: 08/14/2012] [Indexed: 11/26/2022]
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Abstract
BACKGROUND The use of antibiotic prophylaxis for hernia repair is currently a controversial issue given the disparity among study results in this area. OBJECTIVES The objective of this systematic review was to clarify the effectiveness of antibiotic prophylaxis in reducing postoperative wound infection rates in elective open inguinal hernia repair. SEARCH METHODS We searched the Cochrane Colorectal Cancer Group specialized register, by crossing the terms herni* and inguinal or groin and the terms antimicr* or antibiot* , as free text and MeSH terms. A similar search were performed in Medline using the following terms: #1 antibiotic* OR antimicrob* OR anti infecti* OR antiinfecti*; #2 prophyla* OR prevent*; #3 #1 AND #2; #4 clean AND (surgery OR tech* OR proced*); #5 herni*; #6 (wound infection) AND #4; #7 #3 AND (#4 or #5 or #6). National Research Register, ISI-Web, DARE, Scirus, TRIPDATABASE, NHS EED, reference list of the included studies and web of clinical trials register (www.controlled-trials.com and clinicaltrials.gov) were checked to identify further studies. SELECTION CRITERIA Only randomised clinical trials were included. DATA COLLECTION AND ANALYSIS In the present review, we searched for eligible trials in October 2011. This revealed four new included trials, so seventeen trials are included in the meta-analysis. Eleven of them used prosthetic material for hernia repair (hernioplasty) whereas the remaining studies did not (herniorrhaphy). Pooled and subgroup analysis were conducted depending on whether prosthetic material was or not used. A fixed effects model was used in the analysis. MAIN RESULTS The total number of patients included was 7843 (prophylaxis group: 4703, control group: 3140). Overall infection rates were 3.1% and 4.5% in the prophylaxis and control groups, respectively (OR 0.64, 95% CI 0.50 - 0.82). The subgroup of patients with herniorrhaphy had infection rates of 3.5% and 4.9% in the prophylaxis and control groups, respectively (OR 0.71, 95% CI 0.51 - 1.00). The subgroup of patients with hernioplasty had infection rates of 2.4% and 4.2% in the prophylaxis and control groups, respectively (OR 0.56, 95% CI 0.38 - 0.81). AUTHORS' CONCLUSIONS Based on the results of this systematic review the administration of antibiotic prophylaxis for elective inguinal hernia repair cannot be universally recommended. Neither can the administration be recommended against when high rates of wound infection are observed.
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Prosthetic repair of an incarcerated groin hernia with small intestinal resection. Surg Today 2011; 42:359-62. [DOI: 10.1007/s00595-011-0019-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 04/08/2011] [Indexed: 11/27/2022]
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Park CY, Kim JC, Kim DY, Kim SK. Inguinal hernia repair in overweight and obese patients. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011; 81:205-10. [PMID: 22066122 PMCID: PMC3204546 DOI: 10.4174/jkss.2011.81.3.205] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 06/21/2011] [Accepted: 07/13/2011] [Indexed: 12/03/2022]
Abstract
Purpose To describe the clinical characteristics and outcomes after inguinal hernia repair in overweight and obese patients. Methods We retrospectively reviewed the medical records of 636 adult patients who underwent mesh plug inguinal hernia repair performed by one surgeon from November 2001 to January 2009.The clinical characteristics and surgical outcomes of the patients were analyzed. According to the body mass index, patients higher than 23 were defined as overweight and obese patient group (O group) and patients between 18.5 and 23 were defined as normal weight patient group (N group). Seventeen underweight patients were excluded in this study. Results Of 619 cases, the number for O group was 344 (55.6%) and for N group was 275 (44.4%). The mean age was significantly higher in N group (62.2 ± 12.6 vs. 64.4 ± 14.8, P = 0.048). Underlying diseases were present in 226 (65.7%) of the O group and 191 (69.5%) of the N group (P = 0.322). Anesthesia method, operative time and postoperative hospital stay had no significant difference between the two groups. Postoperative complications developed in 41 (11.9%) of the O group and in 28 (10.2%) of the N group, respectively, and no major complications developed in either group. Conclusion Adult inguinal hernias developed at a relatively younger age in overweight and obese patients than in normal weight patients. There were no specific differences in other clinical characteristics and outcomes between the two groups. Therefore inguinal hernia repair in overweight and obese patients is a safe procedure as in normal weight patients.
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Affiliation(s)
- Chan Yong Park
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
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Abstract
Infections of an implanted hernia mesh are a major challenge. The incidence of mesh infections after incisional hernia repair is about 1% for endoscopic techniques and can be more than 15% in open techniques. Intraoperative mesh contamination is considered to be the primary cause. All woven or knitted hernia meshes have recesses where bacteria may adhere and establish colonies. The bacterial spectrum for mesh infection includes skin pathogens, such as Staphylococcus aureus (including MRSA), Streptococcus spp., as well as E. coli, Enterococcus and Mycobacteria. The therapy approach needs to be tailored to the morphological findings and the treatment for uncomplicated phlegmon is broad spectrum antibiotic therapy. If there is encapsulated fluid accumulation, CT-controlled drainage and daily infusion of antiseptics via the drain is a good option. For dermal necrosis, mesh fistula, exposed mesh or enterocutaneous fistula, a precise CT evaluation is necessary to tailor the operation. Vacuum systems are gaining increased acceptance in conditioning the local findings. For most patients the therapeutic concept will be based on individual decisions. If parts of a formerly infected mesh remain in the patient, a lifelong follow-up is necessary.
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Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 2010; 148:544-58. [PMID: 20304452 DOI: 10.1016/j.surg.2010.01.008] [Citation(s) in RCA: 703] [Impact Index Per Article: 50.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 01/14/2010] [Indexed: 12/13/2022]
Abstract
Despite advances in surgical technique and prosthetic technologies, the risks for recurrence and infection are high following the repair of incisional ventral hernias. High-quality data suggest that all ventral hernia repairs should be reinforced with prosthetic repair materials. The current standard for reinforced hernia repair is synthetic mesh, which can reduce the risk for recurrence in many patients. However, permanent synthetic mesh can pose a serious clinical problem in the setting of infection. Assessing patients' risk for wound infection and other surgical-site occurrences, therefore, is an outstanding need. To our knowledge, there currently exists no consensus in the literature regarding the accurate assessment of risk of surgical-site occurrences in association with or the appropriate techniques for the repair of incisional ventral hernias. This article proposes a novel hernia grading system based on risk factor characteristics of the patient and the wound. Using this system, surgeons may better assess each patient's risk for surgical-site occurrences and thereby select the appropriate surgical technique, repair material, and overall clinical approach for the patient. A generalized approach and technical considerations for the repair of incisional ventral hernias are outlined, including the appropriate use of component separation and the growing role of biologic repair materials.
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Systemic Antibiotic Prophylaxis Not Needed for Microsurgical Varicocelectomy. Urology 2008; 71:669-71. [DOI: 10.1016/j.urology.2007.11.093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Revised: 11/02/2007] [Accepted: 11/20/2007] [Indexed: 11/18/2022]
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Abstract
BACKGROUND The use of antibiotic prophylaxis for hernia repair is currently a controversial issue given the disparity among study results in this area. OBJECTIVES The objective of this systematic review was to clarify the effectiveness of antibiotic prophylaxis in reducing postoperative wound infection rates in elective open inguinal hernia repair. SEARCH STRATEGY In the present review, we searched for eligible trials in august 2006, using the search terms below. This revealed four new included trials (total of twelve). We searched the Cochrane Colorectal Cancer Group specialized register, by crossing the terms herni* and inguinal or groin and the terms antimicr* or antibiot* , as free text and MeSH terms. A similar search were performed in Medline and Embase was conducted using the following terms: #1 antibiotic* or antimicrob* or anti infecti* or antiinfecti*; #2 prophyla* or prevent*; #3 #1 and #2; #4 clean and (surgery or tech* or proced*); #5 herni*; #6 (wound infection) and #4; #7 #3 and (#4 or #5 or #6). Reference lists of the included studies were checked to identify additional studies. SELECTION CRITERIA Only randomized clinical trials were included. DATA COLLECTION AND ANALYSIS Twelve randomized clinical trials were identified. Six of them used prosthetic material for hernia repair (hernioplasty) whereas the remaining studies did not (herniorraphy). Pooled and subgroup analysis were conducted depending on whether prosthetic material was or not used. A random effects model was used in the analysis. MAIN RESULTS The total number of patients included was 6705 (treatment group: 4128, control group: 2577). Overall infection rates were 2.9% and 3.9% in the prophylaxis and control groups, respectively (OR 0.64, 95%CI 0.48 - 0.85). The subgroup of patients with herniorrhaphy had infection rates of 3.5% and 4.9% in the prophylaxis and control groups, respectively (OR 0.71, 95% CI 0.51 - 1.00). The subgroup of patients with hernioplasty had infection rates of 1.4% and 2.9% in the prophylaxis and control groups, respectively (OR 0.48, 95% CI 0.27 - 0.85). AUTHORS' CONCLUSIONS Based on the results of this meta-analysis the administration of antibiotic prophylaxis for elective inguinal hernia repair cannot be universally recommended. Nevertheless, its administration cannot either be recommended against when high rates of wound infection are observed.
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Affiliation(s)
- F J Sanchez-Manuel
- General Yagüe Hospital, General and Digestive Surgery, Avenida del Cid s/n, Castilla y Leon, Burgos, Spain, 09005.
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Kalliomäki ML, Meyerson J, Gunnarsson U, Gordh T, Sandblom G. Long-term pain after inguinal hernia repair in a population-based cohort; risk factors and interference with daily activities. Eur J Pain 2007; 12:214-25. [PMID: 17606392 DOI: 10.1016/j.ejpain.2007.05.006] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Revised: 05/16/2007] [Accepted: 05/16/2007] [Indexed: 12/14/2022]
Abstract
In the Swedish Hernia Register 2834 inguinal hernia repairs in 2583 patients were registered in the county of Uppsala 1998-2004. In May 2005 the 2421 patients still alive were requested by mail to fill in a validated questionnaire concerning postherniorrhaphy pain. The final response rate became 72%. Altogether 519 patients (29%) stated that they had pain in the operated groin to some extent during past week. In 98 patients (6%) the pain interfered with daily activities. Factors associated with an increased risk of residual pain in a multivariate logistic regression analysis were age below median, operation for recurrence, open repair technique, history of preoperative pain, and less than three years from surgery. Factors not associated with occurrence of residual pain were gender, method of anaesthesia during surgery, hernia sac diameter, postoperative complications, hernia type, need for emergency operation, reducibility of the hernia sac and complete dissection of the hernia sac. Factors found to be associated with impairment of function due to pain in a multivariate logistic regression analysis were: age below median, female gender, medial hernia, open repair technique, postoperative complications, need for operation for recurrence, presence of preoperative pain and less than three years from surgery. The possibility of long-term pain as an outcome after hernia operations should be taken into consideration in the decision making prior to operation.
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