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Boruah P, Daoud RMEH, Walsh DV, Kharytaniuk N, Fredericks S, Ryan J, Abdelatif A, Birido N, Walsh TN. Patient's Perception of the Role of Gym Activity in Abdominal Wall Herniation in Adults: A Prospective Study. SPORTS MEDICINE - OPEN 2024; 10:88. [PMID: 39134817 PMCID: PMC11319541 DOI: 10.1186/s40798-024-00749-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 07/02/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Despite significant changes in healthcare, work practices, and leisure activity, the proposed precipitating factors for abdominal wall hernias have remained largely unchanged for almost two centuries. We aimed to investigate if there have been shifts in these factors over time by examining patients' perception of precipitating factors for abdominal wall hernia development. This study was conducted in the Royal College of Surgeons In Ireland Department of Surgery, Connolly Hospital, Blanchardstown, Dublin, where patients with abdominal wall hernias completed a questionnaire . RESULTS A total of 277 patients (mean age 55.7; 85.6% male) with abdominal wall hernia completed the questionnaire (66.1% inguinal; 10.8% umbilical; 6.9% paraumbilical; 10.5% epigastric; 3.2% incisional; 1.4% femoral, and 1.1% port-site). One hundred and twenty patients (43.3%) believed their hernia was due to lifting, 71 (25.6%) cited gym activity and 17 (6.1%) cited other sporting activities as the precipitating factor. Traditional factors - chronic cough and constipation - were cumulatively cited only by 11 patients (4.0%), while prostatic obstruction was not cited by any. CONCLUSION This study suggests that fitness pursuits may be an increasing contributor to the development of abdominal wall hernia. Greater attention should be paid to the proper use of gym equipment to minimise the risk of hernia development.
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Affiliation(s)
- Prabir Boruah
- Department of Surgery, Royal College of Surgeons in Ireland, Connolly Hospital, Dublin, Ireland
| | - Rabbani Mahmoud ElSayed Hassan Daoud
- Royal College of Surgeons in Ireland - Medical University Bahrain, Busaiteen, Bahrain.
- Department of Surgery, Royal College of Surgeons in Ireland - Medical University Bahrain, Busaiteen, Bahrain.
| | - Dylan Viani Walsh
- Department of Surgery, Royal College of Surgeons in Ireland, Connolly Hospital, Dublin, Ireland
| | - Natallia Kharytaniuk
- Royal College of Surgeons in Ireland - Medical University Bahrain, Busaiteen, Bahrain
- Academic Department of Surgery, Connolly Hospital, Blanchardstown, Dublin, Ireland
| | - Salim Fredericks
- Department of Biochemistry, Royal College of Surgeons in Ireland - Medical University Bahrain, Busaiteen, Bahrain
| | - James Ryan
- Department of Surgery, Royal College of Surgeons in Ireland, Connolly Hospital, Dublin, Ireland
| | - Asila Abdelatif
- Department of Surgery, Royal College of Surgeons in Ireland, Connolly Hospital, Dublin, Ireland
| | - Nuha Birido
- Department of Surgery, Royal College of Surgeons in Ireland - Medical University Bahrain, Busaiteen, Bahrain
| | - Thomas Noel Walsh
- Department of Surgery, Royal College of Surgeons in Ireland, Connolly Hospital, Dublin, Ireland
- Department of Surgery, Royal College of Surgeons in Ireland - Medical University Bahrain, Busaiteen, Bahrain
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Zelicha H, Bell DS, Chen D, Chen Y, Livingston EH. Obesity and abdominal hernia in ambulatory patients, 2018-2023. Hernia 2024; 28:1317-1324. [PMID: 38795218 PMCID: PMC11297064 DOI: 10.1007/s10029-024-03034-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/28/2024] [Indexed: 05/27/2024]
Abstract
PURPOSE To determine the relationship between abdominal hernia and obesity. Although obesity is frequently cited as a risk factor for abdominal hernia, few studies have confirmed this association (Menzo et al. Surg Obes Relat Dis 14:1221-1232. 10.1016/j.soard.2018.07.005, 2018). METHODS A cross-sectional study of primary care ambulatory patients aged older than 16 years treated at UCLA Health from 01/01/2018 to 06/06/2023. Abdominal hernia was identified by clinic encounter ICD-10 codes (K40-K46). RESULTS There were 41,703 hernias identified among 1,362,440 patients (306.1 per10,000) with a mean age of 62.5 ± 16.1 years, and 57.6% were men. Nearly half (44.7%) of all abdominal hernias were diaphragmatic. There was an approximately equal distribution of the ventral (28.7%) and inguinal (24.3%) hernia. Each hernia type had a different relationship with obesity: The odds of having a ventral hernia increased with BMI in both sexes: BMI 25-29.9 kg/m2 odds ratio (OR) = 1.65, (CI 1.56-1.74); BMI 30-39.9 kg/m2 OR = 2.42 (CI 2.29-2.56), BMI 40-49.9 kg/m2 OR = 2.28 (CI 2.05-2.54) and BMI > = 50 kg/m2 OR = 2.54 (CI 2.03-3.17) all relative to normal BMI. In contrast, the odds of having an inguinal hernia decreased with obesity relative to normal weight [obesity (BMI 30-39.9 kg/m2): OR = 0.60 (CI 0.56-0.65)], morbid obesity (BMI 40-49.9 kg/m2): OR = 0.29 (CI 0.23-0.37). The OR for diaphragmatic hernia peaks with obesity in women and overweight status in men but was found to decrease with morbid obesity [OR = 1.18 (CI 1.07-1.30)]. There was no significant difference between men and women in the prevalence of femoral hernia (men: 0.7/per10,000, women: 0.9/per10,000, p = 0.19). CONCLUSIONS The relationship between hernia and obesity is complex with some hernias decreasing in prevalence as obesity increases. Further research is needed to better understand this paradoxical relationship.
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Affiliation(s)
- H Zelicha
- Department of Surgery, Faculty of Health Sciences, UCLA School of Medicine, CHS 74-121, Los Angeles, CA, 90095, USA
- Department of Medicine, Division of General Internal Medicine, UCLA, Los Angeles, CA, USA
| | - D S Bell
- Department of Medicine, Division of General Internal Medicine, UCLA, Los Angeles, CA, USA
- Informatics Program of the UCLA Clinical and Translational Science Institute (CTSI), UCLA, Los Angeles, CA, USA
| | - D Chen
- Department of Surgery, Faculty of Health Sciences, UCLA School of Medicine, CHS 74-121, Los Angeles, CA, 90095, USA
| | - Y Chen
- Department of Surgery, Faculty of Health Sciences, UCLA School of Medicine, CHS 74-121, Los Angeles, CA, 90095, USA
| | - E H Livingston
- Department of Surgery, Faculty of Health Sciences, UCLA School of Medicine, CHS 74-121, Los Angeles, CA, 90095, USA.
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Wu Q, Yang D, Dong W, Song Z, Yang J, Gu Y. Causal relationship between cigarette smoking behaviors and the risk of hernias: a Mendelian randomization study. Hernia 2024; 28:435-446. [PMID: 38148419 DOI: 10.1007/s10029-023-02925-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/27/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE As the global population continues to age, there is a noticeable yearly rise in the incidence of hernias. Simultaneously, smoking, a widespread addictive behavior and a significant contributor to mortality, has evolved into a pervasive public health concern. Existing literature has already established a connection between smoking and an increased risk of postoperative recurrence and postoperative infections following hernia surgery. However, there remains a dearth of research exploring the association between smoking and hernia morbidity. In this study, our objective is to systematically evaluate the causal relationship between cigarette smoking behaviors and hernia morbidity using a Mendelian randomization (MR) approach. METHODS Hernia-related data were sourced from the FinnGen Biobank database, while cigarette smoking behavior data were gathered from the GWAS and Sequencing Consortium of Alcohol and Nicotine Use. To assess the causal relationship, we employed five methods: the weighted median, the weighted mode the inverse variance weighted (IVW), MR-Egger, and the simple mode. Sensitivity analysis was conducted, incorporating Cochran's Q test, the MR-Egger intercept test, leave-one-out analysis, and funnel plot. The presentation of the causal relationship is expressed as an odds ratio (OR) along with their corresponding 95% confidence intervals (CI). RESULTS Employing the IVW method as the reference standard, we found that smoking intensity is associated with an increased risk of diaphragmatic hernia (OR = 1.21, 95% CI 1.00-1.46, P = 0.047). These consistent findings were further corroborated by the weighted median and weighted mode methods (OR = 1.26, 95% CI 1.03-1.54, P = 0.026; OR = 1.25, 95% CI 1.02-1.52, P = 0.045). Conversely, when applying the IVW method, we identified no statistically significant causal relationship between smoking age, smoking initiation status, smoking cessation status, and the incidence of hernia. CONCLUSIONS Our MR study has uncovered genetic evidence linking smoking intensity and the occurrence of diaphragmatic hernia. The risk of developing diaphragmatic hernia rises in tandem with the intensity of smoking. This emphasizes the crucial role of regularly advising patients to cease smoking in clinical settings.
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Affiliation(s)
- Q Wu
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, 221 Yan'an West Road, Jing'an District, Shanghai, 200040, China
| | - D Yang
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, 221 Yan'an West Road, Jing'an District, Shanghai, 200040, China
| | - W Dong
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, 221 Yan'an West Road, Jing'an District, Shanghai, 200040, China
| | - Z Song
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, 221 Yan'an West Road, Jing'an District, Shanghai, 200040, China
| | - J Yang
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, 221 Yan'an West Road, Jing'an District, Shanghai, 200040, China
| | - Y Gu
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, 221 Yan'an West Road, Jing'an District, Shanghai, 200040, China.
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Glorieux R, Van Aerde M, Vissers S, Fieuws S, De Groof P, Miserez M. Incidence and risk factors of metachronous contralateral inguinal hernia development up to 25 years after unilateral inguinal hernia repair: a single-centre retrospective cohort study. Surg Endosc 2024; 38:1170-1179. [PMID: 38082014 DOI: 10.1007/s00464-023-10606-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/17/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND Patients undergoing unilateral inguinal hernia repair (IHR) are at risk of metachronous contralateral inguinal hernia (MCIH) development. We evaluated incidence and risk factors of MCIH development up to 25 years after unilateral IHR to determine possible indications for concomitant prophylactic surgery of the contralateral groin at the time of primary surgery. METHODS Patients between 18 and 70 years of age undergoing elective unilateral IHR in the University Hospital of Leuven from 1995 to 1999 were studied retrospectively using the electronic health records and prospectively via phone calls. Study aims were MCIH incidence and risk factor determination. Kaplan-Meier curves were constructed and univariable and multivariable Cox regressions were performed. RESULTS 758 patients were included (91% male, median age 53 years). Median follow-up time was 21.75 years. The incidence of operated MCIH after 5 years was 5.6%, after 15 years 16.1%, and after 25 years 24.7%. The incidence of both operated and non-operated MCIH after 5 years was 5.9%, after 15 years 16.7%, and after 25 years 29.0%. MCIH risk increased with older age and decreased in primary right-sided IHR and higher BMI at primary surgery. CONCLUSION The overall incidence of MCIH after 25-year follow-up is 29.0%. Potential risk factors for the development of a MCIH are primary left-sided inguinal hernia repair, lower BMI, and older age. When considering prophylactic repair, we suggest a patient-specific approach taking into account these risk factors, the surgical approach and the risk factors for chronic postoperative inguinal pain.
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Affiliation(s)
- Robin Glorieux
- Department of Abdominal Surgery, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Matthias Van Aerde
- Department of Abdominal Surgery, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Schila Vissers
- Department of Abdominal Surgery, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Steffen Fieuws
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven - University of Leuven, 3000, Leuven, Belgium
| | - Pieter De Groof
- Department of Abdominal Surgery, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Marc Miserez
- Department of Abdominal Surgery, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium
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Perez RD, Villena MA, Zavaleta-Corvera C, Caballero-Alvarado J, Zafra C, Pozzuoli G. [Neutrophil-to-lymphocyte ratio as a predictor of intestinal resection in incarcerated inguinal hernias]. Khirurgiia (Mosk) 2024:51-57. [PMID: 38888019 DOI: 10.17116/hirurgia202401151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
INTRODUCTION Inguinal hernia is defined as a projection of an organ through the inguinal canal. This can be incarcerated as a consequence of continuous inflammation of the hernial sac, which will prevent its return, causing damage to the venous and lymphatic return of the viscera. The neutrophil-to-lymphocyte ratio (NLR) is an easily accessible inflammatory biomarker obtained from blood cell counts. Therefore, the objective was to determine if the NLR is useful as a predictor of intestinal resection in incarcerated inguinal hernias. MATERIAL AND METHOD An observational, analytical, diagnostic test and retrospective study was carried out in a hospital in northern Peru from January 2013 to August 2019 in the Department of General Surgery and Emergency Surgery and Critical Care. Patients diagnosed with unilateral inguinal hernia with intestinal obstruction were included. For the relationship between the event and the exposure, it was analyzed using Chi square (χ2) and T-Student. The sensitivity, specificity, positive predictive value, negative predictive value of the NLR as well as the area under the ROC curve were found to determine the predictive accuracy. RESULTS 161 patients with incarcerated inguinal hernia were studied: group I (20 patients with intestinal resection) and group II (141 patients without intestinal resection). The mean age in groups I and II were 69±16 and 60±17 years (p<0.05); the frequency in males was 70% in group I and 76% in group II (p>0.05). Intestinal obstruction and duration of incarceration >24 hours and the platelet-to-lymphocyte ratio demonstrated significant differences. With respect to NLR taking a cut-off point ≥6.5, a sensitivity of 75%, a specificity of 93.62%, a positive predictive value of 62.5% and a negative predictive value of 96.35% were observed; In addition, when analyzing with the ROC curve, a value of 5.14 was obtained as a predictor of intestinal resection with a sensitivity of 90% and a specificity of 84.4% (p<0.001). Therefore, the NLR >5.14 predicts intestinal resection in patients with incarcerated inguinal hernias with an area under the curve of 0.92 at the Belen Hospital of Trujillo. CONCLUSIONS The neutrophil-to-lymphocyte ratio is useful for predicting intestinal resection with a diagnostic accuracy of 92%.
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Affiliation(s)
- R D Perez
- School of Medicine, Antenor Orrego Private University, Trujillo, Peru
| | - M A Villena
- School of Medicine, Antenor Orrego Private University, Trujillo, Peru
- Belen Hospital of Trujillo, Trujillo, Peru
| | | | - J Caballero-Alvarado
- School of Medicine, Antenor Orrego Private University, Trujillo, Peru
- Regional Hospital of Trujillo, Trujillo, Peru
| | - Ch Zafra
- School of Medicine, Antenor Orrego Private University, Trujillo, Peru
| | - G Pozzuoli
- School of Medicine, Antenor Orrego Private University, Trujillo, Peru
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Chen T, Zhou C, Zhu X, Jiao J, Xue H, Li J, Wang P. Comparison of transumbilical single-incision laparoscopic TAPP versus conventional laparoscopic TAPP in the elderly: A retrospective analysis. Asian J Surg 2023; 46:3620-3626. [PMID: 36914474 DOI: 10.1016/j.asjsur.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/25/2023] [Accepted: 03/02/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND To analyze and compare the clinical efficacy of transumbilical single-incision laparoscopic surgery TAPP(SILS-TAPP) and conventional laparoscopic TAPP(CL-TAPP) in the treatment of senile inguinal hernia. METHODS From January 2019 to June 2021, a total of 221 elderly patients (≥60 years old) with inguinal hernia received SILS-TAPP and CL-TAPP in General Surgery Department of Affiliated Hospital of Nantong University. The perioperative indicators, postoperative complications and follow-up of the two groups were compared to explore the feasibility and superiority of SILS-TAPP in the treatment of inguinal hernia in the elderly. RESULTS There was no difference in demographic characteristics between the two groups. The mean operation time (28.6 ± 4.2 min vs 28.2 ± 5.3 min) in the SILS-TAPP group was not significantly different from that in the CL-TAPP group (Ρ = 0.623), and there was no significant increase in hospital costs(Ρ = 0.748). The intraoperative blood loss (7.4 ± 3.4 ml), VAS score on the postoperative day (2.2 ± 0.7), mean time of resuming activity (8.2 ± 1.9 h) and mean postoperative hospital stay (0.8 ± 0.2 d) in the SILS-TAPP group were better than those in the CL-TAPP group (Ρ < 0. 05).There was no statistical difference in the overall incidence of intraoperative (Ρ = 0.128) and postoperative complications (Ρ = 0.125) between the two groups. CONCLUSION Single-incision laparoscopic surgery TAPP (SILS-TAPP) is feasible and effective in elderly patients, providing a new alternative surgical method for patients who can tolerate general anesthesia.
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Affiliation(s)
- Tao Chen
- Department of General Surgery, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Chun Zhou
- Department of General Practice, Affiliated Hospital of Nantong University, Nantong, China
| | - Xiaojun Zhu
- Department of General Surgery, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Jingyi Jiao
- Department of General Surgery, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Huimin Xue
- Department of General Surgery, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Jianfang Li
- Department of Hernia and Abdominal Wall Surgery, Xiaoshan First People's Hospital, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China.
| | - Peng Wang
- Department of General Surgery, Affiliated Hospital of Nantong University, Nantong, 226001, China.
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Agarwal PK. Study of Demographics, Clinical Profile and Risk Factors of Inguinal Hernia: A Public Health Problem in Elderly Males. Cureus 2023; 15:e38053. [PMID: 37122980 PMCID: PMC10132853 DOI: 10.7759/cureus.38053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Inguinal hernia repair is the most commonly performed elective surgery in India draining significant healthcare resources. This observational study was conducted at a tertiary-level institute in northern India to look into the demographics, clinical profile and risk factors of inguinal hernia. METHOD This study was conducted as an observational study at the tertiary care centre of northern India, including 110 patients who had come to the surgical outpatient department for inguinal hernia repair. After obtaining informed consent from all the participants, demographic details, history and clinical examination were recorded. This was a prospective, single-centre, non-randomized, observational study. RESULTS AND DISCUSSION In our study, 43 patients (39%) were >50 years of age. One hundred and seven patients (97.27%) were males, and three (2.72%) were females. Male: Female ratio was 32:1. The preponderance of males was due to their involvement in more strenuous exercises and lifting weights and the anatomical differences between them. The main risk factor in the present study was lifting heavy weights 55%, followed by altered bowel habits 36.36% and respiratory disease (chronic obstructive airway disease). Smoking and diabetes were also associated as risk factors for the hernia. In this study, the most common side of hernia was on the right side, 63%, on the left, 33% and bilateral in 4% of patients. The indirect hernia was the most common type. CONCLUSION Inguinal hernia is a surgical problem found commonly in the male elderly. Right-sided inguinal hernia is common, with the indirect type being more frequent. Heavy weight lifting and strenuous exercises were commonly found risk factors.
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Affiliation(s)
- Puneet K Agarwal
- Department of General Surgery, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
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Ma Q, Jing W, Liu X, Liu J, Liu M, Chen J. The global, regional, and national burden and its trends of inguinal, femoral, and abdominal hernia from 1990 to 2019: findings from the 2019 Global Burden of Disease Study - a cross-sectional study. Int J Surg 2023; 109:333-342. [PMID: 37093073 PMCID: PMC10389329 DOI: 10.1097/js9.0000000000000217] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 01/05/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Inguinal, femoral, and abdominal hernia repairs are the most common surgical procedure worldwide. However, studies on hernia disease burden are notably limited, in both developed and low-income and middle-income countries (LMICs). We investigated temporal trends in the incidence and prevalence of inguinal, femoral, and abdominal hernias at global, regional, and national levels in 204 countries and territories from 1990 to 2019 using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019). MATERIALS AND METHODS Annual incident cases, prevalent cases, age-standardized incidence rates (ASIRs), and age-standardized prevalence rates (ASPRs) of inguinal, femoral, and abdominal hernias between 1990 and 2019 were extracted from the GBD 2019 study and stratified by sex, age, and location. Percentage changes in incident cases and prevalent cases, and the estimated annual percentage changes of ASIRs and ASPRs were calculated to quantify the trends in the incidence and prevalence of inguinal, femoral, and abdominal hernias. Data analysis for the present study was conducted from 15 June 2022 to 15 July 2022. RESULTS Globally, there were 32.53 million [95% uncertainty interval (UI): 27.71-37.79] prevalent cases and 13.02 million (10.68-15.49) incident cases of inguinal, femoral, and abdominal hernias in 2019, which increased by 36.00% and 63.67%, respectively, compared with 1990. Eighty-six percent of the incident cases were males, the male-to-female ratio was 6 : 1, and most patients were aged 50-69 years. India (2.45 million), China (1.95 million), and Brazil (0.71 million) accounted for more than one-third (39%) of the incident cases worldwide. From 1990 to 2019, the ASIR and ASPR showed a decreasing trend worldwide, except in Central Sub-Saharan Africa, which had an increasing trend in ASIR and ASPR. CONCLUSION The global incident cases and prevalent cases of inguinal, femoral, and abdominal hernias increased substantially from 1990 to 2019, with a heavier burden observed in males, older adults, and in LMICs such as India and China. In addition, the ASIR and ASPR increased substantially in Central Sub-Saharan Africa. More efforts are warranted for hernia management to reduce the burden of inguinal, femoral, and abdominal hernias, such as by providing safe hernia surgical treatment for males, older adults, and LMICs.
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Affiliation(s)
- Qiuyue Ma
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wenzhan Jing
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Xiaoli Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jie Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Huang J, Huffman JE, Huang Y, Do Valle Í, Assimes TL, Raghavan S, Voight BF, Liu C, Barabási AL, Huang RDL, Hui Q, Nguyen XMT, Ho YL, Djousse L, Lynch JA, Vujkovic M, Tcheandjieu C, Tang H, Damrauer SM, Reaven PD, Miller D, Phillips LS, Ng MCY, Graff M, Haiman CA, Loos RJF, North KE, Yengo L, Smith GD, Saleheen D, Gaziano JM, Rader DJ, Tsao PS, Cho K, Chang KM, Wilson PWF, Sun YV, O'Donnell CJ. Genomics and phenomics of body mass index reveals a complex disease network. Nat Commun 2022; 13:7973. [PMID: 36581621 PMCID: PMC9798356 DOI: 10.1038/s41467-022-35553-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 12/09/2022] [Indexed: 12/30/2022] Open
Abstract
Elevated body mass index (BMI) is heritable and associated with many health conditions that impact morbidity and mortality. The study of the genetic association of BMI across a broad range of common disease conditions offers the opportunity to extend current knowledge regarding the breadth and depth of adiposity-related diseases. We identify 906 (364 novel) and 41 (6 novel) genome-wide significant loci for BMI among participants of European (N~1.1 million) and African (N~100,000) ancestry, respectively. Using a BMI genetic risk score including 2446 variants, 316 diagnoses are associated in the Million Veteran Program, with 96.5% showing increased risk. A co-morbidity network analysis reveals seven disease communities containing multiple interconnected diseases associated with BMI as well as extensive connections across communities. Mendelian randomization analysis confirms numerous phenotypes across a breadth of organ systems, including conditions of the circulatory (heart failure, ischemic heart disease, atrial fibrillation), genitourinary (chronic renal failure), respiratory (respiratory failure, asthma), musculoskeletal and dermatologic systems that are deeply interconnected within and across the disease communities. This work shows that the complex genetic architecture of BMI associates with a broad range of major health conditions, supporting the need for comprehensive approaches to prevent and treat obesity.
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Affiliation(s)
- Jie Huang
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Jennifer E Huffman
- Center for Population Genomics, Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
| | - Yunfeng Huang
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
- Atlanta VA Health Care System, Decatur, GA, USA
| | - Ítalo Do Valle
- Network Science Institute and Department of Physics, Northeastern University, Boston, MA, USA
- Division of Population Health and Data Science, MAVERIC, VA Boston Healthcare System, Boston, MA, USA
| | - Themistocles L Assimes
- VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Sridharan Raghavan
- VA Eastern Colorado Healthcare System, Aurora, CO, USA
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Benjamin F Voight
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Genetics, University of Pennsylvania, Philadelphia, PA, USA
- Institute of Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Chang Liu
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Albert-László Barabási
- Network Science Institute and Department of Physics, Northeastern University, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Network and Data Science, Central European University, Budapest, Hungary
| | - Rose D L Huang
- Center for Population Genomics, Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
| | - Qin Hui
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
- Atlanta VA Health Care System, Decatur, GA, USA
| | - Xuan-Mai T Nguyen
- Carle Illinois College of Medicine, Champaign, IL, USA
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
| | - Yuk-Lam Ho
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
| | - Luc Djousse
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Julie A Lynch
- VA Salt Lake City Healthcare, Salt Lake City, UT, USA
- University of Massachusetts, Boston, MA, USA
| | - Marijana Vujkovic
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Department of Medicine; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Catherine Tcheandjieu
- VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Hua Tang
- VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Scott M Damrauer
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Department of Surgery; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Peter D Reaven
- Phoenix VA Health Care System, Phoenix, AZ, USA
- College of Medicine, University of Arizona, Phoenix, AZ, USA
| | - Donald Miller
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA
| | - Lawrence S Phillips
- Atlanta VA Health Care System, Decatur, GA, USA
- Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Maggie C Y Ng
- Vanderbilt Genetics Institute and Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mariaelisa Graff
- Gillings School of Global Public Health, Department of Epidemiology, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Christopher A Haiman
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ruth J F Loos
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kari E North
- Gillings School of Global Public Health, Department of Epidemiology, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Loic Yengo
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - George Davey Smith
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Danish Saleheen
- Center for Non-Communicable Diseases, Karachi, Sindh, Pakistan
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Department of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - J Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel J Rader
- Department of Medicine; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Philip S Tsao
- VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Kelly Cho
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kyong-Mi Chang
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Department of Medicine; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter W F Wilson
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
- Atlanta VA Health Care System, Decatur, GA, USA
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Yan V Sun
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA.
- Atlanta VA Health Care System, Decatur, GA, USA.
| | - Christopher J O'Donnell
- Center for Population Genomics, Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA.
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Cardiology Section, VA Boston Healthcare System, Boston, MA, USA.
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10
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Umeda K, Takeda T, Hakozaki K, Yasumizu Y, Tanaka N, Matsumoto K, Morita S, Kosaka T, Mizuno R, Asanuma H, Oya M. A low subcutaneous fat mass is a risk factor for the development of inguinal hernia after radical prostatectomy. Langenbecks Arch Surg 2022; 407:3107-3112. [PMID: 35729400 DOI: 10.1007/s00423-022-02526-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/21/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Inguinal hernia (IH) after radical prostatectomy (RP) is a complication that impairs quality of life; however, the factors contributing to IH after RP remain unclear. Therefore, we herein attempted to identify the factors responsible for the development of IH after RP. METHODS We reviewed 622 patients who underwent laparoscopic or robot-assisted laparoscopic RP at our hospital between December 2011 and April 2020. The total fat area and visceral fat area were calculated at the level of the umbilicus using computed tomography, and the subcutaneous fat area (SFA) was calculated by subtracting the visceral fat area from the total fat area. The psoas muscle area was measured at the third lumbar vertebrae level using computed tomography to calculate the psoas muscle mass index, which is used in sarcopenia as an index of muscle mass. We investigated the risk factors for IH after laparoscopic or robot-assisted laparoscopic RP. RESULTS IH developed in 88 patients (16.7%). Fifty-seven of these patients underwent hernia repair at our hospital, and 56 (98.2%) had indirect hernias. A multivariate analysis identified SFA (odds ratios: 0.383, p < 0.001) as an independent predictor for the development of IH. Two-year IH-free survival rates were 77.3% in the small SFA group (SFA < 123 cm2) and 88.7% in the large SFA group (SFA ≥ 123 cm2) (p < 0.001). CONCLUSION Subcutaneous fat was associated with the development of IH, particularly indirect IH, after laparoscopic or robot-assisted laparoscopic RP. An indirect IH prevention technique needs to be considered, particularly for patients with less subcutaneous fat.
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Affiliation(s)
- Kota Umeda
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Toshikazu Takeda
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
| | - Kyohei Hakozaki
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Yota Yasumizu
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Nobuyuki Tanaka
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Kazuhiro Matsumoto
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Shinya Morita
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Takeo Kosaka
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Hiroshi Asanuma
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
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11
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Kushner BS, Hamilton J, Han BJ, Sehnert M, Holden T, Holden SE. Geriatric assessment and medical preoperative screening (GrAMPS) program for older hernia patients. Hernia 2022; 26:787-794. [PMID: 33813655 DOI: 10.1007/s10029-021-02389-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/26/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE The incidence of older adults undergoing inguinal and ventral hernia repairs is increasing. Older adults are disproportionately affected by age-related risk factors, which are often under-recognized and may adversely affect surgical outcomes. These age-related risk factors often termed "geriatric syndromes," include multimorbidity, frailty, cognitive impairment, depression, obesity, functional impairment, polypharmacy, and poor subjective health. The aim of this study was to identify the prevalence of age-related risk factors in older patients undergoing elective hernia repair. METHODS Patients aged 60 years or older with a planned elective surgical repair of a ventral or inguinal hernia were prospectively enrolled in a clinic. Subjects completed several validated screening tools for geriatric syndromes. RESULTS Seventy patients completed preoperative assessments (mean age: 68.5 years). In total, 24 (34.3%) screened positive for previously unrecognized objective cognitive impairment (Mini-Cog) and 33 (47.1%) for a subjective memory concern. Sixty patients (85.7%) met criteria for polypharmacy. Additionally, 48 (68.6%) screened positive for either pre-frailty (37, 52.9%) or frailty (11, 15.7%), and 66 (94.3%) had multimorbidity. Twenty-five (35.7%) patients self-rated their health as "poor" or "fair," and 18 (25.7%) patients endorsed some functional impairment. CONCLUSIONS There is a high prevalence of age-related risk factors in older patients undergoing elective hernia repair. Further, these factors are often unrecognized and underappreciated despite their potential to significantly impact informed consent and shared decision making. Additional study is required to define the impact of these age-related risk factors on surgical outcomes, which will inform preoperative risk assessment and optimization through modifiable risk reduction.
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Affiliation(s)
- Bradley S Kushner
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA.
- Department of Minimally Invasive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, St. Louis, MO, 63110, USA.
| | - J Hamilton
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - B J Han
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - M Sehnert
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - T Holden
- Division of Geriatrics and Nutritional Science, Department of Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - S E Holden
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
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12
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Congenital collagenopathies increased the risk of inguinal hernia developing and repair: analysis from a nationwide population-based cohort study. Sci Rep 2022; 12:2360. [PMID: 35149748 PMCID: PMC8837651 DOI: 10.1038/s41598-022-06367-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 01/19/2022] [Indexed: 11/08/2022] Open
Abstract
Herein, we aimed to explore whether male patients with congenital collagen diseases had a higher risk of inguinal herniation than patients without these diseases. Data were retrospectively collected from the National Health Insurance Research Database of Taiwan. The study cohort included 1,801 male patients diagnosed with congenital collagen diseases based on the ICD-9 CM diagnostic codes; after propensity score matching, the control group comprised 6,493 men without congenital collagen diseases. The primary endpoint was inguinal hernia repair during the observation period. During a median follow-up period of 133.9 months, the risk of inguinal herniation in the collagen group was significantly higher than that in the control group (HR = 2.237, 95% CI 1.646-3.291, p < 0.001). This phenomenon was observed in patients younger than 18 years (HR: 3.040, 95% CI 1.819-5.083, p < 0.001) and in those aged 18-80 years (HR: 1.909, 95% CI 1.186-3.073, p < 0.001). Asian men with congenital collagen diseases are at a high risk of developing inguinal hernias, regardless of age. Detailed physical examination and patient education should be performed for these patients to prevent inguinal herniation.
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13
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Kushner BS, Holden T, Han BJ, Hamilton J, Sehnert M, Holden SE. Perioperative outcomes of the Geriatric Assessment and Medical Preoperative Screening (GrAMPS) program pilot for older hernia patients: does chronological age predict outcomes? Surg Endosc 2021; 36:5442-5450. [PMID: 34845548 DOI: 10.1007/s00464-021-08886-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Geriatric Assessment and Medical Preoperative Screening (GrAMPS) program was an initial attempt to understand and to define the prevalence of age-related risk factors in older patients undergoing elective ventral hernia repair (VHR) or inguinal hernia repair (IHR). Preliminary analysis found significant rates of previously unrecognized objective cognitive dysfunction, multimorbidity and polypharmacy. We now examine whether chronological age as a sole risk factor can predict a patient's perioperative outcomes, and if traditional risk calculators that rely heavily on chronological age can accurately capture a patient's true risk. METHODS This was a retrospective secondary analysis of the previously reported GrAMPS trial enrolling patients 60 years and older with a planned elective repair of a ventral or inguinal hernia. The rates of key postoperative outcomes were compared between various cohorts stratified by chronological age. Previously validated risk screening calculators [Charlson Comorbidity Index (CCI), National Surgical Quality Improvement Program (NSQIP)] were compared between cohorts. RESULTS In total, 55 (78.6%) of the 70 patients enrolled in GrAMPS underwent operative intervention by May 2021, including 26 VHR and 29 IHRs. Cohorts stratified by chronological age had similar rates of key perioperative wound and age-related outcomes including readmissions, postoperative complications, non-home discharges, and length of stay. Additionally, while the commonly used risk calculators, CCI and NSQIP, consistently predicted worse outcomes for older hernia patients (stratified by both median age and age-tertiles), screening positive on these risk assessments were not actually predictive of a greater incidence of postoperative complications. CONCLUSIONS Chronological age does not accurately predict worse adverse postoperative complications in older hernia patients. Additionally, traditional risk screening calculators that rely heavily on age to risk stratify may not accurately capture a patient's true surgical risk. Surgeons should continue to explore nuanced patient risk assessments that more accurately capture age-related risk factors to better individualize perioperative risk.
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Affiliation(s)
- Bradley S Kushner
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA.
- Department of Minimally Invasive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, St. Louis, MO, 63110, USA.
| | - Timothy Holden
- Division of Geriatrics and Nutritional Science, Department of Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Britta J Han
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Julia Hamilton
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Margaret Sehnert
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Sara E Holden
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Department of Minimally Invasive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, St. Louis, MO, 63110, USA
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14
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Seo HS, Na Y, Jung J. Analysis of the Occurrence of Diseases Following Gastrectomy for Early Gastric Cancer: a Nationwide Claims Study. J Gastric Cancer 2021; 21:279-297. [PMID: 34691812 PMCID: PMC8505120 DOI: 10.5230/jgc.2021.21.e29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose Various changes in nutrition, metabolism, immunity, and psychological status occur through multiple mechanisms after gastrectomy. The purpose of this study was to predict disease status after gastrectomy by analyzing diseases pattern that occur or change after gastrectomy. Materials and Methods A retrospective cohort study was conducted using nationwide claims data. Patients with gastric cancer who underwent gastrectomy or endoscopic resection were included in the study. Eighteen target diseases were selected and categorized based on their underlying mechanism. The incidence of each target disease was compared by dividing the study sample into those who underwent gastrectomy (cases) and those who underwent endoscopic resection for early gastric cancer (controls). The cases were matched with controls using propensity score matching. Thereafter, Cox proportional hazard models were used to evaluate intergroup differences in disease incidence after gastrectomy. Results A total of 97,634 patients who underwent gastrectomy (84,830) or endoscopic resection (12,804) were included. The incidence of cholecystitis (P<0.0001), pancreatitis (P=0.034), acute kidney injury (P=0.0083), anemia (P<0.0001), and inguinal hernia (P=0.0007) were higher after gastrectomy, while incidence of dyslipidemia (P<0.0001), vascular diseases (ischemic heart disease, stroke, and atherosclerosis; P<0.0001, P<0.0001, and P=0.0005), and Parkinson's disease (P=0.0093) were lower after gastrectomy. Conclusions This study identifies diseases that may occur after gastrectomy in patients with gastric cancer.
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Affiliation(s)
- Ho Seok Seo
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yewon Na
- Artificial Intelligence and Big-Data Convergence Center, Gil Medical Center, Gachon University College of Medicine and Science, Incheon, Korea.,Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Jaehun Jung
- Artificial Intelligence and Big-Data Convergence Center, Gil Medical Center, Gachon University College of Medicine and Science, Incheon, Korea.,Departement of Preventive Medicine, Gachon University College of Medicine, Incheon, Korea
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Mahfouz MEM, Al-Juaid RS. Prevalence and risk factors of abdominal hernia among Saudi population. J Family Med Prim Care 2021; 10:3130-3136. [PMID: 34660458 PMCID: PMC8483121 DOI: 10.4103/jfmpc.jfmpc_622_21] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/01/2021] [Accepted: 07/15/2021] [Indexed: 11/04/2022] Open
Abstract
Objective: Studies assessing prevalence and risk factors of abdominal hernia are scarce in Saudi Arabia, that is why this study aimed to find out the prevalence and risk factors of abdominal hernia among the Saudi Population in 2020. Methods: A cross-sectional study was done on 500 participants. A pre-designed questionnaire included three sections: Section A consisted of sociodemographic, Section B had items for three dimensions: pain at the site of the hernia or the hernia repair, restriction of activities, cosmetic discomfort; Section C included medical history and other associated risk factors of hernia. Results: The prevalence of abdominal hernia in our study was found to be 38.8%. The participants in 18-25 years had less prevalence (21.2%). participants with BMI >25 (Overweight and Obese) had higher prevalence than others. The mean EuraHS-QoL score in participants who had abdominal hernia was significantly higher than patients who didn't have AH. Age >40 years, male gender, BMI >25, congenital anomalies, history of abdominal surgery, history of abdominal trauma, family history, grand multipara, chronic cough, chronic bronchitis, and smoking were potential predictive factors of AH. Conclusion: Abdominal hernia is a common problem in Saudi Arabia. Abdominal hernias are more common in men than women, there is an obvious relationship between obesity, history of abdominal surgery, history of abdominal trauma, family history and hernias. Early diagnosis, easily accessible health facilities and health education are important to prevent complications and improve quality of life.
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Affiliation(s)
- Mohammad Eid M Mahfouz
- Associate Professor of Surgery, Department of Surgery, College of Medicine, Taif University, Taif, Saudi Arabia
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Jan Z, Ali S, Ahmed N, Sarwar MA. Comparison of Common Postoperative Complications Between Lichtenstein Open Repair and Laparoscopic Transabdominal Pre-peritoneal (TAPP) Repair for Unilateral Inguinal Hernia. Cureus 2021; 13:e17863. [PMID: 34660065 PMCID: PMC8502236 DOI: 10.7759/cureus.17863] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Laparoscopic transabdominal pre-peritoneal (TAPP) repair is a minimally invasive technique that is becoming the procedure of choice among surgeons for inguinal hernia repair and research work is still going on comparing TAPP repair with Lichtenstein open mesh repair. The objective of our study is to compare common postoperative complications in Lichtenstein mesh repair and laparoscopic TAPP repair for unilateral inguinal hernia in our unit. Methods Between August 2016 and August 2018, patients with unilateral inguinal hernia and ASA grade I/II were selected in the surgical outpatient department (OPD) and prospectively randomized into two equal groups. Lichtenstein open mesh repair was done in Group-I and laparoscopic TAPP repair in Group-II. The visual analog scale (VAS) was used for the assessment of the intensity of pain. Results A total of 100 patients with a diagnosis of unilateral inguinal hernia were included in the study. Overall, our study showed that there was less postoperative pain in those patients who underwent TAPP repair as compared to patients with Lichtenstein mesh repair (p= <0.05). There were more postoperative complications in Group-I as compared to Group-II. Conclusion Laparoscopic TAPP repair for inguinal hernia is associated with less postoperative pain and other postoperative complications in addition to a shorter hospital stay as compared to Lichtenstein mesh repair. Thus, this is helping in the early return of patients to daily life activities.
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Affiliation(s)
- ZakaUllah Jan
- Department of General Surgery, Khyber Teaching Hospital, Peshawar, PAK
| | - Sajid Ali
- Department of General Surgery, Khyber Teaching Hospital, Peshawar, PAK
| | - Nisar Ahmed
- Department of General Surgery, Khyber Teaching Hospital, Peshawar, PAK
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17
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Inguinal hernia – epidemiology, risk factors, treatment methods (literature review). ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.4.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Inguinal hernias (IH) are widespread in the human population and occur in 27–43 % of men and 3–6 % of women. Many risk factors for IH have been overestimated in the last decade: male gender is considered the leading factor (the ratio between men and women is approximately 1:7), less significant factors are heredity (most significant for women), physical activity (more significant for men), age (peak prevalence of IH occurs at 5 years and 70–80 years), congenital or acquired connective tissue dysplasia, history of prostatectomy, low body mass index.Hernioplasty with the use of synthetic mesh prostheses remains the most popular technique for surgical correction of IH. Performing non-prosthetic hernioplasty is only recommended if mesh prostheses are not available, for example in poor countries. In open hernioplasty using mesh prostheses, different methods are used today: Plug & Patch, Prolene Hernia System, Parietene Progrip, sutureless plastic according to Trabucco, Stoppa, preperitoneal techniques TIPP (trans-inguinal pre-peritoneal), TREPP (transrectus pre-peritoneal), TEP (total extraperitoneal), however, none of them showed significant advantages over the gold standard of open hernioplasty – tensionfree repair according to Liechtenstein.Laparoscopic IH correction is represented by the TAPP (transabdominal preperitoneal) technique, performed through the abdominal cavity, and TEP (total extraperitoneal) – extraperitoneal prosthetic hernioplasty. None of them has a significant advantage in the treatment of IH; therefore, when choosing a treatment method, the surgeon should be guided by the cost of the operation and the level of proficiency in one or another hernioplasty technique.
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18
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Hada G, Zhang S, Song Y, Jaiswar M, Xie Y, Jian F, Lei W. Safety of Inguinal Hernia Repair in the Elderly with Perioperative Continuation of Antithrombotic Therapy. Visc Med 2021; 37:315-322. [PMID: 34540948 DOI: 10.1159/000509895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/02/2020] [Indexed: 02/05/2023] Open
Abstract
Introduction This study aimed to evaluate the safety of an inguinal hernia repair (IHR) under local anesthesia (LA) in the elderly with a perioperative continuation of antithrombotic therapy (AT). Methods A total of 120 patients undergoing elective primary IHR between August 2018 and August 2019 at the West China Hospital of China were prospectively studied, among which 60 patients also had coexisting cardiovascular diseases and had a continuation of AT perioperatively (antithrombotic group); the other 60 patients were not on any prior AT (control group). The primary endpoints were intra- and postoperative hemorrhagic complications, the required interventions for complications based on the Clavien-Dindo classification, and postoperative thromboembolic complications. The secondary endpoints were nonhemorrhagic complications, intraoperative duration, and postoperative length of stay (LOS). Results None of the patients in both groups had significant intraoperative bleeding >10 mL, and there were no significant differences between the 2 groups in terms of the postoperative hemorrhagic complications: bruising (2 vs. 0%, p = 1.000), serosanguinous soakage (7 vs. 3%, p = 0.679), and no hematoma was observed. Interventions required for encountered complications based on the Clavien-Dindo classification grade I (7 vs. 5%, p = 1.000) were assessed. There were no episodes of postoperative thromboembolic complications within 60 days in both groups. There were also no significant differences between the 2 groups in terms of nonhemorrhagic complications, intraoperative duration, and postoperative LOS (p > 0.05 in all). Conclusions The perioperative continuation of AT did not increase the risk of intra- and postoperative hemorrhagic complications following IHR in the elderly. Thus, IHR under LA seems to be safe and feasible in this setting.
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Affiliation(s)
- Gonish Hada
- Department of Gastrointestinal Surgery, Hernia Center, West China Hospital, Sichuan University, Chengdu, China
| | - Sen Zhang
- Department of Gastrointestinal Surgery, Hernia Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yinghan Song
- Department of Day Care Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Mukesh Jaiswar
- Department of Gastrointestinal Surgery, Hernia Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yanyan Xie
- Department of Gastrointestinal Surgery, Hernia Center, West China Hospital, Sichuan University, Chengdu, China
| | - Fushan Jian
- Department of Gastrointestinal Surgery, Hernia Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wenzhang Lei
- Department of Gastrointestinal Surgery, Hernia Center, West China Hospital, Sichuan University, Chengdu, China
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Gubb SJA, Brcic L, Underwood JFG, Kendall KM, Caseras X, Kirov G, Davies W. Medical and neurobehavioural phenotypes in male and female carriers of Xp22.31 duplications in the UK Biobank. Hum Mol Genet 2021; 29:2872-2881. [PMID: 32766777 PMCID: PMC7566349 DOI: 10.1093/hmg/ddaa174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 12/12/2022] Open
Abstract
Deletions spanning the STS (steroid sulfatase) gene at Xp22.31 are associated with X-linked ichthyosis, corneal opacities, testicular maldescent, cardiac arrhythmia, and higher rates of developmental and mood disorders/traits, possibly related to the smaller volume of some basal ganglia structures. The consequences of duplication of the same genomic region have not been systematically assessed in large or adult samples, although evidence from case reports/series has indicated high rates of developmental phenotypes. We compared multiple measures of physical and mental health, cognition and neuroanatomy in male (n = 414) and female (n = 938) carriers of 0.8–2.5 Mb duplications spanning STS, and non-carrier male (n = 192, 826) and female (n = 227, 235) controls from the UK Biobank (recruited aged 40–69 from the UK general population). Clinical and self-reported diagnoses indicated a higher prevalence of inguinal hernia and mania/bipolar disorder respectively in male duplication carriers, and a higher prevalence of gastro-oesophageal reflux disease and blistering/desquamating skin disorder respectively in female duplication carriers; duplication carriers also exhibited reductions in several depression-related measures, and greater happiness. Cognitive function and academic achievement did not differ between comparison groups. Neuroanatomical analysis suggested greater lateral ventricle and putamen volume in duplication carriers. In conclusion, Xp22.31 duplications appear largely benign, but could slightly increase the likelihood of specific phenotypes (although results were only nominally-significant). In contrast to deletions, duplications might protect against depressive symptoms, possibly via higher STS expression/activity (resulting in elevated endogenous free steroid levels), and through contributing towards an enlarged putamen volume. These results should enable better genetic counselling of individuals with Xp22.31 microduplications.
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Affiliation(s)
- Samuel J A Gubb
- Division of Psychological Medicine and Clinical Neurosciences and Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom
| | - Lucija Brcic
- School of Psychology, Cardiff University, Cardiff CF10 3AT, United Kingdom
| | - Jack F G Underwood
- Division of Psychological Medicine and Clinical Neurosciences and Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom.,Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff CF24 4HQ, United Kingdom
| | - Kimberley M Kendall
- Division of Psychological Medicine and Clinical Neurosciences and Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom
| | - Xavier Caseras
- Division of Psychological Medicine and Clinical Neurosciences and Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom
| | - George Kirov
- Division of Psychological Medicine and Clinical Neurosciences and Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom
| | - William Davies
- Division of Psychological Medicine and Clinical Neurosciences and Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff CF24 4HQ, United Kingdom.,School of Psychology, Cardiff University, Cardiff CF10 3AT, United Kingdom.,Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff CF24 4HQ, United Kingdom
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20
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Serra R, Bracale UM, Conforto R, Roncone A, Ielapi N, Michael A, Sodo M, Di Taranto MD, Mastroroberto P, Serraino GF, Provenzano M, Andreucci M. Association between Inguinal Hernia and Arterial Disease: A Preliminary Report. BIOLOGY 2021; 10:biology10080736. [PMID: 34439968 PMCID: PMC8389546 DOI: 10.3390/biology10080736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 12/28/2022]
Abstract
Simple Summary While the association between venous disease and inguinal hernia has been well demonstrated, there is less evidence concerning the association between arterial diseases (AD), such as carotid stenosis, peripheral artery disease and abdominal aortic aneurysms, and inguinal hernia. We surprisingly found that the prevalence of AD is large, being higher than 40% in our study cohort. Moreover, patients with AD as compared to those without AD are characterized by additional other comorbidities such as greater albuminuria, higher frequency of a smoking habit and older age. Hence, we provided a characterization of patients with inguinal hernia with respect to concomitant presence of AD. Abstract Background: Inguinal hernia (IH) is a major problem in general surgery and its prevalence is increasing. The presence of hernias has been associated with a wide spectrum of venous diseases, with the involvement of imbalances in collagen and extracellular matrix deposition and metalloproteinases dysfunction. We aimed to evaluate whether the association between IH and vascular diseases is also present with respect to arterial diseases. Methods: We designed a cross-sectional observational study enrolling consecutive patients undergoing surgical repair of IH. Arterial diseases (AD) considered were carotid stenosis, peripheral artery disease and abdominal aortic aneurysms. Results: Study population consisted of 70 patients. Mean age was 63.2 ± 4.7 years. Prevalence of AD was 42.9% in the whole cohort. AD patients were older (p = 0.015), and more frequently had hypertension (p = 0.001) and active smoking habits (p = 0.001) than the no-AD group. Albumin-to-creatinine ratio (ACR) was higher in AD than in no-AD patients (p < 0.001). At multivariable analysis, increased ACR (odds ratio, OR: 1.14, p < 0.001), old age (OR: 1.25, p = 0.001) and a smoking habit (OR: 3.20, p = 0.001) were significant correlates for the presence of AD. Conclusions: Prevalence of AD in patients with IH is non-negligible. Old age, a smoking habit and an abnormal excretion of urine albumin are associated with the presence of AD in these patients. Future studies are needed to gain more insights into the pathogenic mechanisms underlying this association, exploring also the specific role of metalloproteinases.
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Affiliation(s)
- Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL), “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy;
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy;
- Correspondence:
| | - Umberto Marcello Bracale
- Department of Public Health, University of Naples “Federico II”, 80100 Naples, Italy; (U.M.B.); (M.S.)
| | - Rosy Conforto
- Interuniversity Center of Phlebolymphology (CIFL), “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy;
| | - Arturo Roncone
- Department Surgery, Hospital of Soverato, 88068 Soverato, Italy;
| | - Nicola Ielapi
- Department of Public Health and Infectious Disease, “Sapienza” University of Rome, 00185 Rome, Italy;
| | - Ashour Michael
- Department of Health Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (A.M.); (M.A.)
| | - Maurizio Sodo
- Department of Public Health, University of Naples “Federico II”, 80100 Naples, Italy; (U.M.B.); (M.S.)
| | - Maria Donata Di Taranto
- Department of Molecular Medicine and Medical Biotechnology, University Federico II of Naples, 80100 Naples, Italy;
| | - Pasquale Mastroroberto
- Department of Experimental and Clinical Medicine, University of Catanzaro, 88100 Catanzaro, Italy; (P.M.); (G.F.S.)
| | - Giuseppe Filiberto Serraino
- Department of Experimental and Clinical Medicine, University of Catanzaro, 88100 Catanzaro, Italy; (P.M.); (G.F.S.)
| | - Michele Provenzano
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy;
| | - Michele Andreucci
- Department of Health Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (A.M.); (M.A.)
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21
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Williams ML, McCarthy ASE, Lord SJ, Aczel T, Brooke-Cowden GL. Impact of ultrasound on inguinal hernia repair rates in Australia: a population-based analysis. ANZ J Surg 2021; 91:1604-1609. [PMID: 33870618 DOI: 10.1111/ans.16845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/09/2021] [Accepted: 03/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Inguinal hernias are a common pathology that often requires surgical management. The use of groin ultrasound (GU) to investigate inguinal hernias is a growing area of concern as an inefficient use of healthcare resources. Our aim was to assess changes in the rates of GU and the impact on surgical practice. METHODS Medicare Item Reports and the Australian Institute of Health and Welfare Database were used to estimate annual GU and inguinal hernia repair (IHR) rates per 100 000 population for the period 2000/2001-2017/2018. Pearson's correlation coefficients and linear regression analyses were performed to assess associations between these variables. RESULTS Over the 18-year period, GU rates increased 13-fold from 88 to 1174 per 100 000 population. Overall, total IHR rates decreased from 217 to 192 per 100 000. Overall, unilateral IHR rates have decreased (182-146 per 100 000), bilateral IHRs have increased (35-46 per 100 000), laparoscopic IHR has increased (30-86 per 100 000) and open surgery has declined (187-106 per 100 000). The increase in GU rates were strongly associated with the decrease in unilateral (r = -0.936, P = <0.001) and increase in bilateral IHR rates (r = 0.924, P = <0.001). CONCLUSION The use of GU has increased substantially, potentially representing an unnecessary cost to the healthcare system. Rising GU rates are not associated with an increase in IHR, however, may contribute to the increasing rates of bilateral IHRs. This study supports the opinion that more extensive clinical and health policy initiatives are needed in Australia to address this health issue.
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Affiliation(s)
- Michael L Williams
- Department of Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,The School of Medicine Sydney, The University of Notre Dame, Sydney, New South Wales, Australia
| | | | - Sally J Lord
- The School of Medicine Sydney, The University of Notre Dame, Sydney, New South Wales, Australia
| | - Thomas Aczel
- The School of Medicine Sydney, The University of Notre Dame, Sydney, New South Wales, Australia.,Department of Surgery, Hawkesbury Hospital, Sydney, New South Wales, Australia
| | - Geoffrey L Brooke-Cowden
- The School of Medicine Sydney, The University of Notre Dame, Sydney, New South Wales, Australia.,Department of Surgery, Auburn Hospital, Sydney, New South Wales, Australia
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22
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Bal J, Ilonzo N, Spencer P, Hyakutake M, Leitman IM. Loss of independence after emergency inguinal hernia repair in elderly patients: How aggressive should we be? Am J Surg 2021; 223:370-374. [PMID: 33838864 DOI: 10.1016/j.amjsurg.2021.03.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/02/2021] [Accepted: 03/28/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Loss of independence (LOI) assesses patient quality of life after surgery and is associated with increased readmission and death. This paper compares LOI among the elderly who received elective versus emergent inguinal hernia repair. METHODS The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files from 2015 to 2017 were reviewed for inguinal hernia repairs in patients 70-years-old or older. Chi-square analysis, Student t-test, and backwards multivariate logistic analysis were performed appropriately. RESULTS Patients undergoing elective open or laparoscopic repair were less likely to experience LOI (OR 0.061, CI 0.035-0.106) and (OR 0.052 CI 0.024-0.113), respectively, and they were less likely to experience mortality (OR 0.07, CI 0.026-0.185) and (OR 0.059, CI 0.015-0.229), respectively. CONCLUSIONS Significant debility occurs following emergency inguinal hernia repair in elderly patients. Elective surgery may be indicated more often in order to reduce emergencies and LOI in elderly patients.
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Affiliation(s)
- Japjot Bal
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA
| | - Nicole Ilonzo
- The Mount Sinai Hospital, 1468 Madison Ave, New York, NY, 10029, USA
| | - Princess Spencer
- The Mount Sinai Hospital, 1468 Madison Ave, New York, NY, 10029, USA
| | - Misa Hyakutake
- The Mount Sinai Hospital, 1468 Madison Ave, New York, NY, 10029, USA
| | - I Michael Leitman
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA; 10 Union Square East, Suite 2M, New York, NY, 10003, USA.
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23
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Latenstein CSS, Thunnissen FM, Harker M, Groenewoud S, Noordenbos MW, Atsma F, de Reuver PR. Variation in practice and outcomes after inguinal hernia repair: a nationwide observational study. BMC Surg 2021; 21:45. [PMID: 33472620 PMCID: PMC7816298 DOI: 10.1186/s12893-020-01030-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/22/2020] [Indexed: 11/11/2022] Open
Abstract
Background Inguinal hernia repair has often been used as a showcase to illustrate practice variation in surgery. This study determined the degree of hospital variation in proportion of patients with an inguinal hernia undergoing operative repair and the effect of this variation on clinical outcomes. Methods A nationwide, longitudinal, database study was performed in all hospitals in the Netherlands between 2013 and 2015. Patients with inguinal hernias were collected from the Diagnosis-Related-Group (DRG) database. The case-mix adjusted operation rate in patients with a new DRG determines the observed variation. Hospital variation in case-mix adjusted inguinal hernia repair-rates was calculated per year. Clinical outcomes after surgery were compared between hospitals with high and low adjusted operation-rates. Results In total, 95,637 patients were included. The overall operation rate was 71.6%. In 2013–2015, the case-mix adjusted performance of inguinal hernia repairs in hospitals with high rates was 1.6–1.9 times higher than in hospitals with low rates. Moreover, in hospitals with high adjusted rates of inguinal hernia repair the time to surgery was shorter, more laparoscopic procedures were performed, less emergency department visits were recorded post-operatively, while more emergency department visits were recorded when patients were treated conservatively compared to hospitals with low adjusted operation rates. Conclusion Hospital variation in inguinal hernia repair in the Netherlands is modest, operation-rates vary by less than two-fold, and variation is stable over time. Hernia repair in hospitals with high adjusted rates of inguinal hernia repair are associated with improved outcomes.
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Affiliation(s)
- Carmen S S Latenstein
- Department of Surgery, Radboud University Medical Centre Nijmegen, Geert Grooteplein 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Floris M Thunnissen
- Department of Surgery, Radboud University Medical Centre Nijmegen, Geert Grooteplein 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Mitchell Harker
- Department of Surgery, Radboud University Medical Centre Nijmegen, Geert Grooteplein 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Stef Groenewoud
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mark W Noordenbos
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Femke Atsma
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Philip R de Reuver
- Department of Surgery, Radboud University Medical Centre Nijmegen, Geert Grooteplein 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
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24
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Feasibility of robotic-assisted minimally invasive inguinal hernia repair in patients with urologic considerations including artificial urinary sphincters and bladder herniation. J Robot Surg 2020; 15:695-699. [PMID: 33107011 DOI: 10.1007/s11701-020-01163-7] [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: 09/30/2020] [Accepted: 10/18/2020] [Indexed: 10/23/2022]
Abstract
Robotic surgical technology has the potential to broaden the applicability of minimally invasive approaches into more complex, technically challenging inguinal hernia repairs. A unique patient population requiring inguinal hernia repair are those patients who either have artificial urinary sphincters (AUS) or inguinal bladder herniation (IBH). Traditionally, these patients have not been considered candidates for minimally invasive inguinal hernia repairs. Through this retrospective series, we aim to contribute to the growing body of literature on robotic-assisted inguinal hernia repair (RIHR) by describing our experience with RIHR in this patient subset. We performed a retrospective chart review of RIHR cases performed from June 2017 to April 2019 by a single surgeon at our university-affiliated community hospital. Charts were reviewed for preoperative considerations, operative complications, and postoperative outcomes. A total of three patients with an AUS and six patients with IBH were included, all of whom were male. All the patients received transabdominal preperitoneal (TAPP) approaches, and all received placement of mesh. There were no intraoperative complications and no conversions to open surgery. Postoperatively, one patient with IBH had persistent surgical site pain that resolved after 3 weeks and one patient, also with IBH, had a surgical site seroma that resolved without further intervention. Mean follow-up time was 10.71 and 12.13 months for patients with AUS and IBH, respectively. No patients reported hernia recurrence during this time. This review suggests that the use of robotic assistance for laparoscopic inguinal hernia repair is safe and effective and may provide additional benefits for patients with concurrent urological considerations such as AUS and IBH.
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25
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Balentine CJ, Meier J, Berger M, Reisch J, Cullum M, Lee SC, Skinner CS, Brown CJ. Using Local Anesthesia for Inguinal Hernia Repair Reduces Complications in Older Patients. J Surg Res 2020; 258:64-72. [PMID: 33002663 DOI: 10.1016/j.jss.2020.08.054] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 08/07/2020] [Accepted: 08/24/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Inguinal hernia repair is the most common general surgery operation in the United States. Nearly 80% of inguinal hernia operations are performed under general anesthesia versus 15%-20% using local anesthesia, despite the absence of evidence for the superiority of the former. Although patients aged 65 y and older are expected to benefit from avoiding general anesthesia, this presumed benefit has not been adequately studied. We hypothesized that the benefits of local over general anesthesia for inguinal hernia repair would increase with age. MATERIALS AND METHODS We analyzed 87,794 patients in the American College of Surgeons National Surgical Quality Improvement Project who had elective inguinal hernia repair under local or general anesthesia from 2014 to 2018, and we used propensity scores to adjust for known confounding. We compared postoperative complications, 30-day readmissions, and operative time for patients aged <55 y, 55-64 y, 65-74 y, and ≥75 y. RESULTS Using local rather than general anesthesia was associated with a 0.6% reduction in postoperative complications in patients aged 75+ y (95% CI -0.11 to -1.13) but not in younger patients. Local anesthesia was associated with faster operative time (2.5 min - 4.7 min) in patients <75 y but not in patients aged 75+ y. Readmissions did not differ by anesthesia modality in any age group. Projected national cost savings for greater use of local anesthesia ranged from $9 million to $45 million annually. CONCLUSIONS Surgeons should strongly consider using local anesthesia for inguinal hernia repair in older patients and in younger patients because it is associated with significantly reduced complications and substantial cost savings.
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Affiliation(s)
- Courtney J Balentine
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Surgery, VA North Texas Health Care System, Dallas, Texas
| | - Jennie Meier
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Surgery, VA North Texas Health Care System, Dallas, Texas.
| | - Miles Berger
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Joan Reisch
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Simon C Lee
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Celette Sugg Skinner
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Cynthia J Brown
- Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Care Center, Birmingham, Alabama; Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama; Comprehensive Center for Healthy Aging, University of Alabama at Birmingham, Birmingham, Alabama
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26
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Williams ML, Hutchinson AG, Oh DD, Young CJ. Trends in Australian inguinal hernia repair rates: a 15‐year population study. ANZ J Surg 2020; 90:2242-2247. [DOI: 10.1111/ans.16192] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/28/2020] [Accepted: 07/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Michael L. Williams
- Department of Colorectal Surgery Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - Adam G. Hutchinson
- Department of General Surgery Bendigo Hospital Bendigo Victoria Australia
| | - Daniel D. Oh
- Department of Colorectal Surgery Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - Christopher J. Young
- Department of Colorectal Surgery Royal Prince Alfred Hospital Sydney New South Wales Australia
- Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
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27
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Wu YH, Juan YS, Shen JT, Wang HS, Jhan JH, Lee YC, Geng JH. Lower urinary tract symptoms-Benign prostatic hyperplasia may increase the risk of subsequent inguinal hernia in a Taiwanese population: A nationwide population-Based cohort study. PLoS One 2020; 15:e0234329. [PMID: 32511262 PMCID: PMC7279606 DOI: 10.1371/journal.pone.0234329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/22/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction & objectives It has been suggested that lower urinary tract symptoms—benign prostatic hyperplasia (LUTS-BPH) may be a risk factor for inguinal hernia (IH). The aim of this study was to examine the emergence of a subsequent IH diagnosis in men with and without LUTS-BPH. Methods From a database derived from the National Health Insurance Program covering 99% of the population in Taiwan, 22,310 men with LUTS-BPH and 22,310 matched men without LUTS-BPH were identified and followed for IH from 1997 to 2013. Both IH and LUTS-BPH were defined by the ninth revision of the International Classification of Diseases code (ICD9). Subjects younger than 20 years of age and with IH diagnosed before the index date were excluded. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) for subsequent IH, controlling for potential confounders. Results Men with and without LUTS-BPH had similar age and comorbidity distributions. During the 10 years of follow-up, 1,303 (5.84%) men with LUTS-BPH and 735 (2.53%) men without LUTS-BPH developed IH. The mean time to IH was 4.02 years and 4.44 years, respectively. After adjusting for age and comorbidities, LUTS-BPH was associated with a two-fold increased risk of IH (HR:2.25, 95% CI = 2.04–2.49). Conclusion This nation-wide population-based cohort study showed that LUTS-BPH increased the risk of subsequent IH in a Taiwanese Population.
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Affiliation(s)
- Yi-Hsuan Wu
- Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yung-Shun Juan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Jung-Tsung Shen
- Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
| | - Hsun-Shuan Wang
- Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jhen-Hao Jhan
- Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yung-Chin Lee
- Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jiun-Hung Geng
- Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Kaohsiung Medical University, Kaohsiung, Taiwan
- * E-mail:
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28
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Matsuo M, Tazawa K. Reference range of clinical blood tests in physically independent patients of advanced age with groin hernia in a Japanese hospital. Geriatr Gerontol Int 2019; 19:780-785. [PMID: 31199563 DOI: 10.1111/ggi.13712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/08/2019] [Indexed: 01/21/2023]
Abstract
AIM The present study was carried out to determine the reference ranges of 43 frequently used blood tests in daily practice for physically independent patients of advanced age. METHODS We identified all patients aged ≥20 years who underwent groin hernia repair at Itoigawa General Hospital in Niigata, Japan. The patients' characteristics, preoperative data and prescribed medications were obtained by reviewing the electronic medical records. RESULTS Of 284 patients, 266 with independence in activities of daily life were included in the present study: 72 were assigned to the younger adult group (age 20-64 years), 86 were assigned to the older adult group (age 65-74 years) and 108 were assigned to the advanced age group (age ≥75 years). Patients in the advanced age group had a lower body mass index, less alcohol consumption, more hypertension, lower respiratory function and higher frequency of multidrug therapy. The multiple regression analysis showed significant differences in albumin, gamma-glutamyl transpeptidase, cholinesterase, estimated glomerular filtration rate, uric acid, triglyceride, calcium, phosphate, magnesium and peripheral blood cell counts between the advanced age group and the other two age groups. CONCLUSIONS We identified age-dependent changes in several blood tests among physically independent adults. These results will help to guide accurate interpretation of laboratory results and properly manage patients in geriatric medicine. Geriatr Gerontol Int 2019; 19: 780-785.
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Affiliation(s)
- Mitsuhiro Matsuo
- Department of Internal Medicine, Itoigawa General Hospital, Niigata, Japan
| | - Kenichi Tazawa
- Department of Surgery, Itoigawa General Hospital, Niigata, Japan
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29
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Qin C, Chen J, Shen Y. Individualized tension-free inguinal hernia repair in elderly patients. MINERVA CHIR 2019; 74:275-276. [PMID: 30600964 DOI: 10.23736/s0026-4733.18.07942-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Changfu Qin
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jie Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yingmo Shen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China -
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Watchful Waiting Versus Surgery of Mildly Symptomatic or Asymptomatic Inguinal Hernia in Men Aged 50 Years and Older: A Randomized Controlled Trial. Ann Surg 2017; 267:42-49. [PMID: 28350567 DOI: 10.1097/sla.0000000000002243] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare if watchful waiting is noninferior to elective repair in men aged 50 years and older with mildly symptomatic or asymptomatic inguinal hernia. BACKGROUND The role of watchful waiting in older male patients with mildly symptomatic or asymptomatic inguinal hernia is still not well-established. METHODS In this noninferiority trial, we randomly assigned men aged 50 years and older with mildly symptomatic or asymptomatic inguinal hernia to either elective inguinal hernia repair or watchful waiting. Primary endpoint was the mean difference in a 4-point pain/discomfort score at 24 months of follow-up. Using a 0.20-point difference as a clinically relevant margin, it was hypothesized that watchful waiting was noninferior to elective repair. Secondary endpoints included quality of life, event-free survival, and crossover rates. RESULTS Between January 2006 and August 2012, 528 patients were enrolled, of whom 496 met the inclusion criteria: 234 were assigned to elective repair and 262 to watchful waiting. The mean pain/discomfort score at 24 months was 0.35 [95% confidence interval (CI) 0.28-0.41)] in the elective repair group and 0.58 (95% CI 0.52-0.64) in the watchful waiting group. The difference of these means (MD) was -0.23 (95% CI -0.32 to -0.14). In the watchful waiting group, 93 patients (35·4%) eventually underwent elective surgery and 6 patients (2·3%) received emergent surgery for strangulation/incarceration. Postoperative complication rates and recurrence rates in these 99 operated individuals were comparable with individuals originally assigned to the elective repair group (8.1% vs 15.0%; P = 0.106, 7.1% vs 8.9%; P = 0.668, respectively). CONCLUSIONS Our data could not rule out a relevant difference in favor of elective repair with regard to the primary endpoint. Nevertheless, in view of all other findings, we feel that our results justify watchful waiting as a reasonable alternative compared with surgery in men aged 50 years and older.
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Vad MV, Frost P, Rosenberg J, Andersen JH, Svendsen SW. Inguinal hernia repair among men in relation to occupational mechanical exposures and lifestyle factors: a longitudinal study. Occup Environ Med 2017; 74:769-775. [PMID: 28546321 DOI: 10.1136/oemed-2016-104160] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 04/07/2017] [Accepted: 04/21/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate exposure-response relationships between occupational mechanical exposures and first-time lateral and medial inguinal hernia repair and effects of lifestyle factors. To estimate if occupational mechanical exposures advance the repairs. METHODS This longitudinal study was based on a cohort of men aged 18-65 years with questionnaire data from the Musculoskeletal Research Database at the Danish Ramazzini Centre. We estimated occupational mechanical exposures using a job exposure matrix. First-time inguinal hernia repairs from 1998 to 2014 were identified in the Danish Hernia Database. We used Cox regression analyses and calculated excess fractions among the exposed and rate advancement periods (RAPs). RESULTS Among 17 967 men, we identified 382 lateral and 314 medial repairs. The risk of lateral repairs increased with time spent standing/walking with an HR of 1.45 (95% CI 1.12 to 1.88) for ≥6 hours/day versus <4 hours/day, corresponding to an excess fraction of cases of 31% in the group with ≥6 hours/day. This group had a RAP of 6.7 (95% CI 2.6 to 10.8) years. Medial repairs were not associated with occupational mechanical exposures. A body mass index ≥30 kg/m2 showed lower HRs for both repair types. Leisure-time physical activity and smoking status were not related to any of the outcomes. CONCLUSIONS Assuming a causal relationship, the results suggest that around 30% of all first-time lateral inguinal hernia repairs in the highest exposure category would be preventable if the time spent standing/walking could be reduced from ≥6 to <4 hours/day. The repairs might even be postponed by 6-7 years.
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Affiliation(s)
- Marie Vestergaard Vad
- Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland-University Research Clinic, Herning, Denmark.,Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Poul Frost
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jacob Rosenberg
- Department of Surgical Gastroenterology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Johan Hviid Andersen
- Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland-University Research Clinic, Herning, Denmark
| | - Susanne Wulff Svendsen
- Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland-University Research Clinic, Herning, Denmark
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Tobacco use is not associated with groin hernia repair, a population-based study. Hernia 2017; 21:517-523. [PMID: 28497407 PMCID: PMC5517591 DOI: 10.1007/s10029-017-1617-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 04/14/2017] [Indexed: 12/16/2022]
Abstract
Purpose The pathogenesis of groin hernia is not fully understood and some suggested risk factors are debatable. This population-based study evaluates the association between groin hernia repair and tobacco use. Method An observational study based on register linkage between the Swedish Hernia Register and the Västerbotten Intervention Program (VIP). All primary groin hernia repairs performed from 2001 to 2013 in the county of Västerbotten, Sweden, were included. Results VIP provided data on the use of tobacco in 102,857 individuals. Neither smoking nor the use of snus, increased the risk for requiring a groin hernia repair. On the contrary, heavy smoking decreased the risk for men, HR 0.75 (95% CI 0.58–0.96), as did having a BMI over 30 kg/m2 HR (men) 0.33 (95% CI 0.27–0.40). Conclusion Tobacco use is not a risk factor for requiring a groin hernia repair, whereas having a low BMI significantly increases the risk.
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Razavi SS, Peyvandi H, Badrkhani Jam AR, Safari F, Teymourian H, Mohajerani SA. Magnesium Versus Bupivacaine Infiltration in Controlling Postoperative Pain in Inguinal Hernia Repair. Anesth Pain Med 2015; 5:e30643. [PMID: 26705525 PMCID: PMC4688822 DOI: 10.5812/aapm.30643] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 09/02/2015] [Accepted: 09/22/2015] [Indexed: 11/18/2022] Open
Abstract
Background: Postoperative pain is one of the most common problems after hernia repair. Decrease in postoperative pain accelerates functional recovery, decreases duration of hospital stay and postoperative morbidity. Objectives: To compare postoperative analgesic effect of infiltration of magnesium versus bupivacaine into incision of inguinal hernia repair. Patients and Methods: In a double blind clinical trial, 80 patients’ candidates for elective inguinal hernia repair were enrolled. Right before closure of incision, in Bupivacaine group 5 mL Bupivacaine 0.5% added to 5 mL normal saline and in Magnesium group, 10 mL Magnesium sulfate 20% was infused subcutaneously. Pain score was measured using numeric rating score (NRS) at 1, 3, 6, 12 and 24 hours postoperatively. If NRS was above 3, 1 mg morphine was administered as rescue analgesic until patient felt comfortable or NRS < 3. Results: Postoperative pain scores at 1 and 3 hours were not significantly different between bupivacaine and magnesium groups (P = 0.21, 0.224; respectively). However, at 6 (P = 0.003), 12 (P = 0.028) and 24 (P = 0.022) hours postoperative, pain score (NRS) was significantly lower in bupivacaine group. Number of patients needed at least 1 dose of rescue morphine (P = 0.001), mean number of episodes asked for morphine during next 24 hours (P = 0.001) and total dose of morphine requirement (P = 0.01) were significantly lower in bupivacaine group. Conclusions: Magnesium infiltration did not decrease total dose and number of episodes needed for morphine rescue analgesic. Bupivacaine infiltration into surgical site was more effective than magnesium sulfate infiltration in postoperative pain control.
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Affiliation(s)
- Seyed Sajad Razavi
- Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hasan Peyvandi
- Department of Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Reza Badrkhani Jam
- Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Safari
- Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Houman Teymourian
- Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding author: Houman Teymourian, Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Tel/Fax: +98-2122343657, E-mail:
| | - Seyed Amir Mohajerani
- Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Mourmouris P, Argun OB, Tufek I, Obek C, Skolarikos A, Tuna MB, Keskin S, Kural AR. Nonprosthetic Direct Inguinal Hernia Repair During Robotic Radical Prostatectomy. J Endourol 2015; 30:218-22. [PMID: 26486884 DOI: 10.1089/end.2015.0556] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To report our experience with concomitant hernia repair during robot-assisted radical prostatectomy (RARP) with a nonprosthetic and tissue-based technique. METHODS We conducted a retrospective review on 1005 consecutive patients who underwent RARP between the years 2005 and 2015. Twenty-nine patients, who underwent 37, concurrent, direct, inguinal hernia repairs, were identified (group 1) and compared to a match control group of 29 patients who underwent RARP without hernia repair (group 2). Cases were matched 1:1 for age, body-mass index, and pathologic stage. The reinforcement of the floor was achieved with a modified posterior wall darn repair. The repair consisted of suturing the lateral edge of the rectus abdominis muscle sheath to the ileopectineal ligament (Cooper's ligament) with continuous prolene loose suture. This technique provided a tissue-based repair and the final reinforcement of the floor was expected to ensue by the secondary fibrotic tissue development and maturing between the sutures. RESULTS From a total of 1005 patients who underwent RARP, 29 (2.8%) were preoperatively identified with a primary, direct inguinal hernia and underwent concomitant inguinal herniorrhaphy. The operative time was 147 minutes for group 1 vs 143 minutes for group 2 (p = 0.8). Estimated blood loss was 175 mL for the group with the hernia repair vs 200 mL for the group without repair (p = 0.3). There were no Clavien-Dindo grade >1 complications observed in either of the groups. Mean follow-up period was 32.1 months for group 1 vs 33.3 for group 2 (p = 0.8). Importantly, no hernia recurrences were observed. CONCLUSIONS Inguinal hernias represent an important surgical issue and may be repaired concurrently during radical prostatectomy to minimize the risks of postoperative complications. The concomitant repair of inguinal hernias during robotic radical prostatectomy utilizing a nonprosthetic is a safe and feasible alternative for primary direct hernia repair during prostatectomy.
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Affiliation(s)
- Panagiotis Mourmouris
- 1 Department of Urology, Acibadem Maslak Hospital, Acibadem University , Istanbul, Turkey
| | - Omer Burak Argun
- 1 Department of Urology, Acibadem Maslak Hospital, Acibadem University , Istanbul, Turkey
| | - Ilter Tufek
- 1 Department of Urology, Acibadem Maslak Hospital, Acibadem University , Istanbul, Turkey
| | - Can Obek
- 2 Department of Urology, Cerrahpasa School of Medicine, University of Istanbul , Istanbul, Turkey
| | - Andreas Skolarikos
- 3 2nd Urology Department, Athens Medical School, Sismanogleio General Hospital, University of Athens , Athens, Greece
| | | | - Selcuk Keskin
- 1 Department of Urology, Acibadem Maslak Hospital, Acibadem University , Istanbul, Turkey
| | - Ali Riza Kural
- 1 Department of Urology, Acibadem Maslak Hospital, Acibadem University , Istanbul, Turkey
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Celik O, Akand M, Ekin G, Duman I, Ilbey YO, Erdogru T. Laparoscopic Radical Prostatectomy Alone or With Laparoscopic Herniorrhaphy. JSLS 2015; 19:e2015.00090. [PMID: 26941545 PMCID: PMC4756355 DOI: 10.4293/jsls.2015.00090] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Prostate cancer and inguinal hernia are common health issues in men aged more than 50 years. Recently, more data are accumulating that laparoscopic radical prostatectomy (LRP) and laparoscopic inguinal hernia repair (LIHR) can be performed in the same operation. The purpose of this study was to compare patients who underwent simultaneous extraperitoneal LRP (E-LRP) and LIHR with control patients who underwent only E-LRP in a matched-pairs design. METHODS Medical records of 215 patients were evaluated, and 20 patients who underwent E-LRP+LIHR were compared with 40 patients who underwent only E-LRP in a matched-pairs analysis. Preoperative clinical parameters (age, body mass index, prostate-specific antigen, clinical stage, Gleason score of the prostate biopsy, and prostate volume) and operative data (operation time, duration of catheterization, length of hospital stay, estimated blood loss, time to perform the anastomosis and its quality, and the percentage of patients with bilateral lymphadenectomy) were evaluated, as well as postoperative parameters (pathological stage, Gleason score, specimen weight, follow-up duration, biochemical recurrence, complication rates, and duration of postoperative analgesic treatment). RESULTS No statistically significant differences were found in the preoperative and operative parameters between the 2 study groups. Pathological parameters and the follow-up period and complication rates were similar between the 2 groups. CONCLUSION Performing LIHR and E-LRP during the same operation is safe and feasible in the treatment of patients with prostate cancer and inguinal hernia.
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Affiliation(s)
- Orcun Celik
- Department of Urology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Murat Akand
- Department of Urology, Selcuk University, School of Medicine, Konya, Turkey
| | - Gokhan Ekin
- Department of Urology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Ibrahim Duman
- Department of Urology, Medical Park Antalya Hospital, Antalya, Turkey
| | - Yusuf Ozlem Ilbey
- Department of Urology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Tibet Erdogru
- Minimally Invasive Urology and Robotics Center, Department of Urology, Memorial Atasehir Hospital, Istanbul, Turkey
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Traoré D, Diarra L, Coulibaly B, Bengaly B, Togola B, Traoré A, Traoré H, Ongoïba N, Sissoko F, Koumaré AK. [Inguinal hernia in sub-Saharan Africa: what role for Shouldice technique?]. Pan Afr Med J 2015; 22:50. [PMID: 26664551 PMCID: PMC4662532 DOI: 10.11604/pamj.2015.22.50.6803] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 08/19/2015] [Indexed: 11/29/2022] Open
Abstract
L'objectif était d’étudier l'aspect épidémio-clinique et thérapeutique de la hernie inguinale selon la technique de Shouldice. Nous avons réalisé une étude rétrospective, portant sur les patients opérés pour hernie inguinale selon la technique de Shouldice dans le service de chirurgie B du CHU du Point G, Bamako, Mali. Il a été enregistré 225patients opérés selon la technique de Shouldice. L’âge moyen était de 49 ans +/- 17,7. Il y avait 90,7% (204) hommes soit un sex-ratio de 9,7. Les cultivateurs, les ménagères et les ouvriers ont représenté 51,1% (115). Dans 75,2% (169) les patients ont consulté pour tuméfaction inguinale. En pré opératoire, la hernie était compliquée chez 82 (36,4%) patients dont 24 cas de récidive. L’étranglement herniaire a été la principale complication pré opératoire 58,5% (48/82). Les suites opératoires à un an ont été simples chez 94,2%(210) des patients; elles étaient marquées par 8 cas de récidive, 4 cas de névralgie, 2 cas d'atrophie testiculaire, 1 cas de chéloïde. La technique de Shouldice est la technique de choix pour la cure de la hernie inguinale dans les pays en voie de développement à cause du bon résultat et son coût peu onéreux par rapport aux autres techniques utilisant des dispositifs médicaux.
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Affiliation(s)
- Drissa Traoré
- Faculté de Médecine et d'Odonto Stomatologie de Bamako, Mali ; Institut Africain de Formation en Pédagogie, Recherche et Evaluation en Sciences de la Santé (IAFPRESS) Bamako, Mali ; Service de Chirurgie B CHU du Point G, Mali
| | | | - Bréhima Coulibaly
- Faculté de Médecine et d'Odonto Stomatologie de Bamako, Mali ; Institut Africain de Formation en Pédagogie, Recherche et Evaluation en Sciences de la Santé (IAFPRESS) Bamako, Mali ; Service de Chirurgie B CHU du Point G, Mali
| | | | - Birama Togola
- Faculté de Médecine et d'Odonto Stomatologie de Bamako, Mali ; Service de Chirurgie B CHU du Point G, Mali
| | | | | | - Nouhoum Ongoïba
- Faculté de Médecine et d'Odonto Stomatologie de Bamako, Mali ; Service de Chirurgie B CHU du Point G, Mali
| | - Filifing Sissoko
- Faculté de Médecine et d'Odonto Stomatologie de Bamako, Mali ; Service de Chirurgie B CHU du Point G, Mali
| | - Abdel Karim Koumaré
- Faculté de Médecine et d'Odonto Stomatologie de Bamako, Mali ; Institut Africain de Formation en Pédagogie, Recherche et Evaluation en Sciences de la Santé (IAFPRESS) Bamako, Mali ; Service de Chirurgie B CHU du Point G, Mali
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