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Miller BT, Scheman J, Petro CC, Beffa LRA, Prabhu AS, Rosen MJ, Krpata DM. Psychological disorders in patients with chronic postoperative inguinal pain. Hernia 2023; 27:35-40. [PMID: 35960385 DOI: 10.1007/s10029-022-02662-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/30/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Chronic postoperative inguinal pain (CPIP), a complication of inguinal hernia repair, may negatively affect mental health. The rates of psychological disorders in patients with CPIP are unknown. We aimed to describe the prevalence of psychological disorders coinciding with CPIP. METHODS A retrospective chart review was performed of all patients seen at the Cleveland Clinic Center for Abdominal Core Health's inter-disciplinary Chronic Groin Pain Clinic. This clinic is unique in that all patients are evaluated by a surgeon, a sonographer and radiologist, and a behavioral medicine psychologist. Patient psychological history and treatment, Depression Anxiety and Stress Scale (DASS) scores, pain catastrophizing, and trauma or abuse history were captured. RESULTS From January 2018 to January 2022, 61 patients were evaluated and included in the study. Psychological treatment had been provided to 37 (61%) patients (present: 16 (27%), past: 21 (35%)). The most common psychological disorders represented were depression (N = 13, 22%), anxiety (N = 10, 17%), and post-traumatic stress disorder (N = 5, 8%). DASS scores indicated that 20 (33%) patients were reporting symptoms of depression and 16 (27%) patients were reporting symptoms of anxiety. Of the 40 patients assessed for pain catastrophizing, 28 (70%) reported rumination, 9 (23%) reported magnification, and 23 (58%) reported feelings of helplessness. A childhood history of emotional or physical abuse was reported by 11 (18%) patients. CONCLUSION An inter-disciplinary groin pain clinic has revealed that patients with CPIP frequently have pre-existing complex psychosocial issues. A multi-specialty approach to CPIP may improve preoperative assessments and identify patients who may benefit from further psychological evaluation and treatment.
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Affiliation(s)
- B T Miller
- Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - J Scheman
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - C C Petro
- Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - L R A Beffa
- Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - A S Prabhu
- Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - M J Rosen
- Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - D M Krpata
- Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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2
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Gram-Hanssen A, Öberg S, Rosenberg J. A Critical Appraisal of the Chronic Pain Rate After Inguinal Hernia Repair. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2023; 2:10972. [PMID: 38312409 PMCID: PMC10831660 DOI: 10.3389/jaws.2023.10972] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/10/2023] [Indexed: 02/06/2024]
Abstract
Purpose: To critically appraise highly cited studies reporting on the rate of chronic pain after inguinal hernia repair. Methods: Google Scholar was searched on 23 May 2022. We only included publications with more than 10 citations per year since publication and more than 100 citations in total. Both reports of original data and systematic reviews were included. Risk of bias and quality of the included studies were assessed with either the Joanna Briggs Institute Checklist for Prevalence Studies or the AMSTAR 2 depending on study design. Results: Twenty studies were included and evaluated. The rate of chronic postoperative inguinal pain of any degree ranged from 10%-63%, and the rate of moderate-to-severe pain ranged from 1%-18%. All studies reported the rate of pain of any degree, and most studies reported the rate of moderate-to-severe pain influencing daily activities. Studies used different temporal definitions of chronic pain, but most studies defined it as pain persisting either three or six months postoperatively. Ten studies used unvalidated questionnaires or significantly modified versions of validated questionnaires. Eleven studies primarily included patients receiving open repair. Included studies had median 21 citations per year (range 10-39) and median 387 citations in total (range 127-788). Conclusion: The rates of chronic postoperative inguinal pain reported in the included highly cited studies are possibly inaccurate, excessive, and outdated. New prospective studies based on uniform definitions and standards of measurement are warranted to better assess a contemporary chronic pain rate after inguinal hernia repair.
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Affiliation(s)
- Anders Gram-Hanssen
- Center for Perioperative Optimization, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark
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3
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Barta B, Dumitraș M, Bucur Ș, Giuroiu C, Zlotea R, Constantin MM, Mădan V, Constantin T, Iorga CR. Extraperitoneal Laparoscopic Approach in Inguinal Hernia—The Ideal Solution? J Clin Med 2022; 11:jcm11195652. [PMID: 36233517 PMCID: PMC9573553 DOI: 10.3390/jcm11195652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/16/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background: After more than 20 years since laparoscopy was proposed as a solution for one of the most common surgical pathologies, inguinal hernia, the choice of an intra- or extraperitoneal approach has remained a highly debated topic. Purpose and objectives: This study aimed at analyzing the feasibility of the extraperitoneal approach, by routine for this team/ and answering the question of whether this type of approach can be considered a safe one. Although indications for an intra- or extraperitoneal approach largely overlap, it may also be a matter of surgeon preference in choosing one technique. Methods: The study was retrospective, conducted on a group of 493 patients operated on for inguinal hernia in the clinic, by a single operating team, between January 2012 and March 2022. Results: It was proven that out of the 493 surgeries for inguinal hernia, 95.1% (n = 469) were operated upon by laparoscopic TEP (total extra peritoneal patch plasty approach); 1.62% (n = 8) by laparoscopic TAPP (transabdominal intraperitoneal); and 3.24% (n = 16) by the open, anterior approach (Lichtenstein). There were no intraoperative complications recorded in any of the procedures, while postoperative complications were found in 10.23% of cases (n = 48) in the extraperitoneal approach, and recurrences after the TEP approach were recorded in 0.40% of cases (n = 2). Conclusions: For correctly selected cases, TEP hernia surgery can be considered a safe and reliable approach.
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Affiliation(s)
- Bogdan Barta
- General Surgery Clinic, Euroclinic Regina Maria Hospital, 070000 Bucharest, Romania
| | - Marina Dumitraș
- General Surgery Clinic, Euroclinic Regina Maria Hospital, 070000 Bucharest, Romania
- Correspondence: (M.D.); (Ș.B.)
| | - Ștefana Bucur
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- 2nd Department of Dermatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
- Correspondence: (M.D.); (Ș.B.)
| | - Camelia Giuroiu
- General Surgery Clinic, Euroclinic Regina Maria Hospital, 070000 Bucharest, Romania
| | - Raluca Zlotea
- General Surgery Clinic, Euroclinic Regina Maria Hospital, 070000 Bucharest, Romania
| | - Maria-Magdalena Constantin
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- 2nd Department of Dermatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Victor Mădan
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Urology, Emergency University Central Military Hospital, 010825 Bucharest, Romania
| | - Traian Constantin
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Urology, “Prof. Dr. Th. Burghele” Hospital, 050652 Bucharest, Romania
| | - Cristina Raluca Iorga
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Surgery Clinic, “Dr. Carol Davila” Clinical Nephrology Hospital, 010731 Bucharest, Romania
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Hidalgo NJ, Bachero I, Hoyuela C, Juvany M, Ardid J, Martrat A, Guillaumes S. The transition from open to laparoscopic surgery for bilateral inguinal hernia repair: how we did it. Langenbecks Arch Surg 2022; 407:3701-3710. [PMID: 36070031 DOI: 10.1007/s00423-022-02671-w] [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: 03/15/2022] [Accepted: 08/29/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To describe the transition process from open repair (OR) to laparoscopic repair (LR) of bilateral inguinal hernia in a small basic general hospital METHODS: We describe the technical details and training strategy used to facilitate the transition to systematic LR of bilateral inguinal hernia. We conducted a retrospective analysis of prospectively collected data from all patients undergoing bilateral inguinal hernia repair between January 2017 and December 2020. We analysed the evolution of LR and compared the surgical outcomes: complications, acute pain (24 h), chronic pain (> 3 months), and recurrence (1 year) of the patients operated on by OR and LR. RESULTS We performed 132 bilateral inguinal hernia repairs, 55 (41.7%) ORs, and 77 (58.3%) LRs. A significant difference was observed in the choice of LR over time (2017: 9%, 2018: 32%, 2019: 75%, 2020: 91%, p < 0.001). The mean operative time was shorter in the OR group than in the LR group (56 min vs. 108 min, p < 0.001). However, the operative time of the LR decreased over the years. No significant differences were observed in complications or recurrence. LR was associated with lower acute postoperative pain at 24 h (2.2 vs. 3.1 points, p = 0.021) and lower chronic groin pain than OR (1.3% vs. 12.7%, p = 0.009). CONCLUSION A structured and systematized training process made the transition from OR to LR of bilateral inguinal hernias feasible and safe in a small basic general hospital. This transition did not increase complications or recurrence. Additionally, LR was associated with a decrease in postoperative pain and chronic groin pain.
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Affiliation(s)
- Nils Jimmy Hidalgo
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain.
| | - Irene Bachero
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain
- Universitat Internacional de Catalunya, Barcelona, Spain
| | - Carlos Hoyuela
- Department of Surgery, Hospital de Mollet, Mollet, Spain
| | - Montserrat Juvany
- Department of Surgery, Hospital General Granollers, Granollers, Spain
| | - Jordi Ardid
- Department of General and Digestive Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, Barcelona, Spain
| | - Antoni Martrat
- Department of General and Digestive Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, Barcelona, Spain
| | - Salvador Guillaumes
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, C. de Villarroel, 170, 08036, Barcelona, Spain
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Shah MY, Raut P, Wilkinson T, Agrawal V. Surgical outcomes of laparoscopic total extraperitoneal (TEP) inguinal hernia repair compared with Lichtenstein tension-free open mesh inguinal hernia repair: A prospective randomized study. Medicine (Baltimore) 2022; 101:e29746. [PMID: 35777031 PMCID: PMC9239617 DOI: 10.1097/md.0000000000029746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Inguinal hernia repair is one of the most frequently performed surgery. The ideal procedure for inguinal hernia repair remains controversial. Open Lichtenstein tension-free mesh repair (LMR) is one of the most preferred open techniques with satisfactory outcomes. Laparoscopic approach in inguinal hernia surgery remains controversial, especially in comparison with open procedures. In this study, we have reported a comparison of laparoscopic total extraperitoneal (TEP) inguinal hernia repair with LMR. Postoperative pain, operative time, complications like seroma, wound infection, chronic groin pain, and recurrence rate were parameters to evaluate the outcome. One hundred seventy-four patients were included in the study by consecutive randomized prospective sampling. The patients were divided into 2 groups: group A, laparoscopic TEP inguinal hernia repair, and group B, LMR. The procedures were performed by experienced surgeons. The primary outcomes were evaluated based on postoperative pain and recurrence rate. Secondary outcomes considered for evaluation were operative time, complications like seroma, infection, and chronic groin pain. Severe pain was reported in group A (7.9%) compared to group B (15.1%), which was statistically significant (P < .001). Moderate pain was reported more in group B (70.9%) compared to group A (29.5%) (P < .001). The mean operative time in group A was 84.6 ± 32.2, which was significantly higher than that in group B, 59.2 ± 14.8. There was no major complication in both groups. The chronic pain postoperatively was significantly in higher number of patients in group B vs group A (22.09% vs 3.4%). The postoperative hospital stay period was significantly lesser for group A vs for group B (2.68 ± 1.52 vs 3.86 ± 6.16). Time duration taken to resume normal activities was significantly lower in group A (13.6 ± 6.8) vs (19.8 ± 4.6) in group B (P < .001). Although there is definite evidence of longer operative time and learning curve, laparoscopic TEP has added advantages like less postoperative pain, early resumption of normal activities, less chronic groin pain, and comparable recurrence rate compared to open Lichtenstein repair. Laparoscopic TEP can be performed with acceptable outcomes and less postoperative complications if performed by experienced hands.
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Affiliation(s)
- Mohammed Yunus Shah
- Department of Minimal Access, Bariatric and General Surgery, Al Ahli Hospital, Qatar University, Doha, Qatar
- *Correspondence: Mohammed Yunus Shah, Department of Minimal Access, Bariatric and General Surgery, Al Ahli Hospital, Qatar University, P.O Box 6401, Doha, Qatar (e-mail: )
| | - Pratik Raut
- Maharashtra University of Health Sciences, Maharashtra, India
| | - T.R.V. Wilkinson
- Department of Surgery, NKP Salve Medical College and Research Centre, Nagpur, Maharashtra, India
| | - Vijay Agrawal
- Maharashtra University of Health Sciences, Maharashtra, India
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Bara BK, Mohanty SK, Behera SN, Sahoo AK, Agasti S, Patnaik S, Swain SK. Role of Neurectomy in Inguinodynia Following Hernioplasty: A Randomized Controlled Trial. Cureus 2021; 13:e20306. [PMID: 35024257 PMCID: PMC8742623 DOI: 10.7759/cureus.20306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction To date, Lichtenstein tension-free mesh hernioplasty is being adopted widely for inguinal hernia repair in adults, although it is accompanied by procedural complications such as recurrences, infection, testicular atrophy, post-operative pain, and nerve injury. As the recurrence rate decreased after Lichtenstein's tension-free hernioplasty, surgeons’ point of focus shifted more toward postoperative groin pain (inguinodynia) after inguinal hernia repair, as it has become a quite significant problem. The nerves of interest in the inguinal region are ilioinguinal, iliohypogastric, genitofemoral, and lateral femoral cutaneous nerves. Out of all the nerves, the ilioinguinal nerve is at the greatest risk of entrapment during meshplasty. Chronic groin pain is quite significant following hernia repair, and irrespective of the severity, it can interfere with normal daily activity. The traditional surgical technique recommends the preservation of the ilioinguinal nerve to avoid the morbidity associated with the cutaneous sensory loss supplied by the nerve. One popular belief is that if we excise the ilioinguinal nerve, then the chance of getting post-operative neuralgia due to entrapment, inflammation, neuroma, or fibrotic reactions will almost become zero. Hence, this study was conducted to evaluate the effect of prophylactic excision of the ilioinguinal nerve in the patients undergoing Lichtenstein hernioplasty for inguinal hernias. Methods All consecutive male patients presenting to the Department of Surgery with inguinal hernia and age above 18 years were included in the study. All the patients were operated on under spinal anesthesia. Lichtenstein tension-free hernia repair was taken as the standard procedure for hernia repair. Patients in whom the nerve was preserved were kept in group A, whereas group B comprised patients who had undergone neurectomy. Patients were followed up regarding pain at first, third, and sixth months, at rest, and after exercise. The pain was graded according to the VAS (visual analog scale) scoring. Results In the present study, out of a total of 92 patients, 80 patients were included. In the first month, 15% of the patients in group A had mild pain, while 5% in group B had experienced a moderate degree of pain at rest. After exercise, the result was 30% in group B. Similarly, in the third month of follow-up, it was found that 25% of the patients in group A experienced mild pain, while 12.5% complained about a moderate degree of pain who had to take analgesics for a longer period. After putting them to exercise and then grading the pain, it was found that 32.5% in group A and 15% in group B experienced pain. After follow-up for six months in both groups, it was revealed that there was no significant difference in post-operative pain at rest (10% and 7.5% in groups A and B, respectively). After exercise, 20% of patients in group A complained of pain, while in group B, only 10% experienced pain. There was no significant difference between both the groups while comparing chronic groin pain at rest and after exercise, and after different time intervals in follow-up (p = 0.4513 and 0.548, respectively). Conclusion Prophylactic excision of the ilioinguinal nerve in Lichtenstein tension-free meshplasty decreased the incidence of chronic groin pain after surgery but it was statistically insignificant. Furthermore, this procedure did not affect the quality of life after surgery.
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Nizam S, Saxena N, Yelamanchi R, Sana S, Kardam D. Mesh fixation with fibrin glue versus tacker in laparoscopic totally extraperitoneal inguinal hernia repair. ANZ J Surg 2021; 91:2086-2090. [PMID: 34448342 DOI: 10.1111/ans.17165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The advent of mesh was a breakthrough in the field of hernia surgery. Mechanical methods of mesh fixation are hypothesized to cause more tissue trauma than nonmechanical methods. The present study was conducted to study the outcomes of mesh fixation using fibrin glue, a nonmechanical method versus tackers in totally extraperitoneal repair (TEP) of unilateral inguinal hernia. METHODS A randomized controlled single blinded study was conducted in India from June 2017 to March 2019. Patients diagnosed with unilateral uncomplicated inguinal hernia with a hernial sac of size not more than 5 cm were invited to participate in the study. Sample size was 60 patients randomized into groups just before mesh fixation. In group A mesh was fixed using tackers while in group B mesh was fixed using fibrin glue. Patients were followed-up prospectively for 3 months. RESULTS There was no statistical difference between the two groups with respect to operating time. Average hospital stay and pain scores at all follow-ups were better for fibrin glue group. There was no difference in the incidence of postoperative urinary retention, seroma formation and hematoma formation between the two groups. Patients of fibrin glue group had early restart of daily activities at 15 days follow-up when compared to tacker group. CONCLUSION Fibrin glue fixation technique should be advocated over tackers for mesh fixation in TEP considering the better outcomes and cost-effectiveness of the technique.
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Affiliation(s)
- Saifullah Nizam
- Department of Surgery, PGIMER and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Neeraj Saxena
- Department of Surgery, PGIMER and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Raghav Yelamanchi
- Department of Surgery, PGIMER and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Sana Sana
- Department of Radio Diagnosis, PGIMER and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Dinesh Kardam
- Department of Surgery, PGIMER and Dr. Ram Manohar Lohia Hospital, New Delhi, India
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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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Safety and efficacy in inguinal hernia repair: a retrospective study comparing TREPP, TEP and Lichtenstein (SETTLE). Hernia 2021; 25:1309-1315. [PMID: 33400030 DOI: 10.1007/s10029-020-02361-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND This pilot trial investigates whether the trans rectus sheath extra-peritoneal (TREPP) mesh repair is a safe and effective procedure compared to the currently most performed inguinal hernia repair techniques TEP and Lichtenstein. METHODS Three hundred patients older than 18 years with unilateral inguinal hernia were included in this retrospective cohort study, of which 58 (19.3%) underwent TREPP, 190 (63.3%) TEP and 52 (17.3%) Lichtenstein. The primary outcome of this study was inguinal hernia recurrence rate within 1 year after surgery. Secondary objectives were chronic post-operative inguinal pain (CPIP) lasting more than 6 months, (major) complication rates and operating time. RESULTS Recurrence rate within 1-year post-operative was low overall in the study population and did not differ significantly between TREPP, TEP and Lichtenstein, respectively 1.7, 2.1, 0.0% (P = 0.591). The rate of CPIP for which the patient contacted the hospital was similar in the study groups: TREPP: 1.7%; TEP: 1.6%; Lichtenstein: 1.9%; (P = 0.591). The mean operating time in minutes (SD) was significantly shorter in the TREPP group compared with the two other patient groups (TREPP: 22.2 (± 5.7); TEP: 38.7 (± 14.8); Lichtenstein: 49.3 (± 17.1), P < 0.001). No major complications occurred in any patient of the study groups. CONCLUSION TREPP seems to be an effective and safe technique for unilateral primary inguinal hernia repair. It is found to be comparable to TEP and Lichtenstein in terms of recurrence rates, chronic post-operative inguinal pain, and clinically significant adverse events. This pilot study proves the need for future research into the TREPP technique.
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Roisman S, Dotan AL, Lewitus DY. Polycaprolactone‐based hotmelt adhesive for
hernia‐mesh
fixation. POLYM ADVAN TECHNOL 2020. [DOI: 10.1002/pat.5044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Sabrina Roisman
- Department of Polymer Materials Engineering Shenkar College Ramat‐Gan Israel
| | - Ana L. Dotan
- Department of Polymer Materials Engineering Shenkar College Ramat‐Gan Israel
| | - Dan Y. Lewitus
- Department of Polymer Materials Engineering Shenkar College Ramat‐Gan Israel
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Santos CMT, Pereira CU, Chaves PHS, Tôrres PTRDL, Oliveira DMDP, Rabelo NN. Options to manage postcraniotomy acute pain in neurosurgery: no protocol available. Br J Neurosurg 2020; 35:84-91. [PMID: 32966104 DOI: 10.1080/02688697.2020.1817852] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The physical processes of incision, traction and hemostasis used for craniotomy, stimulate nerve fibers and specific nociceptors, resulting in postoperative pain. During the first 24 h after craniotomy, 87% of patients have postoperatory pain. The rate of suffering pain after craniotomy falls 3% for every year of life. The objective of this study is to review the available therapeutic options to help physicians treating this pain, and discuss pain mechanisms, pathophysiology, plasticity, risk factors and psychological factors. This is a narrative review of the literature from 1970 to June 2019. Data were collected by doing a search in PubMed, EMBASE, Cochrane Reviews and a manual search of all relevant literature references. The literature includes some drugs treatment: Opioids, codeine, morphine, and tramadol, anti-inflammatory non-steroids such as cyclooxygenase-2 inhibitors, gabapentin. It discusses: side effects, pharmacodynamics and indications of each drug, anatomy and Inervation of Skull and its Linigs, pathogenesis of pain Post-craniotomy, scalp nerve block, surgical nerve injury, neuronal plasticity, surgical factors and chronic post-surgical pain.
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A Randomized Controlled Trial Comparing Short-term Outcomes of Self-Gripping (Progrip) Mesh Versus Fibrin Sealant in Laparoscopic Total Extraperitoneal Hernioplasty. Surg Laparosc Endosc Percutan Tech 2020; 30:203-208. [DOI: 10.1097/sle.0000000000000756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Breast cancer is one of the most commonly diagnosed cancers among women, and since the prognosis of breast cancer has substantially improved in past decades, complications of management are becoming increasingly apparent. Persistent pain lasting greater than 3 months after breast cancer surgery is unfortunately a common complication affecting approximately 30% of patients after tumour resection. Persistent breast cancer pain has neuropathic features and is typically mild-to-moderate in intensity, with approximately 10% suffering from severe pain. There is an increasing need to prevent persistent pain through the use of transitional pain programmes and perioperative interventions, and to identify novel treatment modalities to reduce suffering in those who unfortunately develop persistent pain. This review serves to provide an overview on persistent pain after breast cancer surgery, its pathophysiology, and current management strategies.
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Mathes T, Pape-Köhler C, Moerders L, Lux E, Neugebauer EAM. External Validation and Update of the RICP-A Multivariate Model to Predict Chronic Postoperative Pain. PAIN MEDICINE 2019; 19:1674-1682. [PMID: 29121211 DOI: 10.1093/pm/pnx242] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective The development of chronic postsurgical pain (CPSP) is influenced by several factors. The risk index for chronic pain (RICP) was developed to identify patients at high risk for CPSP. The aim of this study was the external validation and update of the RICP. Design Prospective cohort study. Setting Two German hospitals. Subjects Participants who underwent orthopedic surgery, general surgery, visceral surgery, and neurosurgery. Methods The predicted outcome was CPSP at six months. We validated the original RICP externally and performed a model update. Analysis was performed using logistic regression. We analyzed the discrimination and calibration of the model. Furthermore, the updated model was internally validated. Results We included 205 patients. The mean age of participants was 51 years. CPSP was reported by 53.9% of participants. In our population, the original RICP (preoperative pain in the operating field, other preoperative pain, postoperative acute pain, capacity overload, and comorbid stress symptoms) showed a sensitivity of 0.708 and a specificity of 0.727 (area under the curve [AUC] = 0.766, 95% confidence interval [CI] = 0.688-0.843). The updated RICP (preoperative pain in the operating field, other preoperative pain, postoperative acute pain, sex, marital status) yielded a sensitivity of 0.746 and a specificity of 0.726 (AUC = 0.813, 95% CI = 0.740-0.886). The results were confirmed by cross-validation. Pre- and postoperative pain measures showed the highest predictive ability. Discussion The study indicates external validity of the original RICP. The updated RICP also showed good predictive ability. The results are limited by the small sample size and the amount of missing outcome data.
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Affiliation(s)
- Tim Mathes
- Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany
| | | | - Lena Moerders
- Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany
| | - Eberhard Lux
- Department for Anesthesiology and Intensive Care Medicine, Lünen, Germany
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Yimer H, Woldie H. Incidence and Associated Factors of Chronic Pain After Caesarean Section: A Systematic Review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:840-854. [DOI: 10.1016/j.jogc.2018.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 04/05/2018] [Accepted: 04/09/2018] [Indexed: 10/28/2022]
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16
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Karahan AY, Sevinç B, Demirgül R, Senalp E, Turan E, Doğru O, Karahan Ö. Effects of inguinal hernia repair on trunk muscle strength, quality of life, and neuropathic pain1. ISOKINET EXERC SCI 2019. [DOI: 10.3233/ies-192102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ali Yavuz Karahan
- Department of Physical Medicine and Rehabilitation, Usak University Medical School, Usak, Turkey
| | - Barış Sevinç
- Department of General Surgery, Usak University Medical School, Usak, Turkey
| | - Recep Demirgül
- Department of General Surgery, Karapınar State Hospital, Konya, Turkey
| | - Engin Senalp
- Department of Physical Medicine and Rehabilitation, Karaman State Hospital, Karaman, Turkey
| | - Ersin Turan
- Department of General Surgery, Karapınar State Hospital, Konya, Turkey
| | - Osman Doğru
- Department of General Surgery, Konya Training and Research Hospital, Konya, Turkey
| | - Ömer Karahan
- Department of General Surgery, Usak University Medical School, Usak, Turkey
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17
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The Short-Form Inguinal Pain Questionnaire (sf-IPQ): An Instrument for Rating Groin Pain After Inguinal Hernia Surgery in Daily Clinical Practice. World J Surg 2018; 43:806-811. [DOI: 10.1007/s00268-018-4863-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Althaus A, Arránz Becker O, Moser KH, Lux EA, Weber F, Neugebauer E, Simanski C. Postoperative Pain Trajectories and Pain Chronification—an Empirical Typology of Pain Patients. PAIN MEDICINE 2018; 19:2536-2545. [DOI: 10.1093/pm/pny099] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Astrid Althaus
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Cologne, Cologne, Germany
| | | | - Karl-Heinz Moser
- Centre for Ambulant Surgery, Cologne-Merheim Medical Center (CMMC), Cologne, Germany
| | - Eberhard Albert Lux
- Hospital for Pain and Palliative Medicine, Klinikum St-Marien-Hospital, Amberg, Germany
| | | | - Edmund Neugebauer
- Institute for Research in Operative Medicine, University of Witten/Herdecke, Witten, Germany
| | - Christian Simanski
- Department of Trauma, Hand and Foot Surgery, St. Martinus Hospital, Langenfeld, Germany
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19
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Abstract
Chronic pain following inguinal hernia repair is a common problem and feared complication. Up to 16% of people experience chronic pain following the repair of a groin hernia. The aim of this review was to provide an overview of treatment strategies for patients with chronic pain following inguinal hernia repair based on best practice guidelines and current clinical routines. The optimal management of chronic pain following inguinal hernia surgery should begin with a thorough clinical examination to rule out other causes of chronic pain and to rule out a recurrence. A scaled approach to treatment is recommended. Initially, watchful waiting can be tried if it can be tolerated by the patient and then systemic painkillers, escalating to blocks, and surgery as the final option. Surgery should include mesh removal and triple neurectomy following anterior approaches or mesh and tack removal following a posterior approach. The diagnosis and treatment strategies should be performed by or discussed with experts in the field.
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Affiliation(s)
- Kristoffer Andresen
- Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Rosenberg
- Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
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20
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Cha J, Broch A, Mudge S, Kim K, Namgoong JM, Oh E, Kim P. Real-time, label-free, intraoperative visualization of peripheral nerves and micro-vasculatures using multimodal optical imaging techniques. BIOMEDICAL OPTICS EXPRESS 2018; 9. [PMID: 29541506 PMCID: PMC5846516 DOI: 10.1364/boe.9.001097] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Accurate, real-time identification and display of critical anatomic structures, such as the nerve and vasculature structures, are critical for reducing complications and improving surgical outcomes. Human vision is frequently limited in clearly distinguishing and contrasting these structures. We present a novel imaging system, which enables noninvasive visualization of critical anatomic structures during surgical dissection. Peripheral nerves are visualized by a snapshot polarimetry that calculates the anisotropic optical properties. Vascular structures, both venous and arterial, are identified and monitored in real-time using a near-infrared laser-speckle-contrast imaging. We evaluate the system by performing in vivo animal studies with qualitative comparison by contrast-agent-aided fluorescence imaging.
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Affiliation(s)
- Jaepyeong Cha
- Sheikh Zyaed Institute for Pediatric Surgical Innovation, Children's National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA
- These authors contributed equally to this work
| | - Aline Broch
- Sheikh Zyaed Institute for Pediatric Surgical Innovation, Children's National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA
- These authors contributed equally to this work
| | - Scott Mudge
- Sheikh Zyaed Institute for Pediatric Surgical Innovation, Children's National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Kihoon Kim
- Sheikh Zyaed Institute for Pediatric Surgical Innovation, Children's National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA
- Department of Surgery, Inje University Haeundae Paik Hospital, 875 Haeun-daero, Haeundae-gu, Busan 612-896, South Korea
| | - Jung-Man Namgoong
- Sheikh Zyaed Institute for Pediatric Surgical Innovation, Children's National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA
- Department of Surgery, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, South Korea
| | - Eugene Oh
- Sheikh Zyaed Institute for Pediatric Surgical Innovation, Children's National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA
- Department of Biomedical Engineering, The Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD 21218, USA
| | - Peter Kim
- Sheikh Zyaed Institute for Pediatric Surgical Innovation, Children's National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA
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21
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Chen D, Graham D, MacQueen I. Inguinal neuroanatomy: Implications for prevention of chronic postinguinal hernia pain. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2018. [DOI: 10.4103/ijawhs.ijawhs_6_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Staerkle RF, Vuille-dit-Bille RN, Fink L, Soll C, Villiger P. Chronic pain and quality of life after inguinal hernia repair using the COMI-hernia score. Langenbecks Arch Surg 2017; 402:935-947. [DOI: 10.1007/s00423-017-1592-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 05/23/2017] [Indexed: 11/24/2022]
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23
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Zwaans WAR, Koning GG, Gurusamy KS, van Kleef M, Scheltinga MRM, Roumen RMH. Surgical interventions for the management of chronic groin pain after hernia repair (postherniorrhaphy inguinodynia) in adults. Hippokratia 2017. [DOI: 10.1002/14651858.cd012630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Giel G Koning
- Medical Center Leeuwarden; Department of Surgery; Henri Dunantweg 2 intern routing: 29 Leeuwarden Friesland Netherlands 8901 BR
| | - Kurinchi Selvan Gurusamy
- Royal Free Campus, UCL Medical School; Department of Surgery; Royal Free Hospital Rowland Hill Street London UK NW3 2PF
| | - Maarten van Kleef
- Maastricht University Medical Center; Anaesthesiology/Pain Medicine; P. Debyelaan 25 Maastricht Netherlands
| | | | - Rudi MH Roumen
- Máxima Medical Center; General Surgery; Veldhoven Netherlands
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Howells N, Murray J, Wylde V, Dieppe P, Blom A. Persistent pain after knee replacement: do factors associated with pain vary with degree of patient dissatisfaction? Osteoarthritis Cartilage 2016; 24:2061-2068. [PMID: 27521157 DOI: 10.1016/j.joca.2016.07.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/11/2016] [Accepted: 07/27/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Up to 20% of patients experience long-term pain and dissatisfaction following knee replacement. The aim of this study was to investigate factors associated with persistent pain following knee replacement and their implications for patient satisfaction. DESIGN A case-controlled analysis compared patients with established persistent pain with patients who were pain-free. 2:1 frequency matching for age, gender, time from surgery and prosthesis was performed. 1310 patients were approached and 100 patients with persistent pain and 200 matched pain-free controls were included. Variables assessed included mechanical, biological, psychosocial and generalised factors. RESULTS The study found that the degree of dissatisfaction experienced by the patient with persistent pain following knee replacement affected the factors associated with pain. In the most dissatisfied patients, pain was associated with instability in the coronal plane (OR 19.8, 95% CI 3.8-104.0), stiffness (OR 6.4, 95% CI 2.3-18.4) and negative social support (OR 3.3, 95% CI 1.1-10.0). In patients who were less dissatisfied, pain was associated with patellofemoral problems (OR 10.3, 95% CI 3.6-29.6), elevated BMI (OR 2.8, 95% CI 1.4-5.7) and reduced local pain thresholds (OR 4.4, 95% CI 2.0-9.6). Depression (OR 13.6, 95% CI 1.9-96.6) and presence of proximal tibial tenderness (OR 23.5 95% CI 7.8-70.7) were strongly associated with pain regardless of level of satisfaction. CONCLUSIONS Patients with persistent pain after knee replacement are dissatisfied. This study identifies factors associated with the worst pain outcomes, which lead to the greatest levels of dissatisfaction. Particular efforts with a holistic multidisciplinary approach should be focused towards these "red flag" factors in order to minimise persistent pain after knee replacement.
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Affiliation(s)
- N Howells
- Avon Orthopaedic Centre, North Bristol NHS Trust, UK.
| | - J Murray
- Avon Orthopaedic Centre, North Bristol NHS Trust, UK
| | - V Wylde
- Musculoskeletal Research Unit, University of Bristol, UK
| | | | - A Blom
- Musculoskeletal Research Unit, University of Bristol, UK
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25
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Wennström I, Berggren P, Akerud L, Järhult J. Equal Results with Laparoscopic and Shouldice Repairs of Primary Inguinal Hernia in Men. Report from a Prospective Randomised Study. Scand J Surg 2016; 93:34-6. [PMID: 15116817 DOI: 10.1177/145749690409300107] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim: To compare the laparoscopic and Shouldice techniques for repair of inguinal hernia. Material: 261 healthy men over 50 years with primary, unilateral inguinal hernia were randomly allocated to laparoscopic (total extraperitoneal approach, TEP) treatment (n = 131) or to a modified Shouldice technique (n = 130). Results: Apart from a longer operative time in the laparoscopic group, there were no significant differences between the two methods with regard to perioperative complications, hospital stay, recurrencies or pain in the groin. Conclusions: Results following the total extraperitoneal laparoscopic and the Shouldice technique do not differ significantly 2 years after hernia repair.
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Affiliation(s)
- I Wennström
- Center of Gastrointestinal Disease, Ersta Hospital, Stockholm, Sweden
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26
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Jin J, Peng L, Chen Q, Zhang D, Ren L, Qin P, Min S. Prevalence and risk factors for chronic pain following cesarean section: a prospective study. BMC Anesthesiol 2016; 16:99. [PMID: 27756207 PMCID: PMC5069795 DOI: 10.1186/s12871-016-0270-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 10/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic post-surgical pain (CPSP) remains a major clinical problem which may be associated with impaired activities of daily life and decreased health-related quality of life. Although cesarean section is one of the most commonly performed operations, chronic pain after cesarean delivery has not been well-studied. The purpose of this prospective study was to assess the incidence and risk factors of chronic pain at 3, 6 and 12 months after cesarean delivery. METHODS We prospectively investigated preoperative demographic and psychological factors, intraoperative clinical factors, and acute postoperative pain in a cohort of 527 women undergoing cesarean section. The women were interviewed and completed pain questionnaires after 3, 6 and 12 months. Questions were about pain intensity, frequency, and location, as well as medical treatment and impact on daily living. RESULTS The incidence of CPSP at 3, 6 and 12 months after cesarean section was 18.3 %, 11.3 % and 6.8 %, respectively. Most of the women with CPSP experienced mild pain at rest. The incidence of moderate and severe pain on movement was high at 3 month, and then has a significant decrease at 6 and 12 months. CPSP had a negative influence on the activities of daily living. Independent predictors of CPSP at 3 months included higher average pain intensity on movement within 24 h postoperatively, preoperative depression, and longer duration of surgery. At 6 months, more severe pain during movement within 24 h of surgery and preoperative depression were predictive of pain persistence. And 12 months after surgery, only higher average pain score on movement within 24 h following cesarean section was found to be significant associated with CPSP. The three models all showed moderate discrimination and good calibration for the prediction of CPSP at 3, 6 and 12 months postoperatively. CONCLUSIONS CPSP was not rare in women undergoing cesarean section. Patients with more intense of acute postoperative pain on movement, preoperative depression, and longer surgical time had greater risk for CPSP following surgery.
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Affiliation(s)
- Juying Jin
- Department of Anesthesiology, the First Affiliated Hospital, Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China
| | - Lihua Peng
- Department of Anesthesiology, the First Affiliated Hospital, Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China
| | - Qibin Chen
- Department of Anesthesiology, the First Affiliated Hospital, Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China
| | - Dong Zhang
- Department of Anesthesiology, the First Affiliated Hospital, Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China
| | - Li Ren
- Department of Anesthesiology, the First Affiliated Hospital, Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China
| | - Peipei Qin
- Department of Anesthesiology, the First Affiliated Hospital, Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China
| | - Su Min
- Department of Anesthesiology, the First Affiliated Hospital, Chongqing Medical University, 1 Youyi Road, Chongqing, 400016, China.
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27
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The transinguinal preperitoneal technique (TIPP) in inguinal hernia repair does not cause less chronic pain in relation to the ProGrip technique: a prospective double-blind randomized clinical trial comparing the TIPP technique, using the PolySoft mesh, with the ProGrip self-fixing semi-resorbable mesh. Hernia 2016; 21:17-27. [PMID: 27539079 DOI: 10.1007/s10029-016-1522-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 07/29/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND Position of the mesh and the method of fixation are important in the occurrence of chronic pain in inguinal herniorrhaphy. An RCT was conducted to evaluate chronic pain after transinguinal preperitoneal (TIPP) repair compared with a Lichtenstein-like repair with a semi-resorbable self-fixing mesh (ProGrip). METHODS Patients with a primary unilateral inguinal hernia were randomized either to the TIPP (PolySoft mesh) or to repair with a ProGrip mesh. Primary objective was the occurrence of chronic pain after surgery. Secondary objectives were, i.e., recurrences, complications, and quality of life. Follow-up occurred after 2 weeks, 3 months, and 1 year. Patients and physicians were blinded. RESULTS Two hundred and fifty-eight patients were randomized to TIPP or ProGrip mesh repair. Two hundred and thirty-eight were included in the analysis: 122 in the TIPP group and 116 in the ProGrip group. Baseline characteristics were compatible. After 2 weeks and 3 months, there was significantly more moderate and severe pain in the ProGrip group on different pain scores. Median pain scores were very low in both groups after 3 months and 1 year (0-0.5 on a scale of 0-10). There was no difference in pain scores between both groups after 1 year. Recurrence rates were low; three patients in each group (2.6 % ProGrip and 2.5 % TIPP). CONCLUSION There was no significant difference in chronic pain between the inguinal repairs with the use of a ProGrip mesh compared with a TIPP repair at 1 year after surgery. In both groups, the occurrence of chronic pain was low.
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28
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Affiliation(s)
- David K Nguyen
- Department of Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Parviz K Amid
- Department of Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA; Lichtenstein Amid Hernia Clinic at UCLA, 1304 15th Street, Suite 102, Santa Monica, CA 90404, USA
| | - David C Chen
- Department of Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA; Lichtenstein Amid Hernia Clinic at UCLA, 1304 15th Street, Suite 102, Santa Monica, CA 90404, USA.
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29
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Liem L, Mekhail N. Management of Postherniorrhaphy Chronic Neuropathic Groin Pain: A Role for Dorsal Root Ganglion Stimulation. Pain Pract 2016; 16:915-23. [PMID: 26914499 DOI: 10.1111/papr.12424] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/29/2015] [Accepted: 11/11/2015] [Indexed: 12/21/2022]
Abstract
Chronic neuropathic groin pain is a sequela of hernia surgery that occurs at unacceptably high rates, causing widespread impacts on quality of life. Although the medical community is beginning to recognize the role of surgical technique in the initiation and maintenance of postherniorrhaphy neuropathic pain, little information exists regarding pain management strategies for this condition. This review presents a summary of the pain condition state, its treatment options, and treatment recommendations. Both literature review and clinical experience were used to develop a proposed a treatment algorithm for the treatment of postherniorrhaphy pain. The development of chronic pain may be prevented via a number of perioperative measures. For pain that is already established, some surgical approaches including inguinal neurectomy can be effective, in addition to standard pharmacological treatments and local infiltrations. An unmet need may still exist with these options, however, leaving a role for neuromodulation for the treatment of intractable cases. A pain management algorithm for iterative interventions including stimulation of the dorsal root ganglion (DRG) is described. It is expected that cross-disciplinary awareness of surgeons for nonsurgical pain management options in the treatment of chronic neuropathic postherniorrhaphy pain will contribute to better clinical outcomes.
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Affiliation(s)
- Liong Liem
- Sint Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - Nagy Mekhail
- Evidence-Based Pain Management Research, Cleveland Clinic, Cleveland, Ohio, U.S.A
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AlJamal YN, Zendejas B, Gas BL, Ali SM, Heller SF, Kendrick ML, Farley DR. Annual Surgeon Volume and Patient Outcomes Following Laparoscopic Totally Extraperitoneal Inguinal Hernia Repairs. J Laparoendosc Adv Surg Tech A 2016; 26:92-8. [DOI: 10.1089/lap.2015.0368] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yazan N. AlJamal
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Benjamin Zendejas
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Becca L. Gas
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Shahzad M. Ali
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Stephanie F. Heller
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Michael L. Kendrick
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - David R. Farley
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
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Pozek JPJ, Beausang D, Baratta JL, Viscusi ER. The Acute to Chronic Pain Transition: Can Chronic Pain Be Prevented? Med Clin North Am 2016; 100:17-30. [PMID: 26614716 DOI: 10.1016/j.mcna.2015.08.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Chronic postsurgical pain (CPSP) is a distressing disease process that can lead to long-term disability, reduced quality of life, and increased health care spending. Although the exact mechanism of development of CPSP is unknown, nerve injury and inflammation may lead to peripheral and central sensitization. Given the complexity of the disease process, no novel treatment has been identified. The preoperative use of multimodal analgesia has been shown to decrease acute postoperative pain, but it has no proven efficacy in preventing development of CPSP.
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Affiliation(s)
- John-Paul J Pozek
- Department of Anesthesiology, Thomas Jefferson University, Gibbon Building, Suite 8280, 111 South 11th Street, Philadelphia, PA 19107, USA.
| | - David Beausang
- Department of Anesthesiology, Thomas Jefferson University, Gibbon Building, Suite 8490, 111 South 11th Street, Philadelphia, PA 19107, USA
| | - Jaime L Baratta
- Department of Anesthesiology, Thomas Jefferson University, Gibbon Building, Suite 8280, 111 South 11th Street, Philadelphia, PA 19107, USA
| | - Eugene R Viscusi
- Department of Anesthesiology, Thomas Jefferson University, Gibbon Building, Suite 8490, 111 South 11th Street, Philadelphia, PA 19107, USA
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Abstract
Chronic pain after surgery is common.Surgery is widely performed therefore the at risk population is large.The mechanisms of chronic pain after surgery are complex.There are many risk factors associated with onset of chronic post-surgical pain: demographic, genetic and medical.Unnecessary and inappropriate surgery should be avoided.
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Affiliation(s)
- Michael Je Neil
- Consultant Anaesthetists, The Pain Service, Ninewells Hospital and Medical School, Dundee, DD1 9SY
| | - William A Macrae
- Consultant Anaesthetists, The Pain Service, Ninewells Hospital and Medical School, Dundee, DD1 9SY
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Hallén M, Sevonius D, Westerdahl J, Gunnarsson U, Sandblom G. Risk factors for reoperation due to chronic groin postherniorrhaphy pain. Hernia 2015; 19:863-9. [PMID: 26238397 DOI: 10.1007/s10029-015-1408-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 07/05/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chronic groin postherniorrhaphy pain (CGPP) is common and sometimes so severe that surgical treatment is necessary. The aim of this study was to identify risk factors for being reoperated due to CGPP. METHODS All 195,707 repairs registered in the Swedish Hernia Register between 1999 and 2011 were included in the study. Out of these, 28,947 repairs were excluded since they were registered as procedures on the same patient after a previous repair. Age, gender, hernia anatomy (indirect reference), method of repair (anterior sutured repair reference) and postoperative complications were included in a multivariate Cox analysis with reoperation due to CGPP as endpoint. RESULTS Of the patients included in the study cohort, 218 (0.13%) later underwent reoperation due to CGPP, including 31 (14%) women. Median age at the primary repair was 61.5 years. Risk factors for being reoperated were age < median [hazard ratio (HR) 3.03, 95% confidence interval (CI) 2.22-4.12], female gender (HR 2.13, CI 1.41-3.21), direct hernia (HR 1.35, CI 1.003-1.81), other hernia (HR 6.03, CI 3.08-11.79), Lichtenstein repair (HR 2.22, CI 1.16-4.25), plug repair (HR 3.93, CI 1.96-7.89), other repair (HR 2.58, CI 1.08-6.19), bilateral repair (HR 2.58, CI 1.43-4.66) and postoperative complication (HR 4.40, CI 3.25-5.96). CONCLUSIONS Risk factors for being reoperated due to CGPP in this cohort included low age, female gender, a direct hernia, a previous Lichtenstein or plug repair, bilateral repair and postoperative complications. Further research on how to avoid CGPP and explore the effectiveness of surgery for CGPP is necessary.
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Affiliation(s)
- M Hallén
- Department of Surgery, Clinical Sciences Lund, Lund University and Skane University Hospital, 221 85, Lund, Sweden.
| | - D Sevonius
- Department of Surgery, Clinical Sciences Lund, Lund University and Skane University Hospital, 221 85, Lund, Sweden
| | - J Westerdahl
- Department of Surgery, Clinical Sciences Lund, Lund University and Skane University Hospital, 221 85, Lund, Sweden
| | - U Gunnarsson
- Department of Surgical and Perioperative Sciences, Umeå University, 901 85, Umeå, Sweden
| | - G Sandblom
- CLINTEC, Division of Surgery, Karolinska Institute, 141 86, Stockholm, Sweden
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Lange JFM, Lange MM, Voropai DA, van Tilburg MWA, Pierie JPEN, Ploeg RJ, Akkersdijk WL. Trans rectus sheath extra-peritoneal procedure (TREPP) for inguinal hernia: the first 1,000 patients. World J Surg 2015; 38:1922-8. [PMID: 24510248 DOI: 10.1007/s00268-014-2475-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION After the introduction of mesh in inguinal hernia repair, the focus to improve surgical technique has changed from recurrence to chronic postoperative inguinal pain. At present, the most common surgical techniques are the Lichtenstein hernioplasty and total extraperitoneal procedure. Both techniques have their own specific disadvantages, with regard to potential nerve damage and the necessity of general anesthesia, respectively. OBJECTIVE The goal of this study was to evaluate the results of a new technique in which the inguinal nerves are not at risk, and in which general anesthesia is not needed: trans rectus sheath extraperitoneal procedure (TREPP). MATERIAL AND METHODS Between 2006 and 2010, a total of 1,000 patients were treated for inguinal hernia with TREPP. A questionnaire concerning pain, sensibility changes, patient satisfaction, and recurrence was sent to all patients. RESULTS The questionnaire was completed by 932 patients. Almost 90% of patients had not experienced any pain since the surgical procedure; 8% of patients reported experiencing some pain, but less than preoperatively; and 2% of patients reported an increase in pain postoperatively. Recurrence occurred in 1 and 3% were unsure about this. Reduced sensibility of the scar, scrotum, and upper leg was reported by 12.4, 1.4, and 1.5%, respectively. Overall, 97.4% of patients were satisfied with the results of the surgical procedure. The time period in which TREPP was performed was not associated with any of the outcome measures. CONCLUSION TREPP has proven to be a feasible new technique for inguinal hernia repair, with excellent results, justifying a randomized controlled trial in which TREPP should be compared with standard techniques.
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Affiliation(s)
- J F M Lange
- Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands,
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Geh N, Schultz M, Yang L, Zeller J. Retroperitoneal course of iliohypogastric, ilioinguinal, and genitofemoral nerves: A study to improve identification and excision during triple neurectomy. Clin Anat 2015; 28:903-9. [DOI: 10.1002/ca.22592] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 06/26/2015] [Accepted: 06/26/2015] [Indexed: 12/25/2022]
Affiliation(s)
- Ndi Geh
- University of Michigan Medical School; Ann Arbor Michigan
| | - Mike Schultz
- University of Michigan Medical School; Ann Arbor Michigan
| | - Lynda Yang
- Department of Neurosurgery; University of Michigan Medical School; Ann Arbor Michigan
| | - John Zeller
- Department of Surgery; University of Michigan Medical School; Ann Arbor Michigan
- Department of Orthopedic Surgery; University of Michigan Medical School; Ann Arbor Michigan
- Department of Emergency Medicine; University of Michigan Medical School; Ann Arbor Michigan
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Olasehinde OO, Adisa AO, Agbakwuru EA, Etonyeaku AC, Kolawole OA, Mosanya AO. A 5-year Review of Darning Technique of Inguinal Hernia Repair. Niger J Surg 2015; 21:52-5. [PMID: 25838768 PMCID: PMC4382644 DOI: 10.4103/1117-6806.152722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Context: The Darning technique of inguinal hernia repair is a tissue-based technique with documented low recurrence rate in some parts of the world. Though practiced in our setting, little is documented on its outcome. Aims: The aim was to review the outcome of Darning technique of inguinal hernia repair in our setting. Study Design: A descriptive retrospective study. Patients and Methods: Clinical records of all patients who had inguinal hernia repair using the Darning technique between January 2007 and December 2011 in our institution were obtained. Details of sociodemographic data, intraoperative findings and postoperative complications were reviewed. Statistical Analysis Used: simple frequencies, proportions and cross-tabulations. Results: A total of 132 patients whose ages ranged from 15 to 84 years (mean = 49.4 years) with a male: female ratio of 12:1 were studied. Majority of the hernias were right sided (68.9%), mostly indirect (81.8%). The procedures were for emergencies in 17 (12.9%) cases whereas the rest (87.1%) were done electively. Most procedures, 110 (83.3%) were performed under local anesthesia. Surgical site infection was the most common complication occurring in six patients (4.5%), while four patients (3%) had chronic groin pain. At a mean follow-up period of 15 months there were two recurrences (1.5%) both occurring in patients with bilateral hernias (P = 0.001). Conclusions: The Darning technique of inguinal hernia repair is a safe and effective method for inguinal hernia repair in our setting.
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Affiliation(s)
- Olalekan O Olasehinde
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Adewale O Adisa
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Elugwaraonu A Agbakwuru
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Amarachukwu C Etonyeaku
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Oladapo A Kolawole
- Department of Surgery, Ladoke Akintola University Teaching Hospital, Osogbo, Nigeria
| | - Arinze O Mosanya
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
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Bates AT, Divino C. Laparoscopic surgery in the elderly: a review of the literature. Aging Dis 2015; 6:149-55. [PMID: 25821642 DOI: 10.14336/ad.2014.0429] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 04/29/2014] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic techniques are gradually replacing many common surgical procedures that are performed in an increasingly aging population. Laparoscopy places different physiologic demands on the body than in open surgery. PubMed was searched for evidence related to the use of laparoscopy in the elderly population to treat common surgical pathologies. Randomized trials, systematic reviews, and meta-analyses were preferred. Currently, over 40% of all surgeries performed in the U.S. are on patients older than 65 years. By the end of the 21st century, Americans are expected to live 20 years longer than the current average. However, elderly patients clearly show higher rates of surgical morbidity and mortality overall. Laparoscopic techniques show decreased wound complications, post-operative ileus, intraoperative blood loss, and reduced need for post-operative rehabilitation. In conclusion, laparoscopic surgery is safe in the elderly population and affords multiple advantages including decreased pain and convalescence. However, the physiology of laparoscopy places demands on elderly patients that typically present with more medical comorbidities.
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Affiliation(s)
| | - Celia Divino
- Mount Sinai Medical Center, New York, NY 10029, USA
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Lomanto D, Cheah WK, Faylona JM, Huang CS, Lohsiriwat D, Maleachi A, Yang GPC, Li MKW, Tumtavitikul S, Sharma A, Hartung RU, Choi YB, Sutedja B. Inguinal hernia repair: toward Asian guidelines. Asian J Endosc Surg 2015; 8:16-23. [PMID: 25598054 DOI: 10.1111/ases.12141] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 08/20/2014] [Indexed: 01/09/2023]
Abstract
Groin hernias are very common, and surgical treatment is usually recommended. In fact, hernia repair is the most common surgical procedure performed worldwide. In countries such as the USA, China, and India, there may easily be over 1 million repairs every year. The need for this surgery has become an important socioeconomic problem and may affect health-care providers, especially in aging societies. Surgical repair using mesh is recommended and widely employed in Western countries, but in many developing countries, tissue-to-tissue repair is still the preferred surgical procedure due to economic constraints. For these reason, the development and implementation of guidelines, consensus, or recommendations may aim to clarify issues related to best practices in inguinal hernia repair in Asia. A group of Asian experts in hernia repair gathered together to debate inguinal hernia treatments in Asia in an attempt to reach some consensus or develop recommendations on best practices in the region. The need for recommendations or guidelines was unanimously confirmed to help overcome the discrepancy in clinical practice between countries; the experts decided to focus mainly on the technical aspects of open repair, which is the most common surgery for hernia in our region. After the identification of 12 main topics for discussion (indication, age, and sex; symptomatic and asymptomatic hernia: type of hernia; type of treatment; hospital admission; preoperative care; anesthesia; surgical technique; perioperative care; postoperative care; early complications; and long-term complications), a search of the literature was carried out according to the five levels of the Oxford Classification of Evidence and the four grades of recommendation.
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Affiliation(s)
- Davide Lomanto
- Minimally Invasive Surgery Centre, Department of Surgery, Yong Loo Lin School of Medicine, National University Health System, National University Singapore, Singapore
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Magnusson N, Gunnarsson U, Nordin P, Smedberg S, Hedberg M, Sandblom G. Reoperation for persistent pain after groin hernia surgery: a population-based study. Hernia 2014; 19:45-51. [DOI: 10.1007/s10029-014-1340-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 12/11/2014] [Indexed: 12/16/2022]
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Chronic Pain after Inguinal Hernia Repair. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:839681. [PMID: 27437477 PMCID: PMC4897331 DOI: 10.1155/2014/839681] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 12/02/2014] [Accepted: 12/02/2014] [Indexed: 11/18/2022]
Abstract
Background. Chronic postherniorrhaphy groin pain is defined as pain lasting >6 months after surgery, which is one of the most important complications occurring after inguinal hernia repair, which occurs with greater frequency than previously thought. Material and Methods. Patients undergoing elective inguinal hernioplasty in Victoria Hospital from November 2011 to May 2013 were included in the study. A total of 227 patients met the inclusion criteria and were available for followup at end of six months. Detailed preoperative, intraoperative, and postoperative details of cases were recorded according to proforma. The postoperative pain and pain at days two and seven and at end of six months were recorded on a VAS scale. Results. Chronic pain at six-month followup was present in 89 patients constituting 39.4% of all patients undergoing hernia repair. It was seen that 26.9% without preoperative pain developed chronic pain whereas 76.7% of patients with preoperative pain developed chronic pain. Preemptive analgesia failed to show statistical significance in development of chronic pain (P = 0.079). Nerve injury was present in 22 of cases; it was found that nerve injury significantly affected development of chronic pain (P = 0.001). On multivariate analysis, it was found that development of chronic pain following hernia surgery was dependent upon factors like preoperative pain, type of anesthesia, nerve injury, postoperative local infiltration, postoperative complication, and most importantly the early postoperative pain. Conclusions. In the present study, we found that chronic pain following inguinal hernia repair causes significant morbidity to patients and should not be ignored. Preemptive analgesia and operation under local anesthesia significantly affect pain. Intraoperative identification and preservation of all inguinal nerves are very important. Early diagnosis and management of chronic pain can remove suffering of the patient.
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Schou Bredal I, Smeby NA, Ottesen S, Warncke T, Schlichting E. Chronic pain in breast cancer survivors: comparison of psychosocial, surgical, and medical characteristics between survivors with and without pain. J Pain Symptom Manage 2014; 48:852-62. [PMID: 24703940 DOI: 10.1016/j.jpainsymman.2013.12.239] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 12/11/2013] [Accepted: 12/19/2013] [Indexed: 10/25/2022]
Abstract
CONTEXT According to the literature, 25%-60% of women treated for breast cancer, regardless of the stage, experience pain. Many risk factors have been suggested, with many possible confounding factors. OBJECTIVES The aim was to investigate psychosocial, surgical, and medical factors associated with chronic pain by comparing breast cancer survivors with chronic pain with survivors without chronic pain. In addition, we investigated the prevalence, intensity, and body location of chronic pain after breast cancer treatment nationwide. METHODS A nationwide postal survey of 1332 women who received surgery and adjuvant therapy for breast cancer in Norway two to six years before the onset of this study. RESULTS A total of 832 women (63%) returned the questionnaires, and 41% reported pain, of which 51% had mild, 41% moderate, and 8% severe pain. Among the women who experienced pain, 33.8% reported symptoms and signs of neuropathic pain. Young age (odds ratio [OR], 0.95; 95% CI, 0.93-0.98; P < 0.0001), axillary lymph node dissection with subsequent chemotherapy and radiotherapy (OR, 1.69; 95% CI, 1.07-2.67; P = 0.02), other illness that caused pain (OR, 2.37; 95% CI, 1.72-3.26; P < 0.0001), depression (OR, 2.07; 95% CI, 1.25-3.40; P = 0.004), and anxiety (OR, 1.83; 95% CI, 1.26-2.66; P = 0.002) were associated with chronic pain. CONCLUSION Young age, previous comorbidities (such as back pain, arthritis, arthrosis, and fibromyalgia), and combined treatment with axillary lymph node dissection, chemotherapy, and radiotherapy were risk factors for chronic pain. Whether depression or anxiety is a risk factor for chronic pain remains unclear.
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Affiliation(s)
- Inger Schou Bredal
- Oslo University Hospital, Oslo, Norway; University of Oslo, Oslo, Norway.
| | | | - Stig Ottesen
- Oslo University Hospital, Oslo, Norway; University of Oslo, Oslo, Norway
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Pellino G, Selvaggi F. Preventing inguinodynia after hernia surgery: does the type of mesh matter? World J Surg 2014; 39:543-4. [PMID: 25123181 DOI: 10.1007/s00268-014-2729-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Gianluca Pellino
- Unit of General Surgery, Second University of Naples, Piazza Miraglia 2, 80138, Naples, Italy,
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Langeveld HR, Klitsie P, Smedinga H, Eker H, Van't Riet M, Weidema W, Vergouwe Y, Bonjer HJ, Jeekel J, Lange JF. Prognostic value of age for chronic postoperative inguinal pain. Hernia 2014; 19:549-55. [PMID: 25092408 DOI: 10.1007/s10029-014-1282-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 07/07/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Chronic postoperative inguinal pain (CPIP) is considered the most common and serious long-term problem after inguinal hernia repair. Young age has been described as a risk factor for developing chronic pain after several surgical procedures. Our aim was to assess if age has prognostic value on CPIP. METHODS The database of a randomized trial; the LEVEL trial, 669 patients, TEP versus Lichtenstein, was used for analysis. Data on incidence and intensity of preoperative pain, postoperative pain and CPIP at 1 year were collected. The association of age with incidence and intensity of pain was assessed with regression analysis. Further, hernia type and surgical technique were studied in combination with age and CPIP as possible risk factors on CPIP over age alone. RESULTS Younger patients (18-40 years) presented more often with CPIP than middle-aged patients (40-60 years) and elderly (>60 years); 43 vs. 29 vs. 19 %; overall 27 %. Younger and middle-aged patients had more frequently preoperative pain; 54 vs. 55 vs. 41 % and intensity of pain was higher during the first three postoperative days (VAS on day 1: 5.5 vs. 4.5 vs. 3.9 and on day 3: 3.8 vs. 2.9 vs. 2.6). Indirect-type hernias were seen more often in younger patients (77 vs. 51 vs. 48 %) and were not related to CPIP or with surgical technique. CONCLUSIONS Almost one out of three patients experiences CPIP. The younger the patient, the higher the risk of CPIP. Hernia type and surgical technique did not influence CPIP.
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Affiliation(s)
- H R Langeveld
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands,
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Shamita C, Rohit K. A comparative study of inguinodynia following lichtenstein hernioplasty with or without elective neurectomy of ilioinguinal nerve. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s13126-014-0115-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bjurstrom MF, Nicol AL, Amid PK, Chen DC. Pain control following inguinal herniorrhaphy: current perspectives. J Pain Res 2014; 7:277-90. [PMID: 24920934 PMCID: PMC4045265 DOI: 10.2147/jpr.s47005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Inguinal hernia repair is one of the most common surgeries performed worldwide. With the success of modern hernia repair techniques, recurrence rates have significantly declined, with a lower incidence than the development of chronic postherniorrhaphy inguinal pain (CPIP). The avoidance of CPIP is arguably the most important clinical outcome and has the greatest impact on patient satisfaction, health care utilization, societal cost, and quality of life. The etiology of CPIP is multifactorial, with overlapping neuropathic and nociceptive components contributing to this complex syndrome. Treatment is often challenging, and no definitive treatment algorithm exists. Multidisciplinary management of this complex problem improves outcomes, as treatment must be individualized. Current medical, pharmacologic, interventional, and surgical management strategies are reviewed.
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Affiliation(s)
| | - Andrea L Nicol
- Department of Anesthesiology, University of Kansas, Kansas City, KS, USA
| | - Parviz K Amid
- Department of Surgery, Lichtenstein Amid Hernia Clinic at UCLA, UCLA, Los Angeles, CA, USA
| | - David C Chen
- Department of Surgery, Lichtenstein Amid Hernia Clinic at UCLA, UCLA, Los Angeles, CA, USA
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Inguinal hernia repair using a synthetic long-term resorbable mesh: results from a 3-year prospective safety and performance study. Hernia 2014; 18:723-30. [PMID: 24770701 PMCID: PMC4177566 DOI: 10.1007/s10029-014-1249-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 04/06/2014] [Indexed: 01/05/2023]
Abstract
PURPOSE Conventional meshes for hernia repair and abdominal wall reinforcement are usually made from polypropylene, polyester or other synthetic plastic materials known to promote foreign body reactions and a state of chronic inflammation that may lead to long-term complications. A novel approach is to use long-term resorbable implants like TIGR(®) Matrix Surgical Mesh. Preclinical studies have shown that this mesh maintains mechanical integrity beyond the point in time where newly formed tissue is capable of carrying the abdominal loads. METHODS This was a first-in-man, prospective, pilot study performed during 2009, at two sites in Sweden. Forty patients with primary inguinal hernias were enrolled for Lichtenstein repair using TIGR(®) Matrix Surgical Mesh. The primary endpoint was safety as assessed by monitoring the incidence of adverse events and serious adverse events (SAEs) both related and unrelated to the mesh. The secondary endpoint was pain or discomfort. Visual Analogue Scale (VAS) 0-10 and Inguinal Pain Questionnaire were used for scoring pain and discomfort. Included patients have been followed for 36 months using ultrasound in combination with clinical examination. RESULTS All patients followed a normal early postoperative course. After 12 months no SAEs were reported. None of the patients with an isolated lateral inguinal hernia (LIH) had developed a recurrence but 4 (44 %) with medial and 4 (33 %) with combined hernias had recurred at 36-month follow-up. After 3-year follow-up none of the patients with LIH reported pain in the VAS-form and none of those patients could feel the sensation of a mesh in their groin. In the total study population 5 (16 %) patients experienced chronic pain in the form of mild sporadic pain and 3 (9.7 %) patients could feel the sensation of a mesh in their groin. CONCLUSION The use of a synthetic long-term resorbable mesh (TIGR(®) Matrix Surgical Mesh) in Lichtenstein repair was found to be safe, without recurrences, and promising regarding pain/discomfort at 3-year follow-up in patients with LIH. However, patients with medial and combined inguinal hernias had high recurrence rates.
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Mesh Fixation at Laparoscopic Inguinal Hernia Repair: A Meta-Analysis Comparing Tissue Glue and Tack Fixation. World J Surg 2014; 38:2558-70. [DOI: 10.1007/s00268-014-2547-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Wide nervous section to prevent post-operative inguinodynia after prosthetic hernia repair: a single center experience. Hernia 2014; 19:565-70. [DOI: 10.1007/s10029-014-1248-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 04/04/2014] [Indexed: 10/25/2022]
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Achelrod D, Stargardt T. Cost-utility analysis comparing heavy-weight and light-weight mesh in laparoscopic surgery for unilateral inguinal hernias. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2014; 12:151-163. [PMID: 24526592 DOI: 10.1007/s40258-014-0082-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Hernioplasty is one of the most frequent surgeries in the UK. Light-weight mesh (LWM) has the potential to reduce chronic groin pain but its cost-effectiveness compared with heavy-weight mesh (HWM) is unknown. OBJECTIVE Our objective was to conduct a cost-utility analysis between laparoscopic hernioplasty with HWM and LWM for unilateral inguinal hernias. METHODS A Markov model simulated costs and health outcomes over a period of 1 year (2012) from the societal and National Health Service (NHS) perspective (England). The main outcome was cost per quality-adjusted life-year (QALY) gained. Surgery results were gleaned from the randomized control trial by Bittner et al. Other input parameters were drawn from the literature and public sources of the NHS. RESULTS From the societal perspective, LWM induces lower incremental costs (-£88.85) than HWM but yields a slightly smaller incremental effect (-0.00094 QALYs). The deterministic incremental cost-effectiveness ratio (ICER) for HWM compared with LWM amounts to £94,899 per QALY, while the probabilistic ICER is £118,750 (95 % confidence interval [CI] £57,603-180,920). Owing to the withdrawal of productivity losses from the NHS perspective, LWM causes higher incremental costs (£13.09) and an inferior incremental effect (-0.00093), resulting in a dominance of HWM over LWM (ICER 95 % CI -£12,382 to -£21,590). CONCLUSIONS There is no support for the adoption of LWM as standard treatment from an NHS perspective. However, given the small differences between HWM and LWM, LWM has at least the potential of improving patient outcomes and reducing expenditure from the societal perspective.
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Affiliation(s)
- Dmitrij Achelrod
- Hamburg Center for Health Economics (HCHE), University of Hamburg, Esplanade 36, 20354, Hamburg, Germany,
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Mahan MA, Kader AK, Brown JM. Robot-assisted triple neurectomy for iatrogenic inguinal pain: a technical note. Acta Neurochir (Wien) 2014; 156:171-5. [PMID: 24026228 DOI: 10.1007/s00701-013-1857-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 08/17/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Painful neuromas are a relatively common complication of hernia and abdominal wall surgery. OBJECTIVE Surgical neurectomy has the potential to to provide durable relief for chronic pain; however, current surgical approaches are not without morbidity or anatomical challenges.We sought a surgical alternative. METHODS In the treatment of a case of incapacitating inguinal pain, we performed an anterior transperitoneal approach using a surgical robot. RESULTS This approach was facile and provided elegant anatomical visualization. CONCLUSION This case describes the first known robot-assisted laparoscopic triple neurectomy and details a simplified, transperitoneal approach.
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