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Matovu A, Löfgren J, Wladis A, Nordin P, Sandblom G, Pettersson HJ. Incidence of groin hernia repairs in women and parity: a population-based cohort study among women born in Sweden between 1956 and 1983. Hernia 2024; 28:1231-1238. [PMID: 38520614 PMCID: PMC11296966 DOI: 10.1007/s10029-024-03011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/03/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION The aim of this study was to evaluate the association between parity and the incidence rate of groin hernia repair in women. METHOD This study was based on two Swedish national registers, the Medical Birth Register (MBR), and the Swedish Hernia Register (SHR). The cohort constituted of women born between 1956 and 1983. Data on vaginal and cesarean deliveries were retrieved from the MBR. The birth and hernia registers were cross matched to identify hernia repairs carried out after deliveries. RESULTS A total of 1,535,379 women were born between 1956 and 1983. Among these, 1,417,237 (92.3%) were registered for at least one birth. The incidence rate for Inguinal Hernia Repair (IHR) and Femoral Hernia Repair (FHR) was 10.7 per 100,000 person-year and 2.6 per 100,000 person-year, respectively. Compared with women registered for one delivery, the incidence rate ratio for IHR was 1.31 (95% Confidence Interval: 1.23-1.40) among women registered for two deliveries, 1.70 (1.58-1.82) among women registered for ≥ 3 deliveries. Additionally, the incidence rate ratios were higher 1.30 (1.14-1.49) and 1.70 (1.49-1.95) for FHR among women with two and ≥ 3 registered deliveries, respectively. CONCLUSION In the present cohort, higher parity was associated with a higher incidence of inguinal as well as FHRs.
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Affiliation(s)
- A Matovu
- Mubende Regional Referral Hospital, Plot 6, Kakumiro Road, P.O. Box 4, Mubende, Uganda.
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - J Löfgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - A Wladis
- Linköping University, Linköping, Sweden
| | - P Nordin
- Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Umeå, Sweden
| | - G Sandblom
- Department of Surgery, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - H J Pettersson
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Reistrup H, Andresen K, Öberg S, Rosenberg J. Higher rate of chronic pain in young men after open mesh vs nonmesh repair of elective primary unilateral indirect inguinal hernia: A nationwide questionnaire study. Curr Probl Surg 2024; 61:101459. [PMID: 38548427 DOI: 10.1016/j.cpsurg.2024.101459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Hugin Reistrup
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kristoffer Andresen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Stina Öberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
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Maertens F, Chan PH, Prentice HA, Brill ER, Paxton EW, Mostaedi R. Female sex and ipsilateral reoperation risk following mesh-based inguinal hernia repair: a cohort study including 131,626 repairs in adults from an integrated healthcare system over a 10-year period. Hernia 2024; 28:25-31. [PMID: 37682377 DOI: 10.1007/s10029-023-02878-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: 04/21/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
PURPOSE We sought to compare females and males for the risk of reoperation following different inguinal hernia repair approaches (open, laparoscopic, and robotic). METHODS We conducted a retrospective cohort study including all patients aged ≥ 18 who underwent first inguinal hernia repair with mesh within a US integrated healthcare system (2010-2020). Data were obtained from the system's integrated electronic health record. Multiple Cox proportional-hazards regression was used to evaluate the association between sex and risk for ipsilateral reoperation during follow-up. Analysis was stratified by surgical approach (open, laparoscopic, and robotic). RESULTS The study cohort was comprised of 110,805 patients who underwent 131,626 inguinal hernia repairs with mesh, 10,079 (7.7%) repairs were in females. After adjustment for confounders, females had a higher risk of reoperation than males following open groin hernia repair (hazard ratio [HR] = 1.98, 95% CI 1.74-2.25), but a lower reoperation risk following laparoscopic repair (HR = 0.70, 95% CI 0.51-0.97). The crude 5-year cumulative reoperation probability following robotic repair was 2.8% in males and no reoperations were observed for females. Of females who had a reoperation, 10.3% (39/378) were for a femoral hernia, while only 0.6% (18/3110) were for femoral hernias in males. CONCLUSION In a large multi-center cohort of mesh-based inguinal hernia repair patients, we found a higher risk for reoperation in females after an open repair approach compared to males. Lower risk was observed for females through a minimally invasive approach (laparoscopic or robotic) and may be due to the ability to identify an occult femoral hernia through these approaches.
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Affiliation(s)
- F Maertens
- Department of Surgery, The Permanente Medical Group, 3600 Broadway, 3rd Floor, Suite 38, Oakland, CA, 94611, USA.
| | - P H Chan
- Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego, CA, USA
| | - H A Prentice
- Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego, CA, USA
| | - E R Brill
- Department of Surgery, The Permanente Medical Group, Santa Clara, CA, USA
| | - E W Paxton
- Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego, CA, USA
| | - R Mostaedi
- Department of Surgery, The Permanente Medical Group, Richmond, CA, USA
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Assakran BS, Al-Harbi AM, Abdulrahman Albadrani H, Al-Dohaiman RS. Risk Factors for Postoperative Complications in Hernia Repair. Cureus 2024; 16:e51982. [PMID: 38205086 PMCID: PMC10777094 DOI: 10.7759/cureus.51982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 01/12/2024] Open
Abstract
Background and objective Hernias of the abdominal wall were prevalent in people of all ages worldwide, with an overall prevalence of 1.7 percent. Recently, laparoscopic and Lichtenstein mesh repairs have become popular as they provide a rapid return to normal activities with low recurrence rates. There is a relatively high risk of complications following hernia repair, such as wound seroma/hematoma, urinary retention, and superficial incisional infection. As for complications that may develop after hernia repair, we discussed risk factors contributing to postoperative complications after hernia repair in this study. Methods This study was a retrospective descriptive study of all patients who underwent hernia repair. The cohort of patients data would be collected from patients using an interview-based questionnaire. The data obtained will be entered into a spreadsheet and analyzed using the Statistical Package for the Social Sciences (SPSS) 23.0 package (IBM Corp., Armonk, NY). Results In the current study, we collected data from 274 patients with hernia. The majority of participants were male (79.9%, n = 219), while (37.7%, n = 100) overweight, and (29.8%, n = 79) obese. Among the participants, (82.8%, n = 227) did not experience any complications, while (17.2%, n = 47) reported complications. The types of complications observed were as follows: seroma formation (2.9%, n = 8), wound infection (5.8%, n = 16), and mesh infection (1.8 %, n = 5). There were no significant associations between gender and the presence of complications. However, a significant association was found between BMI and complications (p < 0.001). Diabetes mellitus also showed a significant association with complications (p = 0.005), with a higher proportion of complications among participants with diabetes. Conclusion In the current study, we found a significant prevalence of postoperative complications with significant risk factors such as obesity and diabetic mellitus. Additional investigation is warranted to validate these correlations and investigate supplementary variables that could potentially contribute to postoperative problems in hernia surgery.
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Zhou Z, Li Y, Li B, Yan L, Lei Y, Tong C. Construction and validation of a predictive model for the risk of bowel resection in adults with incarcerated groin hernia. BMC Surg 2023; 23:375. [PMID: 38082259 PMCID: PMC10714612 DOI: 10.1186/s12893-023-02245-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/18/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND It is difficult to definitively determine the degree of ischemia in the bowel in which an incarcerated groin hernia is embedded. Failure to diagnose and intervene promptly and accurately increases the rate of bowel resection and patient mortality. The aim of this study is to investigate the risk factors for incarcerated inguinal hernia complicating bowel necrosis with resection and to establish a predictive model as a reference for clinical work. METHODS Patients with incarcerated groin hernia who were admitted to our hospital were retrospectively analyzed. They were divided into bowel resection and non-bowel resection groups based on whether bowel resection was performed in the surgical record and postoperative pathological results. Risk factors for the development of bowel resection in incarcerated groin hernia were analyzed by univariate analysis and multivariate logistic regression, respectively. The screened independent risk factors were used to establish a prediction model, and finally, the predictive ability and accuracy of the model were validated and the clinical benefit was analyzed. RESULTS A total of 345 patients with incarcerated groin hernia were included, of whom 58 underwent bowel resection for bowel necrosis and 287 did not. Multifactorial logistic regression analysis identified bowel obstruction (OR, 7.285 [95% CI, 2.254-23.542], P = 0.001), peritonitis (OR, 16.786 [95% CI, 5.436-51.838], P = 0.000), duration of incarcerated groin hernia (OR, 1.009 [95% CI, 1. 001-1.018], P = 0.034), heart rate (OR, 1.109 [95% CI, 1.021-1.205], P = 0.014), and preoperative total protein (OR, 0.900 [95% CI, 0.836-0.969], P = 0.005) were independent risk factors for bowel resection in incarcerated groin hernia. The predictive value of the established prediction model was basically in agreement with the measured value with a consistency index of 0.938 (0.901-0.974) and had a good clinical benefit. CONCLUSION Clinical screening and management of independent risk factors for bowel resection in patients with incarcerated groin hernia should be strengthened. The predictive model developed in this study has high diagnostic efficacy for bowel resection associated with incarcerated inguinal hernia, with the aim of reducing the incidence of bowel resection and unplanned secondary surgery.
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Affiliation(s)
- Zheqi Zhou
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
- Yan'an University, Yan'an, 716000, China
| | - Yujie Li
- Yan'an University, Yan'an, 716000, China
| | - Bin Li
- Department of Gynecology, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Likun Yan
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Yingying Lei
- Tianjin Medical University, Tianjin, 300052, China
| | - Cong Tong
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China.
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Rasmussen L, Farooqui W, Ries A, Stadeager MW. Synchronic development of hydrocele and groin hernia during pregnancy: a case report. J Med Case Rep 2023; 17:433. [PMID: 37752576 PMCID: PMC10523710 DOI: 10.1186/s13256-023-04099-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 07/16/2023] [Indexed: 09/28/2023] Open
Abstract
INTRODUCTION Hydroceles of the canal of Nuck are rare, and have not been described in relation to pregnancy. CASE PRESENTATION A 34-year-old Caucasian female patient had bilateral groin swelling debuted during her pregnancy. A preoperative magnetic resonance imaging scan found bilateral hydroceles of the canal of Nuck. Operative findings and histological examinations revealed a left-sided inguinal hernia and a right-sided hydrocele. The patient was discharged well and without signs of postoperative complications or hernia recurrence. DISCUSSION In this case, a hydrocele and a hernia sac were morphologically identical in terms of preoperative appearance and development. Given the morphological correlation, it was surprising to find different operative findings confirmed by the histopathological examination. CONCLUSION This is the first ever report of the synchronic development of two morphologically identical cystic processes, with one being a hydrocele and the other a hernia sac. In addition, the hydrocele developed during pregnancy, making this case even more unique.
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Affiliation(s)
- Lise Rasmussen
- Gastrounit, Copenhagen University Hospital - Amager and Hvidovre, 2650, Hvidovre, Denmark.
| | - Waqas Farooqui
- Gastrounit, Copenhagen University Hospital - Amager and Hvidovre, 2650, Hvidovre, Denmark
| | - Annedorte Ries
- Department of Pathorlogy, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
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Lin R, Lin X, Yang Y, Wang C, Fang H, Chen Y, Huang H, Lu F. Laparoscopic transabdominal preperitoneal repair for female patients with groin hernias. BMC Womens Health 2023; 23:422. [PMID: 37559009 PMCID: PMC10413729 DOI: 10.1186/s12905-023-02527-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 07/04/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Laparoscopic transabdominal preperitoneal repair (TAPP) was recommended for female patients with groin hernias. Whereas, only a few studies focused on whether and how to preserve the round ligament of the uterus in TAPP. METHODS Clinical data of 159 female patients with 181 groin hernias who underwent TAPP at a single institution in China from January 2016 to June 2022 were retrospectively reviewed and collected. RESULTS All the patients underwent the operation smoothly without conversion. Division of the round ligament was performed for 33 hernias. Preservation of the round ligament was adopted for 148 hernias, 51 with the "keyhole" technique, 86 with the "longitudinal incision of peritoneum" method, and 11 with total dissection of the round ligament. The mean operative time was 55.6 ± 8.7 min for unilateral TAPP and 99.1 ± 15.8 min for bilateral TAPP. The mean estimated blood loss was 7.1 ± 4.5 mL. The postoperative complications included 6 (3.3%) cases of seroma, 1 (0.5%) case of hematoma, and 3 (1.6%) cases of mild chronic pain. The incidences of chronic pelvic pain and genital prolapse seemed to be higher in the division group than in the preservation groups (6.1% vs. 0.6% and 3.0% vs. 0%, separately). However, no statistical difference was observed (p > 0.05). CONCLUSIONS TAPP is feasible and effective for female patients with groin hernias, especially in preserving the round ligament of the uterus.
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Affiliation(s)
- Ronggui Lin
- Department of General surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian China
| | - Xianchao Lin
- Department of General surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian China
| | - Yuanyuan Yang
- Department of General surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian China
| | - Congfei Wang
- Department of General surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian China
| | - Haizong Fang
- Department of General surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian China
| | - Yanchang Chen
- Department of General surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian China
| | - Heguang Huang
- Department of General surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian China
| | - Fengchun Lu
- Department of General surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian China
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Virk SK, Lopez E, Pardo KM, Gonzalez AM. Incidental Finding of a Lipoleiomyoma During Robotic Inguinal Hernia Repair: A Case Report. Cureus 2023; 15:e40635. [PMID: 37476115 PMCID: PMC10355229 DOI: 10.7759/cureus.40635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Lipoleiomyomas are rare, fatty variants of leiomyomas (commonly referred to as fibroid), which are frequently found in the uterine corpus and cervix. Here, we present a case of a robotic inguinal hernia repair with resection of an incidental lipoleiomyoma. A 74-year-old woman presented to the office with complaints of pain and a palpable mass in the right inguinal region. Physical examination revealed tender, moderate-to-large bilateral inguinal hernias. Robotic bilateral inguinal hernia repair with mesh was performed. Intraoperatively, a mass measuring 4 × 3 cm was noted near the round ligament of the uterus. The mass was encapsulated without invading any surrounding structures. The mass was resected and sent to the histopathology department. The pathological evaluation identified a leiomyoma filled with mature adipocytes, compatible with the diagnosis of an extrauterine lipoleiomyoma. Lipoleiomyoma incidentally found in the inguinal canal is extremely rare. The medical literature regarding this incidental finding is limited. Resection of the mass was easily performed using the same robotic instruments as used for the inguinal hernia repair.
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Affiliation(s)
- Shohab K Virk
- Department of Surgery, Baptist Hospital of Miami, Miami, USA
| | - Edilin Lopez
- Department of Surgery, Baptist Health South Florida, Miami, USA
| | - Katrina M Pardo
- Department of Surgery, Baptist Health South Florida, Miami, USA
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Hoffmann H, Mechera R, Nowakowski D, Adolf D, Kirchhoff P, Riediger H, Köckerling F. Gender differences in epigastric hernia repair: a propensity score matching analysis of 15,925 patients from the Herniamed registry. Hernia 2023:10.1007/s10029-023-02799-8. [PMID: 37160505 DOI: 10.1007/s10029-023-02799-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/25/2023] [Indexed: 05/11/2023]
Abstract
INTRODUCTION In recent surgical literature, gender-specific differences in the outcome of hernia surgery has been analyzed. We already know that female patients are at higher risk to develop chronic postoperative pain after inguinal, incisional, and umbilical hernia surgery. In this study, we evaluated the impact of gender on the outcome after epigastric hernia surgery. METHODS A covariable-adjusted matched-paired analysis with data derived from the Herniamed registry was performed. In total of 15,925 patients with 1-year follow-up data were included in the study. Propensity score matching was performed for the 7786 female (48.9%) and 8139 male (51.1%) patients, creating 6350 pairs (81.6%). RESULTS Matched-paired analysis revealed a significant disadvantage for female patients for pain on exertion (12.1% vs. 7.6%; p < 0.001) compared to male patients. The same effect was demonstrated for pain at rest (6.2% in female patients vs. 4.1% in male patients; p < 0.001) and pain requiring treatment (4.6% in female patients vs. 3.1% in male patients; p < 0.001). All other outcome parameters showed no significant differences between female and male patients. CONCLUSIONS Female patients are at a higher risk for chronic pain after elective epigastric hernia repairs compared to the male patient population. These results complete findings of previous studies showing the same effect in inguinal, umbilical, and incisional hernia repair.
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Affiliation(s)
- H Hoffmann
- Center for Hernia Surgery and Proctology, ZweiChirurgen GmbH, St. Johanns Vorstadt 44, 4056, Basel, Switzerland.
- Clinic for Orthopedics and Surgery, Merian Iselin Clinic, Basel, Switzerland.
| | - R Mechera
- Breast and Endocrine Surgery, St. George Hospital, Kogarah, NSW, 2217, Australia
| | - D Nowakowski
- Center for Hernia Surgery and Proctology, ZweiChirurgen GmbH, St. Johanns Vorstadt 44, 4056, Basel, Switzerland
- Clinic for Orthopedics and Surgery, Merian Iselin Clinic, Basel, Switzerland
| | - D Adolf
- StatConsult, Magdeburg, Germany
| | - P Kirchhoff
- Center for Hernia Surgery and Proctology, ZweiChirurgen GmbH, St. Johanns Vorstadt 44, 4056, Basel, Switzerland
- Clinic for Orthopedics and Surgery, Merian Iselin Clinic, Basel, Switzerland
| | - H Riediger
- Center for Hernia Surgery, Vivantes Humboldt Clinic, Berlin, Germany
| | - F Köckerling
- Center for Hernia Surgery, Vivantes Humboldt Clinic, Berlin, Germany
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Harman M, Champaigne K, Cobb W, Lu X, Chawla V, Wei L, Luzinov I, Mefford OT, Nagatomi J. A Novel Bio-Adhesive Mesh System for Medical Implant Applications: In Vivo Assessment in a Rabbit Model. Gels 2023; 9:372. [PMID: 37232966 PMCID: PMC10217475 DOI: 10.3390/gels9050372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/08/2023] [Accepted: 04/13/2023] [Indexed: 05/27/2023] Open
Abstract
Injectable surgical sealants and adhesives, such as biologically derived fibrin gels and synthetic hydrogels, are widely used in medical products. While such products adequately adhere to blood proteins and tissue amines, they have poor adhesion with polymer biomaterials used in medical implants. To address these shortcomings, we developed a novel bio-adhesive mesh system utilizing the combined application of two patented technologies: a bifunctional poloxamine hydrogel adhesive and a surface modification technique that provides a poly-glycidyl methacrylate (PGMA) layer grafted with human serum albumin (HSA) to form a highly adhesive protein surface on polymer biomaterials. Our initial in vitro tests confirmed significantly improved adhesive strength for PGMA/HSA grafted polypropylene mesh fixed with the hydrogel adhesive compared to unmodified mesh. Toward the development of our bio-adhesive mesh system for abdominal hernia repair, we evaluated its surgical utility and in vivo performance in a rabbit model with retromuscular repair mimicking the totally extra-peritoneal surgical technique used in humans. We assessed mesh slippage/contraction using gross assessment and imaging, mesh fixation using tensile mechanical testing, and biocompatibility using histology. Compared to polypropylene mesh fixed with fibrin sealant, our bio-adhesive mesh system exhibited superior fixation without the gross bunching or distortion that was observed in the majority (80%) of the fibrin-fixed polypropylene mesh. This was evidenced by tissue integration within the bio-adhesive mesh pores after 42 days of implantation and adhesive strength sufficient to withstand the physiological forces expected in hernia repair applications. These results support the combined use of PGMA/HSA grafted polypropylene and bifunctional poloxamine hydrogel adhesive for medical implant applications.
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Affiliation(s)
- Melinda Harman
- 301 Rhodes Engineering Research Center, Bioengineering Department, Clemson University, Clemson, SC 29634, USA
- School of Medicine Greenville, Prisma Health Upstate, University of South Carolina, Greenville, SC 29605, USA
| | - Kevin Champaigne
- 301 Rhodes Engineering Research Center, Bioengineering Department, Clemson University, Clemson, SC 29634, USA
- Circa Bioscience, Charleston, SC 29412, USA
| | - William Cobb
- School of Medicine Greenville, Prisma Health Upstate, University of South Carolina, Greenville, SC 29605, USA
| | - Xinyue Lu
- 301 Rhodes Engineering Research Center, Bioengineering Department, Clemson University, Clemson, SC 29634, USA
| | | | - Liying Wei
- Materials Science & Engineering Department, Clemson University, Clemson, SC 29634, USA
| | - Igor Luzinov
- Materials Science & Engineering Department, Clemson University, Clemson, SC 29634, USA
| | - O. Thompson Mefford
- 301 Rhodes Engineering Research Center, Bioengineering Department, Clemson University, Clemson, SC 29634, USA
- Materials Science & Engineering Department, Clemson University, Clemson, SC 29634, USA
| | - Jiro Nagatomi
- 301 Rhodes Engineering Research Center, Bioengineering Department, Clemson University, Clemson, SC 29634, USA
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Zhao Y, Xu Z, Wang T, Zhou D, Tang N, Zhang S, Chen C. The impact of laparoscopic versus open inguinal hernia repair for inguinal hernia treatment: A retrospective cohort study. Health Sci Rep 2023; 6:e1194. [PMID: 37056467 PMCID: PMC10089615 DOI: 10.1002/hsr2.1194] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/31/2023] [Indexed: 04/15/2023] Open
Abstract
Objectives Although laparoscopic inguinal hernia repair (LIHR) has been widely accepted for treating inguinal hernia, the procedure remains very technical and challenging. The present study aimed to assess the effect of LIHR in relation to operation time, intraoperative hemorrhage and postoperative hospitalization. Methods A total of 503 patients with inguinal hernia admitted at the Wuxi Rehabilitation Hospital between June 2019 and July 2021 were included in this retrospective cohort study. Binary logistic and linear regressions were used for categorical and continuous outcomes, respectively. The learning curve was drawn by cumulative sum analysis. Results Multivariate logistic regression analysis identified LIHR as an independent factor associated with prolonging operation time (odd ratio [OR] = 1.750, 95% confidence interval [CI]: 1.215-2.520, p = 0.003) and decreasing intraoperative hemorrhage levels (OR = 0.079, 95 CI: 0.044-0.142, p < 0.001). Multivariate linear regression identified LIHR (Coefficient = -0.702, 95% CI: [-1.050] to [-0.354], p < 0.001) as an independent factor for shortening postoperative hospitalization time. After learning curve, LIHR (OR = 1.409, 95% CI: 0.948 to 2.094, p = 0.090) no longer resulted as a risk factor prolonging operation time. Conclusions LIHR is an important independent predictive factor for decreasing intraoperative hemorrhage levels and shortening postoperative hospitalization time. Additionally, LIHR does not prolong operation time after the learning curve.
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Affiliation(s)
- Yong Zhao
- Department of General SurgeryWuxi Rehabilitation HospitalWuxiChina
| | - Zipeng Xu
- Department of General SurgeryXishan People's Hospital of Wuxi CityWuxiChina
| | - Tao Wang
- Department of General SurgeryWuxi Rehabilitation HospitalWuxiChina
| | - Dingxing Zhou
- Department of Emergency SurgeryWuxi Second Hospital of Traditional Chinese MedicineWuxiChina
| | - Neng Tang
- Department of Hepatic‐Biliary‐Pancreatic Surgerythe Affiliated Drum Tower Hospital of Nanjing University Medical schoolNanjingChina
| | - Shuo Zhang
- Department of Hepatic‐Biliary‐Pancreatic Surgerythe Affiliated Drum Tower Hospital of Nanjing University Medical schoolNanjingChina
| | - Chaobo Chen
- Department of General SurgeryXishan People's Hospital of Wuxi CityWuxiChina
- Department of Hepatic‐Biliary‐Pancreatic Surgerythe Affiliated Drum Tower Hospital of Nanjing University Medical schoolNanjingChina
- Department of Immunology, Ophthalmology & ORLComplutense University School of MedicineMadridSpain
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Niebuhr H, Köckerling F, Fortelny R, Hoffmann H, Conze J, Holzheimer RG, Koch A, Köhler G, Krones C, Kukleta J, Kuthe A, Lammers B, Lorenz R, Mayer F, Pöllath M, Reinpold W, Schwab R, Stechemesser B, Weyhe D, Wiese M, Zarras K, Meyer HJ. [Inguinal hernia operations-Always outpatient?]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:230-236. [PMID: 36786812 PMCID: PMC9950173 DOI: 10.1007/s00104-023-01818-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 06/17/2023]
Abstract
Inguinal hernia operations represent the most frequent operations overall with 300,000 interventions annually in Germany, Austria and Switzerland (DACH region). Despite the announced political willingness and the increasing pressure from the legislator to avoid costly inpatient treatment by carrying out as many outpatient operations as possible, outpatient treatment has so far played a subordinate role in the DACH region. The Boards of the specialist societies the German Hernia Society (DHG), the Surgical Working Group Hernia (CAH of the DHG), the Austrian Hernia Society (ÖHG) and the Swiss Working Group Hernia Surgery (SAHC) make inroads into this problem, describe the initial position and assess the current situation.
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Affiliation(s)
- H Niebuhr
- Hamburger Hernien Centrum, Eppendorfer Baum 8, 20249, Hamburg, Deutschland.
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Ma Q, Liu X, Yang H, Gu L, Chen J. Utilization of laparoscopic and open inguinal hernia repair at a large hernia center in China: a single-center observational study. Surg Endosc 2023; 37:1140-1148. [PMID: 36138248 DOI: 10.1007/s00464-022-09624-w] [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: 06/29/2022] [Accepted: 09/11/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The utilization of laparoscopic and open inguinal hernia repair in China remains unclear. We aim to investigate the rates of laparoscopic and open inguinal hernia repairs and its associated factors at a large hernia center. METHODS Data were obtained from the front sheet of medical records of Beijing Chaoyang hospital. Adult inguinal hernia inpatients who underwent hernia repairs between 2013 and 2020 were included. We calculated the overall rates of laparoscopic and open inguinal hernia repairs and compared the rate of laparoscopic repairs between different sex, age groups, types, and sides of inguinal hernias. Multivariable logistic regression was used to examine factors associated with the rate of laparoscopic repairs. RESULTS 14,481 inpatients with inguinal hernia were included. 91.78% were male, 75.43% were more than 50 years, 75.20% were unilateral inguinal hernia, and 64.57% were indirect inguinal hernia. Overall, 49.47% underwent laparoscopic repairs and 50.53% underwent open repairs. Women had lower rate of laparoscopic repair than men, especially in those with unilateral hernias. Bilateral and direct inguinal hernia had higher rates of laparoscopic repair than unilateral and indirect inguinal hernia. Multivariable logistic regression showed that inpatients who were women, > 70 years, pantaloon inguinal hernia, with obstruction, and more comorbidities were less likely to have laparoscopic repairs. CONCLUSION Around 50% of inguinal hernia patients at a large hernia center underwent laparoscopic repairs, which was more commonly performed in male, young, bilateral inguinal hernia, and inpatients without comorbidities. More efforts were needed to increase the safe and effective laparoscopic utilization among female patients with inguinal hernias.
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Affiliation(s)
- Qiuyue Ma
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Number 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| | - Xiaoli Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Number 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| | - Huiqi Yang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Number 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China.
| | - Le Gu
- Department of Medical Record, Beijing Chaoyang Hospital, Capital Medical University, Number 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| | - Jie Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Number 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
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Lindenbergh KC, van Duinen AJ, Ahlbäck JG, Kamoh J, Bah S, Ashley T, Löfgren J, Grobusch MP, Sankoh O, Bolkan HA. Prevalence, incidence, repair rate, and morbidity of groin hernias in Sierra Leone: cross-sectional household study. BJS Open 2023; 7:6991921. [PMID: 36655327 PMCID: PMC9849845 DOI: 10.1093/bjsopen/zrac158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/08/2022] [Accepted: 10/26/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Knowledge about the prevalence of groin hernias in sub-Saharan Africa is limited. Previous studies have demonstrated a higher incidence of the condition than the annual repair rate. This study aimed to investigate prevalence, incidence, annual repair rate, morbidity, and health-seeking behaviour of persons with groin hernias in Sierra Leone. METHODS This population-based, cross-sectional household survey on groin hernias in Sierra Leone was part of the Prevalence Study on Surgical Conditions 2020 (PRESSCO 2020). Those who indicated possible groin hernia were asked problem-specific questions and underwent physical examination to confirm or exclude the diagnosis. RESULTS 3626 study participants were interviewed. The prevalence of untreated groin hernia was 1.1 per cent (95 per cent c.i. 0.8 to 1.5 per cent), whereas the prevalence of untreated and treated groin hernia was 2.5 per cent (95 per cent c.i. 2.0 to 3.0 per cent). The proportion of recurrence was 13.1 per cent. An incidence of 389 (95 per cent c.i. 213 to 652) groin hernia cases per 100 000 people per year was identified, while a population-based annual hernia repair rate estimation was 470 (95 per cent c.i. 350 to 620) per 100 000 people. Out of 39 participants with groin hernia, non-ignorable pain was reported by eight and 27 reported financial shortcomings as a reason for not seeking healthcare. CONCLUSIONS Groin hernias are common in Sierra Leone and although the repair rate might match the incidence, the existing backlog of untreated hernias is likely to remain. It may be possible to reduce the number of recurrences through improved management. Measures to reduce financial barriers to treatment seem crucial to improve the health of people with groin hernias in Sierra Leone.
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Affiliation(s)
| | - Alex J van Duinen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway,Department of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway,CapaCare, Norway, Sierra Leone, The Netherlands
| | - Johan G Ahlbäck
- Department of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | | | - Silleh Bah
- Statistics Sierra Leone, Tower Hill, Freetown, Sierra Leone
| | - Thomas Ashley
- CapaCare, Norway, Sierra Leone, The Netherlands,Kamakwie Wesleyan Hospital, Kamakwie, Sierra Leone
| | - Jenny Löfgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Martin P Grobusch
- Masanga Medical Research Unit, Masanga, Sierra Leone,Centre of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands,Institute of Tropical Medicine, University of Tubingen, Tubingen, Germany,Centre de Recherches Medicales en Lambarene (CERMEL), Lambarene, Gabon,Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Osman Sankoh
- Statistics Sierra Leone, Tower Hill, Freetown, Sierra Leone,School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa,Heidelberg Institute of Global Health, University of Heidelberg Medical School, Heidelberg, Germany
| | - Håkon A Bolkan
- Correspondence to: Håkon A. Bolkan, MD PhD, Norwegian University of Science and Technology, Postboks 8900, Torgarden, 7491 Trondheim, Norway (e-mail: )
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Fafaj A, Lo Menzo E, Rosen MJ. Intraoperative Urinary Catheter Use and Risk of Postoperative Urinary Retention -Reply. JAMA Surg 2023; 158:106. [PMID: 36260303 DOI: 10.1001/jamasurg.2022.5160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Aldo Fafaj
- Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Emanuele Lo Menzo
- Cleveland Clinic Florida, Weston Hospital, Department of General Surgery, Digestive Disease and Surgery Institute, Weston
| | - Michael J Rosen
- Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio
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Soppe S, Slieker S, Keerl A, Muller MK, Wirsching A, Nocito A. Emergency repair and smoking predict recurrence in a large cohort of ventral hernia patients. Hernia 2022; 26:1337-1345. [PMID: 36138268 DOI: 10.1007/s10029-022-02672-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/30/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Ventral hernias are frequent and hernia repair is regularly performed by general surgeons. Emergency repair is less frequent and can be challenging. Long-term data comparing outcomes of emergency- vs. elective ventral hernia repair are scarce. METHODS Consecutive patients undergoing emergency and elective ventral hernia repair at our institution were prospectively entered in our HerniaMed database between August 2013 and February 2020. Patients were contacted after 1 and 5 years to assess long-term complications. Risk factors for emergency repair and hernia recurrence were assessed by univariate and multivariate analysis. RESULTS We included 1307 patients. Emergency and elective hernia repair were performed in 11% and 89% of patients with 1-year follow-up rates of 94% and 92%. Female gender, BMI > 40 kg/m2, ASA class 3 and 4, large size umbilical herniation (> 4 cm) and epigastric herniation were more frequent in emergency hernia repair. Binary logistic regression analysis identified emergency repair and smoking as predictors of recurrence (Odds ratio: 4.04 and 95% confidence interval: 1.67-14.21, p = 0.004; Odds ratio: 2.94 and 95% confidence interval: 1.33-9.15, p = 0.011). Furthermore, female gender and significant comorbidity (ASA class 3 and 4) were risk factors for emergency repair (Odds ratio: 1.98 and 95% confidence interval: 01.05-3.74, p = 0.034; Odds ratio: 3.54 and 95% confidence interval: 1.79-6.98, p < 0.001). CONCLUSIONS Emergency repair and smoking predicted hernia recurrence. Females and highly comorbid patients are at increased risk for emergency repair and should be prioritized for early elective hernia repair.
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Affiliation(s)
- S Soppe
- Department of Surgery, Cantonal Hospital of Baden, Im Ergel 1, 5404, Baden, Switzerland
| | - S Slieker
- Department of Surgery, Cantonal Hospital of Baden, Im Ergel 1, 5404, Baden, Switzerland
| | - A Keerl
- Department of Surgery, Cantonal Hospital of Baden, Im Ergel 1, 5404, Baden, Switzerland
| | - M K Muller
- Department of Surgery, Cantonal Hospital of Frauenfeld, Frauenfeld, Switzerland
| | - A Wirsching
- Department of Surgery, Cantonal Hospital of Baden, Im Ergel 1, 5404, Baden, Switzerland
| | - A Nocito
- Department of Surgery, Cantonal Hospital of Baden, Im Ergel 1, 5404, Baden, Switzerland.
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Risk of bowel resection in incarcerated inguinal hernia: watch out for ASA score and hernia type. Langenbecks Arch Surg 2022; 407:3711-3717. [PMID: 35974249 DOI: 10.1007/s00423-022-02650-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/03/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Incarcerated inguinal hernias can promote bowel ischemia. Emergent bowel resection is associated with increased postoperative morbidity. Risk factors for bowel resection might identify patients who benefit from elective inguinal hernia repair. METHODS Sixty-five consecutive patients undergoing emergency inguinal hernia repair between 2012 and 2018 at our institution were entered in a prospective database. Data analysis was approved by the local ethics committee. Patient characteristics, surgery data, and postoperative outcomes were compared between patients with and without bowel resection. Risk factors for bowel resection were assessed with univariate and multivariate analysis. RESULTS Patients requiring bowel resection were more often female (87%, P = 0.004) and presented in 67% with a femoral hernia. Postoperative complications occurred more often after hernia reduction and bowel resection compared to no resection (67% vs. 36%, P = 0.035). ASA score 3-4 and femoral herniation were independent predictors of bowel resection (P = 0,046 and P = 0,047, respectively). CONCLUSION Highly comorbid patients can profit from early elective hernia repair to prevent bowel resection.
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Invited Commentary: Round Ligament Management in Female Patients: Art Meets Science. J Am Coll Surg 2022; 234:1200. [PMID: 35703819 DOI: 10.1097/xcs.0000000000000163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ali MA, Hagbevor I, Abedi E. Multiple complicated concurrent hernias with rare findings: Case report. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yelorda K, Rose L, Bundorf MK, Muhammad HA, Morris AM. Association Between High-Deductible Health Plans and Hernia Acuity. JAMA Surg 2022; 157:321-326. [PMID: 35152285 PMCID: PMC8842195 DOI: 10.1001/jamasurg.2021.7567] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/06/2021] [Indexed: 11/14/2022]
Abstract
IMPORTANCE About half of people younger than 65 years with private insurance are enrolled in a high-deductible health plan (HDHP). While these plans entail substantially higher out-of-pocket costs for patients with chronic medical conditions who require ongoing care, their effect on patients undergoing surgery who require acute care is poorly understood. It is plausible that higher out-of-pocket costs may lead to delays in care and more complex surgical conditions. OBJECTIVE To determine the association between enrollment in HDHPs and presentation with incarcerated or strangulated hernia. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort analysis included privately insured patients aged 18 to 63 years from a large commercial insurance claims database who underwent a ventral or groin hernia operation from January 2016 through June 2019 and classified their coverage as either a traditional health plan or an HDHP per the Internal Revenue Service's definition. Multivariable regression, adjusting for demographic and clinical covariates, was used to examine the association between enrollment in an HDHP and the primary outcome of presentation with an incarcerated or strangulated hernia. EXPOSURES Traditional health plan vs HDHP. MAIN OUTCOMES AND MEASURES Presence of an incarcerated or strangulated hernia per International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes. RESULTS Among 83 281 patients (71.9% men and 28.1% women; mean [SD] age, 48.7 [10.9] years) who underwent hernia surgery, 27 477 (33.0%) were enrolled in an HDHP and 21 876 (26.2%) had a hernia that was coded as incarcerated or strangulated. The mean annual deductible was considerably higher for those in the HDHP group than their traditional health plan counterparts (unadjusted mean [SD], $3635 [$2094] vs $705 [$737]; adjusted, -$2931; P < .001). Patients in the HDHP group were more likely to present with an incarcerated or strangulated hernia (adjusted odds ratio, 1.07; 95% CI, 1.03-1.11; P < .001). CONCLUSIONS AND RELEVANCE In this cohort study, enrollment in an HDHP was associated with higher odds of presenting with an incarcerated or strangulated hernia, which is more likely to require emergency surgery that precludes medical optimization. These data suggest that, among patients with groin and ventral hernias, enrollment in an HDHP may be associated with delays in surgical care that result in complex disease presentation.
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Affiliation(s)
- Kirbi Yelorda
- Department of Surgery, Stanford University School of Medicine, Stanford, California
- S-SPIRE Center, Palo Alto, California
| | - Liam Rose
- S-SPIRE Center, Palo Alto, California
- Health Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, California
| | - M. Kate Bundorf
- Sanford School of Public Policy, Duke University, Durham, North Carolina
| | - Huda A. Muhammad
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Arden M. Morris
- Department of Surgery, Stanford University School of Medicine, Stanford, California
- S-SPIRE Center, Palo Alto, California
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Takayama Y, Kaneoka Y, Maeda A, Takahashi T, Seita K. Long-Term Outcomes Using a Questionnaire After Inguinal Hernia Repair in Female. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03323-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Difficulties in Diagnosing Extraperitoneal Ureteroinguinal Hernias: A Review of the Literature and Clinical Experience of a Rare Encounter in Acute Surgical Care Settings. Diagnostics (Basel) 2022; 12:diagnostics12020353. [PMID: 35204443 PMCID: PMC8871209 DOI: 10.3390/diagnostics12020353] [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: 01/10/2022] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 02/05/2023] Open
Abstract
Although inguinal hernia repair is one of the most common surgical procedures, finding a retroperitoneal structure, such as the ureter, is a rather rare occurrence. Ureteroinguinal hernias may arise in the presence or absence of obstructive uropathy, the latter raising difficulties in diagnosis for the general surgeon performing a regular inguinal hernia surgery. This study aims to collect the relevant literature describing the diagnosis and management of ureteroinguinal hernias and update it with a case encountered in our clinic. The following study was reported following the SCARE guidelines. The relevant literature describes less than 150 cases of ureteroinguinal hernias overall, considering the 1.7% prevalence of inguinal hernias in the general population. With only 20% of these hernias being described as extraperitoneal, such an encounter becomes an extremely rare finding. Our clinical experience brings a case of a 75-year-old male with frequent urinary tract infections and a large irreducible inguinoscrotal hernia of about 20/12 cm located at the right scrotum. The patient underwent an open inguinal hernia repair technique under general anesthesia, incidentally finding an extraperitoneal ureteral herniation. Segmental ureterectomy was performed with uneventful recovery. Intraoperatively, finding an incidental ureteroinguinal hernia raises concerns about probable urinary tract complications during regular hernia repair surgery and whether the diagnosis is likely to happen prior to surgical intervention. Although imaging is rarely indicated in inguinal hernias, the case reports show that a pelvic CT scan with urography in symptomatic patients with urinary symptoms will provide accurate confirmation of the diagnosis. The relevant literature is limited due to the rarity of respective cases, thus making standardized management of such cases unlikely.
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Ali M, Abedi E, Hagbevor I, Kyei M. Bilateral female inguinal hernia repair in Margaret Marquart Catholic Hospital and review of literature. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2022; 12:47-52. [PMID: 36213812 PMCID: PMC9536410 DOI: 10.4103/jwas.jwas_10_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 05/31/2022] [Indexed: 11/20/2022]
Abstract
Background: Bilateral inguinal hernias are relatively rare in females compared to men. The management outcome of bilateral nylon darn, a method predominantly used in sub-Saharan Africa for same time repairs in complicated or elective hernia surgeries is largely unknown. Aims and Objectives: Our aim is to report a rare case of same time bilateral inguinal hernia obstruction and review the outcome of bilateral nylon darn posterior wall repairs after herniotomy. Design of the Study: This was a retrospective analysis of bilaterally operated inguinal hernia female patients data that was retrieved for the past 6-year period. Settings: All complete records of female patients who had same time bilateral inguinal hernia repairs at the Margaret Marquart Catholic Hospital (district hospital), for the period January 2015 to December 2020 were included in the study. Materials and Methods: Patient biodata, clinical notes on diagnosis, surgical management, postoperative care, and complications were extracted from hospital records and analysed. Results: A total of 14 patients aged between 40 and 87 years which represented 1.85% of the total hernia repairs were female with same time bilateral inguinal hernia repairs. Seven (50%) patients presented at the emergency with hernias detected over a year. Surgical site infection and pains after surgery were the predominant complications and occurred more common after emergency repairs. Conclusion: Emergency bilateral inguinal hernia repairs were three times associated with surgical site infection compared to elective repairs.
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Fitzgibbons R, McBee P, Walters R. Current status of inguinal hernia management: A review. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2022. [DOI: 10.4103/ijawhs.ijawhs_36_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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Waist Circumference is not Superior to Body Mass Index in Predicting Groin Hernia Repair in Either Men or Women. World J Surg 2021; 46:401-408. [PMID: 34727205 PMCID: PMC8724106 DOI: 10.1007/s00268-021-06359-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/23/2022]
Abstract
Background and aims A high body mass index (BMI) is considered a risk factor for ventral abdominal wall hernias but protective for the development of groin hernias. The reason for this is unclear. The surrounding abdominal fat in obesity might “protect” and limit the passage through the inguinal canal. The aim was to compare two different methods used for obesity registration in groin hernia patients and to investigate the hypothesis of high BMI/low groin hernia risk phenomenon. Methods This was a population-based observational study comparing BMI to waist circumference (WC) as well as their correlations to the quantity of groin hernia repair performed in either sex. Two national registers were crosslinked to a large regional register including information on WC. Results A larger WC and a higher BMI were associated with a lower risk of having groin hernia repair in both sexes. There was no difference using either WC or BMI as a risk factor for groin hernia repair in either sex. There was no advantage to using body composition based on WC rather than BMI for surgery indication. Conclusions Overweight patients, both men and women, have a lower risk of undergoing groin hernia repair regardless of fat distribution. BMI is a well-established method for obesity registration and is recommended in the evaluation of hernia patients.
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Alomar OSK. Modified Halsted's operation for inguinal hernia repair: A new technique. Ann Med Surg (Lond) 2021; 71:102968. [PMID: 34712482 PMCID: PMC8529394 DOI: 10.1016/j.amsu.2021.102968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background Inguinal hernia is a frequent problem presented to surgical clinic in Iraq. Surgical treatment options for inguinal hernia are numerous, selecting the appropriate method or technique depends on different factors. Aim of study To find a new technique for open inguinal hernia repair with no recurrence even in recurrent cases, without major complications during or after surgery, and can be used even by new surgeons with little experience. Patients & methods A retrospective cross sectional study conducted in the Medical City teaching hospital and Private Hospitals in Baghdad, during the period from January 1, 2000, to December 30, 2016 on convenient sample of 408 Iraqi patients with inguinal hernia. The patients were treated by modified Halsted's technique by open surgery applying polypropylene mesh. The patients were followed up through frequent visits and phone calls to assess the recurrence and complications. Results No recurrence of inguinal hernia was reported after 5-10 years follow up, while 94.9% of patients reported postoperative complications commonly oedema of spermatic cord. There was a highly significant association between male gender hernia patients and post Modified Halsted operation complications (p < 0.001). A highly significant association was observed between direct hernia and post Modified Halsted operation complications (p < 0.001). The significant risk factors related to complications were anemia and collagen disease. Conclusions The modified Halsted's operation for inguinal hernia repair is effective in treatment of inguinal hernia with low recurrence and complications rate.
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Inguinal hernia – epidemiology, risk factors, treatment methods (literature review). ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.4.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Inguinal hernias (IH) are widespread in the human population and occur in 27–43 % of men and 3–6 % of women. Many risk factors for IH have been overestimated in the last decade: male gender is considered the leading factor (the ratio between men and women is approximately 1:7), less significant factors are heredity (most significant for women), physical activity (more significant for men), age (peak prevalence of IH occurs at 5 years and 70–80 years), congenital or acquired connective tissue dysplasia, history of prostatectomy, low body mass index.Hernioplasty with the use of synthetic mesh prostheses remains the most popular technique for surgical correction of IH. Performing non-prosthetic hernioplasty is only recommended if mesh prostheses are not available, for example in poor countries. In open hernioplasty using mesh prostheses, different methods are used today: Plug & Patch, Prolene Hernia System, Parietene Progrip, sutureless plastic according to Trabucco, Stoppa, preperitoneal techniques TIPP (trans-inguinal pre-peritoneal), TREPP (transrectus pre-peritoneal), TEP (total extraperitoneal), however, none of them showed significant advantages over the gold standard of open hernioplasty – tensionfree repair according to Liechtenstein.Laparoscopic IH correction is represented by the TAPP (transabdominal preperitoneal) technique, performed through the abdominal cavity, and TEP (total extraperitoneal) – extraperitoneal prosthetic hernioplasty. None of them has a significant advantage in the treatment of IH; therefore, when choosing a treatment method, the surgeon should be guided by the cost of the operation and the level of proficiency in one or another hernioplasty technique.
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Stanton AP. An enlarging vulvar mass. JAAPA 2021; 34:56-57. [PMID: 34448781 DOI: 10.1097/01.jaa.0000769708.52059.e9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Amanda P Stanton
- Amanda P. Stanton practices in the Department of Medical and Surgical Gynecology at Mayo Clinic in Jacksonville, Fla., and is an instructor of obstetrics and gynecology at Mayo Clinic College of Medicine and Science. The author has disclosed no potential conflicts of interest, financial or otherwise
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Uili Coelho JC, El Hosni AV, Araujo Moreira G, Nemer Hajar F, Hass Aguilera YS, Teixeira de Freitas AC, Paggi Claus CM. Groin Hernia in Females Routinely Treated by Totally Extraperitoneal Laparoscopic Approach. JSLS 2021; 25:JSLS.2021.00021. [PMID: 34248342 PMCID: PMC8249219 DOI: 10.4293/jsls.2021.00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background and Objectives: There is a dearth of studies on laparoscopic treatment of female groin hernia. Our study assessed the outcome of groin hernia repair in females employing the totally extraperitoneal laparoscopic (TEP) access. Methods: Data of all females who were subjected to laparoscopic groin herniorrhaphy, from August 1998 to February 2020 were retrospectively obtained. Groin hernia repair was routinely started with TEP access. Results: A total of 2,399 patients who underwent laparoscopic groin herniorrhaphy, 254 (10.6%), were females. Most females (n = 191; 75.2%) had single hernia and the remaining (n = 63; 24.8%) had bilateral hernias, making a total of 317 hernias operated. Indirect inguinal hernia was the most common hernia type (72.5%), followed by femoral hernia (17.4%) and direct hernia (10.1%). Prior lower abdominal operations were recorded in 97 (38.2%) patients. Conversion to a laparoscopic transabdominal preperitoneal procedure was performed due to technical difficulties to dissect the preperitoneal space in 17 patients (6.7%) and to open procedure in only one patient (0.4%) with incarcerated femoral hernia in whom an incidental perforation of the small bowel occurred. Intra- and postoperative complications occurred in 12 (4.7%) and 15 (5.9%) patients, respectively. There was no mortality. Most patients (n = 221; 87%) were discharged on the same day of the operation. Hernia recurrence was diagnosed in 6 patients (2.4%). Conclusion: It is concluded that females with groin hernia may be successfully treated with totally extraperitoneal laparoscopic access, with low conversion and complication rates.
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Affiliation(s)
| | | | | | - Faissal Nemer Hajar
- Department of Surgery of the Hospital Nossa Senhora das Graças, Curitiba, Brazil
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Sex Differences, Sleep Disturbance and Risk of Persistent Pain Associated With Groin Hernia Surgery: A Nationwide Register-Based Cohort Study. THE JOURNAL OF PAIN 2021; 22:1360-1370. [PMID: 33964413 DOI: 10.1016/j.jpain.2021.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/30/2021] [Accepted: 04/14/2021] [Indexed: 02/06/2023]
Abstract
Persistent pain after groin hernia repair is a major health problem. Sleep disturbance is associated with heightened pain sensitivity. The main objective of this study was to examine the role of sleep disturbance in the development and long-term maintenance of chronic postherniorrhaphy inguinal pain (CPIP), with exploration of sex differences. From 2012 to 2017, a national cohort of patients with prior groin hernia repair (n = 2084;45.8% females) were assessed for the development of CPIP 12 months after surgery. Patients then underwent long-term (median 5.0 years) follow-up to evaluate the contribution of sex and sleep disturbance on the maintenance of CPIP. Associations between pre- and postoperative sleep problems (assessed at long-term follow-up) and CPIP were tested using logistic regression. Females had higher rates of CPIP with negative impact on daily activities 12 months after surgery as compared to males (14.6 vs 9.2%, P < .0005), and were more likely to have moderate-severe CPIP in the long-term (3.1 vs 1.2%, P = .003). Preoperative sleep problems predicted development of CPIP 12 months after surgery (adjusted odds ratio [aOR] 1.76 [95%CI 1.26-2.46], P = .001) and CPIP in the long-term (aOR 2.20 [1.61-3.00] , P < .0001). CPIP was associated with insomnia and depression. Sleep disturbance may increase the risk for CPIP, and contribute to maintenance of postsurgical pain. PERSPECTIVE: Females are at heightened risk for CPIP as compared to males. Increased severity of pain symptoms are linked to poorer sleep and psychiatric morbidity. Given the robust associations between sleep disturbance and CPIP, interventions which consolidate and promote sleep, especially in females, may improve long-term pain control.
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Köckerling F, Heine T, Adolf D, Zarras K, Weyhe D, Lammers B, Mayer F, Reinpold W, Jacob D. Trends in Emergent Groin Hernia Repair-An Analysis From the Herniamed Registry. Front Surg 2021; 8:655755. [PMID: 33859994 PMCID: PMC8042323 DOI: 10.3389/fsurg.2021.655755] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/08/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: While the proportion of emergency groin hernia repairs in developed countries is 2.5–7.7%, the percentage in developing countries can be as high as 76.9%. The mortality rate for emergency groin hernia repair in developed countries is 1.7–7.0% and can rise to 6–25% if bowel resection is needed. In this present analysis of data from the Herniamed Registry, patients with emergency admission and operation within 24 h are analyzed. Methods: Between 2010 and 2019 a total of 13,028 patients with emergency admission and groin hernia repairs within 24 h were enrolled in the Herniamed Registry. The outcome results were assigned to the year of repair and summarized as curves. The total patient collective is broken down into the subgroups with pre-operative manual reduction (taxis) of the hernia content, operative reduction of the hernia content without bowel resection and with bowel resection. The explorative Fisher's exact test was used for statistical assessment of significant differences with Bonferroni adjustment for multiple testing. Results: The proportion of emergency admissions with groin hernia repair within 24 h was 2.7%. The percentage of women across the years was consistently 33%. The part of femoral hernias was 16%. The proportion of patients with pre-operative reduction (taxis) remained unchanged at around 21% and the share needing bowel resection was around 10%. The proportion of TAPP repairs rose from 21.9% in 2013 to 38.0% in 2019 (p < 0.001). Between the three groups with pre-operative taxis, without bowel resection and with bowel resection, highly significant differences were identified between the patients with regard to the rates of post-operative complications (4% vs. 6.5% vs. 22.7%; p < 0.0001), complication-related reoperations (1.9% vs. 3.8% vs. 17.7%; p < 0.0001), and mortality rate (0.3% vs. 0.9% vs. 7.5%; p < 0.001). In addition to emergency groin hernia repair subgroups female gender and age ≥66 years are unfavorable influencing factors for perioperative outcomes. Conclusion: For patients with emergency groin hernia repair the need for surgical reduction or bowel resection, female gender and age ≥66 years have a highly significantly unfavorable influence on the perioperative outcomes.
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Affiliation(s)
- Ferdinand Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Berlin, Germany
| | | | | | - Konstaninos Zarras
- Department of Visceral, Minimally Invasive and Oncologic Surgery, Academic Teaching Hospital of University of Düsseldorf, Marien Hospital, Düsseldorf, Germany
| | - Dirk Weyhe
- Pius Hospital, Department of General and Visceral Surgery, University Hospital of Visceral Surgery, Oldenburg, Germany
| | - Bernhard Lammers
- Department of Surgery I, Section Coloproctology and Hernia Surgery, Lukas Hospital, Neuss, Germany
| | - Franz Mayer
- Department of Surgery, Paracelsus Medical Private University Salzburg, Salzburg, Germany
| | - Wolfgang Reinpold
- Department of Surgery, Wilhelmsburger Hospital Groß Sand, Academic Teaching Hospital of University Hamburg, Hamburg, Germany
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Kohga A, Kawabe A, Yajima K, Okumura T, Yamashita K, Isogaki J, Suzuki K, Muramatsu K, Komiyama A. Does preoperative enhanced CT predict requirement of intestinal resection in the patients with incarcerated myopectineal hernias containing small bowel? Hernia 2020; 25:1279-1287. [PMID: 33128678 DOI: 10.1007/s10029-020-02325-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/19/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Bowel wall enhancement on CT imaging is considered one of the useful features for the prediction of the presence of irreversible ischemic change in patients with small bowel obstruction. However, the applicability of CT imaging in patients with incarcerated hernias has not been investigated in detail. The aim of this retrospective study was to evaluate the feasibility of preoperative CT findings for the prediction of the presence of irreversible ischemic change in patients with incarcerated hernias containing small bowel. METHODS Included in this study were 76 patients who underwent surgery for preoperatively diagnosed incarcerated hernias containing small bowel (27 inguinal hernias, 37 femoral hernias and 12 obturator hernias) at our hospital between January 2011 and June 2020. The preoperative clinicoradiological features were compared between the groups, and predictors for intestinal resection were evaluated. RESULTS Nineteen patients required intestinal resection (Resection group), and the other 57 patients did not require intestinal resection (Nonresection group). Multivariate analyses revealed that age ≥ 80 years (p = 0.018, odds ratio = 6.604) and the absence of bowel wall enhancement (p = 0.032, odds ratio = 51.200) were independent predictors for intestinal resection. In resected specimens, all patients with an absence of bowel wall enhancement on preoperative enhanced CT had ischemic changes extending beyond the muscularis propria. CONCLUSIONS Preoperative enhancement CT yields useful information for the prediction of the presence of irreversible ischemic change in patients with incarcerated hernias containing small bowel.
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Affiliation(s)
- A Kohga
- Division of Surgery, Fujinomiya City General Hospital, 3-1, Nishiki-cho, Fujinomiya, Shizuoka, 4180076, Japan.
| | - A Kawabe
- Division of Surgery, Fujinomiya City General Hospital, 3-1, Nishiki-cho, Fujinomiya, Shizuoka, 4180076, Japan
| | - K Yajima
- Division of Surgery, Fujinomiya City General Hospital, 3-1, Nishiki-cho, Fujinomiya, Shizuoka, 4180076, Japan
| | - T Okumura
- Division of Surgery, Fujinomiya City General Hospital, 3-1, Nishiki-cho, Fujinomiya, Shizuoka, 4180076, Japan
| | - K Yamashita
- Division of Surgery, Fujinomiya City General Hospital, 3-1, Nishiki-cho, Fujinomiya, Shizuoka, 4180076, Japan
| | - J Isogaki
- Division of Surgery, Fujinomiya City General Hospital, 3-1, Nishiki-cho, Fujinomiya, Shizuoka, 4180076, Japan
| | - K Suzuki
- Division of Surgery, Fujinomiya City General Hospital, 3-1, Nishiki-cho, Fujinomiya, Shizuoka, 4180076, Japan
| | - K Muramatsu
- Division of Radiology, Fujinomiya City General Hospital, Shizuoka, Japan
| | - A Komiyama
- Division of Pathology, Fujinomiya City General Hospital, Shizuoka, Japan
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Danawar NA, Mekaiel A, Raut S, Reddy I, Malik BH. How to Treat Hernias in Pregnant Women? Cureus 2020; 12:e8959. [PMID: 32766002 PMCID: PMC7398739 DOI: 10.7759/cureus.8959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/02/2020] [Indexed: 11/30/2022] Open
Abstract
A hernia is a common surgical problem. Although hernias during pregnancy are uncommon, they can be challenging for both the surgeon and the patient if present. To date, there is no consensus in the medical community regarding the elective repair of hernias in pregnant women. The debate mainly concerns three areas: the timing, the approach, and the surgical technique. This study aims to offer a clear pathway in this field based on the best available data. In this study, we collected reviews written in English and published in PubMed from 2010 to 2020 (the exception being three articles that were published before 2010, which we retained since they contained relevant information). We used regular and Medical Subject Headings (MeSH) keywords. Two of the authors screened the collected studies to select the best articles that would fit our inclusion criteria for the review. The articles considered for this review can be classified into retrospective studies, case reports, and reviews. No randomized controlled trials were found. The lack of an agreement about the treatment of ventral hernias in fertile women makes the decision to treat and the process challenging. The treatment significantly depends on two factors: the symptoms and the pregnancy status at diagnosis. If the hernia is incarcerated or strangulated at presentation, an emergency repair is obligatory. If the hernia is symptomatic, but not complicated, elective surgery should be offered. The timing of repair will depend on whether the patient is already pregnant or non-pregnant. In pregnant patients, if the hernia is small and asymptomatic, it may be better to delay the surgery until after delivery or after the last pregnancy. If the hernia is symptomatic and seems to affect the patient's quality of life, it may be better to postpone the repair until the second trimester or after delivery if complications do not occur. Internal herniation (IH) should be suspected as a cause of the abdominal pain in pregnant women who have undergone laparoscopic Roux-en-Y gastric bypass (LRYGB). In pre-pregnancy patients, if the hernia is large and symptomatic, it may be better to do an elective repair and then wait for one or two years before the next pregnancy. However, if the hernia is small or minimally symptomatic, it may be better to hold the repair until after delivery or after the last pregnancy. Pregnancy may be considered a significant risk factor for hernia recurrence. The laparoscopic mesh repair should be offered whenever possible, whereas the open approach may be preferred in complicated cases. The suture repair may be suitable for both small hernias and in cases of gross contamination.
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Affiliation(s)
- Nuaman A Danawar
- General Surgery, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Andrew Mekaiel
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Sumit Raut
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Ishani Reddy
- Psychiatry and Behavioral Sciences, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Bilal Haider Malik
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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Stodolski M, Zirngibl H, Ambe PC. Gender discrimination in endoscopic groin hernia repair. Minimal invasive groin hernia repair is offered less often to female patients compared to male patients. J Visc Surg 2019; 157:271-276. [PMID: 31870628 DOI: 10.1016/j.jviscsurg.2019.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Groin hernia repair constitutes a very common procedure in general surgery. Minimal invasive closure of groin hernia has evolved to become the standard means of closure. However, there seems to be a gender-associated discrimination with regard to endoscopic groin hernia repair. We investigated the rate of endoscopic closure in female patients undergoing groin hernia closure. MATERIALS AND METHODS A retrospective analysis of the data of patients undergoing elective groin hernia repair within a four-year period from 2013 to 2016 was performed. The rate of endoscopic hernia repair was calculated for both genders. RESULTS Eight hundred and forty-six patients including 94 females and 752 males were included for analysis. The female group was significantly older compared to the male group (68.0 vs. 61.0 yrs, P=0.02). The rate of endoscopic groin hernia repair was significantly lower in the female group compared to in the male cohort (30% vs. 60%, P=0.001). The overall duration of surgery was 74.0min in the female cohort and 93.0min in the male group, P=0.001. However, there was no statistically significant difference amongst both groups with regard to the duration of surgery for endoscopic repair: 78.0min in the female group and 89.0min in the male group, P=0.67. CONCLUSION Findings from this retrospective collective suggests that, there might be some degree of sex discrimination with regard to endoscopic groin hernia repair in favor of the male population.
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Affiliation(s)
- M Stodolski
- Department of Surgery, Helios Universitätsklinikum Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - H Zirngibl
- Department of Surgery, Helios Universitätsklinikum Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - P C Ambe
- Department of Surgery, Helios Universitätsklinikum Wuppertal, Witten/Herdecke University, Wuppertal, Germany; Department of General, Visceral and Transplantation Surgery, University Hospital Münster Albert-Schweitzer-Campus 1, Gebäude W1 Waldeyerstraße 1, 48149 Münster, Germany.
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Köckerling F, Hoffmann H, Adolf D, D Weyhe, Reinpold W, Koch A, Kirchhoff P. Female sex as independent risk factor for chronic pain following elective incisional hernia repair: registry-based, propensity score-matched comparison. Hernia 2019; 24:567-576. [PMID: 31776879 PMCID: PMC7210249 DOI: 10.1007/s10029-019-02089-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/04/2019] [Indexed: 11/24/2022]
Abstract
Introduction To date, little attention has been paid by surgical scientific studies to sex as a potential influence factor on the outcome. Therefore, there is a sex bias in the surgical literature. With an incidence of more than 20% after 3 years, incisional hernias are a common complication following abdominal surgical procedures. The proportion of women affected is around 50%. There are very few references in the literature to the influence of sex on the outcome of elective incisional hernia repair. Materials and methods In all, 22,895 patients with elective incisional hernia repair from the Herniamed Registry were included in the study. The patients had undergone elective incisional hernia repair in a laparoscopic IPOM, open sublay, open IPOM, open onlay or suture technique. 1-year follow-up was available for all patients. Propensity score matching was performed for the 11,480 female (50.1%) and 11,415 male (49.9%) patients, creating 8138 pairs (82.0%) within fixed surgical procedures. Results For pain on exertion (11.7% vs 18.3%; p < 0.001), pain at rest (7.53% vs 11.1%; p < 0.001), and pain requiring treatment (5.4% vs 9.1%; p < 0.001) highly significant disadvantages were identified for the female sex when comparing the different results within the matched pairs. That was also confirmed on comparing sex within the individual surgical procedures. No sex-specific differences were identified for the postoperative complications, complication-related reoperations or recurrences. Less favorable intraoperative complication results in the female sex were observed only for the onlay technique. Conclusions Female sex is an independent risk factor for chronic pain after elective incisional hernia repair.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - H Hoffmann
- Center for Hernia Surgery and Proctology, St. Johanns-Vorstadt 44, 4056, Basel, Switzerland
| | - D Adolf
- StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany
| | - D Weyhe
- Pius Hospital Oldenburg, Medical Campus of University of Oldenburg, University Hospital of Visceral Surgery, Georgstraße 12, 26121, Oldenburg, Germany
| | - W Reinpold
- Department of Surgery, Wilhelmsburger Hospital Groß Sand, Academic Teaching Hospital of University Hamburg, Groß Sand 3, 21107, Hamburg, Germany
| | - A Koch
- Hernia Center Cottbus, Gerhard-Hauptmann-Strasse 15, 03044, Cottbus, Germany
| | - P Kirchhoff
- Center for Hernia Surgery and Proctology, St. Johanns-Vorstadt 44, 4056, Basel, Switzerland
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Köckerling F, Sheen AJ, Berrevoet F, Campanelli G, Cuccurullo D, Fortelny R, Friis-Andersen H, Gillion JF, Gorjanc J, Kopelman D, Lopez-Cano M, Morales-Conde S, Österberg J, Reinpold W, Simmermacher RKJ, Smietanski M, Weyhe D, Simons MP. The reality of general surgery training and increased complexity of abdominal wall hernia surgery. Hernia 2019; 23:1081-1091. [PMID: 31754953 PMCID: PMC6938469 DOI: 10.1007/s10029-019-02062-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/27/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The Accreditation and Certification of Hernia Centers and Surgeons (ACCESS) Group of the European Hernia Society (EHS) recognizes that there is a growing need to train specialist abdominal wall surgeons. The most important and relevant argument for this proposal and statement is the growing acceptance of the increasing complexity of abdominal wall surgery due to newer techniques, more challenging cases and the required 'tailored' approach to such surgery. There is now also an increasing public awareness with social media, whereby optimal treatment results are demanded by patients. However, to date the complexity of abdominal wall surgery has not been properly or adequately defined in the current literature. METHODS A systematic search of the available literature was performed in May 2019 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library, with 75 publications identified as relevant. In addition, an analysis of data from the Herniamed Hernia Registry was performed. The percentage of patients with hernia- or patient-related characteristics which unfavorably impacted the outcome of inguinal and incisional hernia repair was also calculated. RESULTS All present guidelines for abdominal wall surgery recommend the utilization of a 'tailored' approach. This relies on the prerequisite that any surgical technique used has already been mastered, as well as the recognized learning curves for each of the several techniques that can be used for both inguinal hernia (Lichtenstein, TEP, TAPP, Shouldice) and incisional hernia repairs (laparoscopic IPOM, open sublay, open IPOM, open onlay, open or endoscopic component separation technique). Other hernia- and patient-related characteristics that have recognized complexity include emergency surgery, obesity, recurrent hernias, bilateral inguinal hernias, groin hernia in women, scrotal hernias, large defects, high ASA scores, > 80 years of age, increased medical risk factors and previous lower abdominal surgery. The proportion of patients with at least one of these characteristics in the Herniamed Hernia Registry in the case of both inguinal and incisional hernia is noted to be relatively high at around 70%. In general surgery training approximately 50-100 hernia repairs on average are performed by each trainee, with around only 25 laparo-endoscopic procedures. CONCLUSION A tailored approach is now employed and seen more so in hernia surgery and this fact is referred to and highlighted in the contemporaneous hernia guidelines published to date. In addition, with the increasing complexity of abdominal wall surgery, the number of procedures actually performed by trainees is no longer considered adequate to overcome any recognized learning curve. Therefore, to supplement general surgery training young surgeons should be offered a clinical fellowship to obtain an additional qualification as an abdominal wall surgeon and thus improve their clinical and operative experience under supervision in this field. Practicing general surgeons with a special interest in hernia surgery can undertake intensive further training in this area by participating in clinical work shadowing in hernia centers, workshops and congresses.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - A J Sheen
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester, M13 9WL, UK
| | - F Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Universitair Ziekenhuis Gent, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - G Campanelli
- General and Day Surgery Unit, Center of Research and High Specialization for the Pathologies of Abdominal Wall and Surgical Treatment and Repair of Abdominal Hernia, Milano Hernia Center, Instituto Clinico Sant'Ambrogio, University of Insurbria, Milan, Italy
| | - D Cuccurullo
- Department of General, Laparoscopic and Robotic Surgery, Chief Week Surgery Departmental Unit, A.O. dei Colli Monaldi Hospital Naples, Naples, Italy
| | - R Fortelny
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital, 1160, Vienna, Austria
- Medical Faculty of Sigmund Freud University, 1020, Vienna, Austria
| | - H Friis-Andersen
- Surgical Department, Horsens Regional Hospital, Aarhus University, Sundvey 30, 8700, Horsens, Denmark
| | - J F Gillion
- Unité de Chirurgie Viscérale, Hôpital Privé d'Antony, 1, Rue Velpeau, 92160, Antony, France
| | - J Gorjanc
- Department of Surgery, Krankenhaus der Barmherzigen Brüder, Spitalgasse 26, 9300, St. Veit an der Glan, Austria
| | - D Kopelman
- Department of Surgery Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - M Lopez-Cano
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, University Hospital Virgen del Rocío, Av. Manuel Siurot, s/n, 41013, Seville, Spain
| | - J Österberg
- Department of Surgery, Mora Hospital, 79285, Mora, Sweden
| | - W Reinpold
- Wilhelmsburger Krankenhaus Gross-Sand, Gross-Sand 3, 21107, Hamburg, Germany
| | - R K J Simmermacher
- Department of Surgery, University Medical Center Utrecht, Heidelbergglaan 100, Utrecht, The Netherlands
| | - M Smietanski
- Department of General Surgery and Hernia Centre, Hospital in Puck, Medical University of Gdansk, Gdansk, Poland
| | - D Weyhe
- School of Medicine and Health Sciences, University Hospital for Visceral Surgery, Pius Hospital Oldenburg, Medical Campus University of Oldenburg, Georgstr. 12, 26121, Oldenburg, Germany
| | - M P Simons
- Department of Surgery, OLVG Hospital, Amsterdam, The Netherlands
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Ilonzo N, Gribben J, Neifert S, Pettke E, Leitman IM. Laparoscopic inguinal hernia repair in women: Trends, disparities, and postoperative outcomes. Am J Surg 2019; 218:726-729. [PMID: 31353033 DOI: 10.1016/j.amjsurg.2019.07.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/25/2019] [Accepted: 07/17/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION This study analyzed trends in laparoscopic inguinal hernia repair over time, rates of laparoscopic repair in women, and subsequent postoperative outcomes. METHODS Data for 237,503 patients undergoing repair of an initial, reducible inguinal hernia were analyzed using the National Surgical Quality Improvement Program (NSQIP) database for years 2006-2017. Data were analyzed by univariate and multivariate analysis. RESULTS Since 2006, there was an increased proportion of laparoscopic inguinal hernia surgeries, from 20.49% in 2006 to 36.36% in 2017 (p < .001). The percentage of women with bilateral inguinal hernias that underwent laparoscopic repair was less than the percentage of men (31.58% vs. 41.43%, p < .001). Based on multivariate analysis, women were less likely to have laparoscopic hernia repair (OR 0.74, CI 0.71-0.76). Postoperative complications were overall low. CONCLUSION A greater proportion of inguinal hernia repairs are performed laparoscopically. Women with bilateral inguinal hernias are more likely than men to undergo open rather than laparoscopic inguinal hernia repair.
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Affiliation(s)
- Nicole Ilonzo
- Icahn School of Medicine at Mount Sinai, United States
| | - Jeanie Gribben
- Mount Sinai St. Luke's-West, 425 West 59th Street, Suite 7B, New York, NY, 10019, United States
| | - Sean Neifert
- Mount Sinai St. Luke's-West, 425 West 59th Street, Suite 7B, New York, NY, 10019, United States
| | - Erica Pettke
- Icahn School of Medicine at Mount Sinai, United States.
| | - I Michael Leitman
- Mount Sinai St. Luke's-West, 425 West 59th Street, Suite 7B, New York, NY, 10019, United States
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Berry B, Keshishian K, Taylor F, Willmott F. Multidisciplinary management of an incarcerated femoral hernia containing an ovary in a 41-year-old multiparous women. BMJ Case Rep 2019; 12:12/5/e229571. [PMID: 31118176 DOI: 10.1136/bcr-2019-229571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Brendan Berry
- Department of Surgery, Whipps Cross University Hospital, London, UK
| | | | - Fiona Taylor
- Department of Surgery, Whipps Cross University Hospital, London, UK
| | - Fredric Willmott
- Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, London, UK
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Köckerling F. TEP for elective primary unilateral inguinal hernia repair in men: what do we know? Hernia 2019; 23:439-459. [PMID: 31062110 PMCID: PMC6586704 DOI: 10.1007/s10029-019-01936-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 03/26/2019] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Based on the new international guidelines for groin hernia management, there is no one surgical technique that is suited to all patient characteristics and diagnostic findings. Therefore, a tailored approach should be used. Here, a distinction must be made between primary unilateral inguinal hernia in men and in women, bilateral inguinal hernia, scrotal inguinal hernia, inguinal hernia following pelvic and lower abdominal procedures, patients with severe cardiopulmonary complications, recurrent inguinal hernias and incarcerated inguinal and femoral hernias. This paper now explores the relevant studies on TEP for elective primary unilateral inguinal hernia in men, which constitutes the most common indication for repair. MATERIAL A systematic search of the available literature was performed in February 2019 using Medline, PubMed, Scopus, Embase, Springer Link and the Cochrane Library. Only meta-analyses, systematic reviews, RCTs and comparative registry studies were considered. 117 publications were identified as relevant. RESULTS RCTs and comparative registry analyses demonstrated the advantages of TEP with regard to postoperative complications, complication-related reoperations, and postoperative and chronic pain compared with Lichtenstein repair for elective primary unilateral inguinal hernia repair in men. No relevant differences were found compared with TAPP. Mesh fixation is not needed in TEP, but heavyweight meshes result in a lower recurrence rate. Extraperitoneal bupivacaine analgesia vs placebo does not demonstrate any advantages, but drainage is advantageous for seroma prophylaxis. The risk of chronic pain is negatively influenced by small defects, younger patient age, preoperative pain, higher BMI, postoperative complications, higher ASA score and risk factors. CONCLUSION For the subgroup of elective primary unilateral inguinal hernia in men, accounting for a proportion of less than 50% of the total collective, advantages were identified for TEP compared with open Lichtenstein repair but not versus TAPP.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
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Alexey VA, Bashankaev B. Laparoscopic round ligament preserving repair for groin hernia in women: A critical appraisal. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2019. [DOI: 10.4103/ijawhs.ijawhs_23_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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