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Sbacco V, Petrucciani N, Lauteri G, Cossa A, Portinari M, Brescia A, Garulli G. Management of groin hernias in emergency setting: differences in indications and outcomes between laparoscopic and open approach. A single-center retrospective experience. Langenbecks Arch Surg 2024; 409:48. [PMID: 38277083 PMCID: PMC10817833 DOI: 10.1007/s00423-024-03238-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Abstract
PURPOSE The use of minimally invasive groin hernia repair techniques in an emergency setting is still debated and its widespread is limited. The aim of this study is to evaluate the safety and efficacy of the laparoscopic transabdominal preperitoneal (TAPP) technique in the treatment of inguinal and femoral hernias in emergency setting based on our experience, comparing indications and outcomes with the open technique. METHODS A retrospective analysis was performed including all patients with incarcerated and/or strangulated groin hernia who underwent emergency surgery from November 2019 to September 2022. Perioperative variables and short- and long-term outcomes were examined. Statistical analysis was performed using chi-square test for nominal variables and Student's t test for continuous ones. A p value < 0.05 was considered statistically significant. RESULTS Sixty-six patients were included: 29 patients were treated with TAPP technique (Tapp group) and 37 with open technique plus diagnostic laparoscopy (Open group). Patients in the TAPP group were younger, had less severe clinical scenarios, and had a trend for lower Charlson Comorbidity Index, whereas ASA score and BMI were similar. The small bowel was more frequently herniated in the open group. Bilateral hernia repair was performed in 20.69% of patients in the Tapp group versus 0% in the Open group (p = 0.004). Bowel resection was more frequent in the open group (48.65% vs 0% of the Tapp group, p < 0.001) length of surgery was comparable in the two groups. In the Tapp group, the length of hospitalization was significantly shorter (2.59 ± 2.28 days vs. 9.08 ± 14.48 days; p = 0.023). Postoperative complications, according to Clavien-Dindo, were more severe in Open group where there were two deaths. There were no differences in the number of readmission and re-operations at 30 days and in the recurrence rate. CONCLUSIONS Emergency repair of inguinal and femoral hernias using TAPP is a valuable option, safe and feasible in selected patients. In this series, indications for TAPP were reserved to younger patients with less comorbidities and less severe clinical scenario. Future randomized studies are needed to compare TAPP with open emergency hernia surgery in all settings. Potential advantages of TAPP are the reduction of postoperative complications, earlier recovery, and the possibility of bilateral treatment.
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Affiliation(s)
- V Sbacco
- Department of Medical and Surgical Sciences and Translational Medicine, Unit of Colorectal Oncologic Surgery, "Sant'Andrea" University Hospital, Sapienza University of Rome, Rome, Italy
- Unit of General and Emergency Surgery, Infermi Hospital, Rimini, Italy
| | - N Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, Unit of Colorectal Oncologic Surgery, "Sant'Andrea" University Hospital, Sapienza University of Rome, Rome, Italy.
| | - G Lauteri
- Department of Medical and Surgical Sciences and Translational Medicine, Unit of Colorectal Oncologic Surgery, "Sant'Andrea" University Hospital, Sapienza University of Rome, Rome, Italy
| | - A Cossa
- Department of Medical and Surgical Sciences and Translational Medicine, Unit of Colorectal Oncologic Surgery, "Sant'Andrea" University Hospital, Sapienza University of Rome, Rome, Italy
| | - M Portinari
- Unit of General and Emergency Surgery, Infermi Hospital, Rimini, Italy
| | - A Brescia
- Department of Medical and Surgical Sciences and Translational Medicine, Unit of Colorectal Oncologic Surgery, "Sant'Andrea" University Hospital, Sapienza University of Rome, Rome, Italy
| | - G Garulli
- Unit of General and Emergency Surgery, Infermi Hospital, Rimini, Italy
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Soliani G, De Troia A, Portinari M, Targa S, Carcoforo P, Vasquez G, Fisichella PM, Feo CV. Laparoscopic versus open incisional hernia repair: a retrospective cohort study with costs analysis on 269 patients. Hernia 2017; 21:609-618. [PMID: 28396956 DOI: 10.1007/s10029-017-1601-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 03/30/2017] [Indexed: 01/29/2023]
Abstract
PURPOSE To compare clinical outcomes and institutional costs of elective laparoscopic and open incisional hernia mesh repairs and to identify independent predictors of prolonged operative time and hospital length of stay (LOS). METHODS Retrospective observational cohort study on 269 consecutive patients who underwent elective incisional hernia mesh repair, laparoscopic group (N = 94) and open group (N = 175), between May 2004 and July 2014. RESULTS Operative time was shorter in the laparoscopic versus open group (p < 0.0001). Perioperative morbidity and mortality were similar in the two groups. Patients in the laparoscopic group were discharged a median of 2 days earlier (p < 0.0001). At a median follow-up over 50 months, no difference in hernia recurrence was detected between the groups. In laparoscopic group total institutional costs were lower (p = 0.02). At Cox regression analysis adjusted for potential confounders, large wall defect (W3) and higher operative risk (ASA score 3-4) were associated with prolonged operative time, while midline hernia site was associated with increased hospital LOS. Open surgical approach was associated with prolongation of both operative time and LOS. CONCLUSIONS Laparoscopic approach may be considered safely to all patients for incisional hernia repair, regardless of patients' characteristics (age, gender, BMI, ASA score, comorbidities) and size of the wall defect (W2-3), with the advantage of shorter operating time and hospital LOS that yields reduced total institutional costs. Patients with higher ASA score and large hernia defects are at risk of prolonged operative time, while an open approach is associated with longer duration of surgical operation and hospital LOS.
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Affiliation(s)
- G Soliani
- University of Ferrara, Ferrara, Italy.,Department of Surgery, S. Anna University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - A De Troia
- University of Ferrara, Ferrara, Italy.,Department of Surgery, S. Anna University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - M Portinari
- University of Ferrara, Ferrara, Italy.,Department of Surgery, S. Anna University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - S Targa
- University of Ferrara, Ferrara, Italy.,Department of Surgery, S. Anna University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - P Carcoforo
- University of Ferrara, Ferrara, Italy.,Department of Surgery, S. Anna University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - G Vasquez
- University of Ferrara, Ferrara, Italy.,Department of Surgery, S. Anna University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - P M Fisichella
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.,Boston VA Healthcare System, 1400 VFW Parkway (112), West Roxbury, MA, 02132, USA
| | - C V Feo
- University of Ferrara, Ferrara, Italy. .,Department of Surgery, S. Anna University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy.
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Feo C, Portinari M, Ascanelli S, Targa S, Dos Santos E, Camerani S, Castelli M, Verri M, Volta C, Bonvento B, Vagnoni E. Impact of an ERAS programme on clinical outcomes and institutional costs in elective laparoscopic and open colorectal resections. Clin Nutr ESPEN 2016. [DOI: 10.1016/j.clnesp.2016.02.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Carcoforo P, Raiji MT, Langan RC, Lanzara S, Portinari M, Maestroni U, Palini GM, Zanzi MV, Bonazza S, Pedriali M, Feo CV, Stojadinovic A, Avital I. Infiltrating lobular carcinoma of the breast presenting as gastrointestinal obstruction: a mini review. J Cancer 2012; 3:328-32. [PMID: 22866167 PMCID: PMC3408697 DOI: 10.7150/jca.4735] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 07/03/2012] [Indexed: 12/18/2022] Open
Abstract
One in twelve American women will develop breast cancer, with infiltrating lobular carcinoma (ILC) comprising approximately 15% of these cases. The incidence of ILC has been increasing over the last several decades. It has been hypothesized that this increase is associated with combined replacement hormonal therapy. Although pathologically distinct from infiltrating ductal carcinoma (IDC), ILC is treated in the same manner as IDC. However, ILC demonstrates significantly different patterns of late local recurrence and distant metastasis. The incidence of extra-hepatic gastrointestinal metastases is reported to be 6% to 18%, with stomach being most common. Herein, we present a brief review of the literature and a typical case involving ILC initially presenting as a small bowel obstruction. Evidence suggests that the late clinical patterns of ILC are distinctly separate from IDC and physicians need be cognizant of its late local recurrence and unique late metastatic pattern. Different follow up strategy should be entertained in patients with ILC.
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Affiliation(s)
- P Carcoforo
- 1. Section of General Surgery, Department of Surgical, Anaesthesiological and Radiological Sciences, Azienda Ospedaliero-Universitaria, Arcispedale Sant'Anna, Ferrara, Italy
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