1
|
Chiu MK, Hadied MO, Klochko C, van Holsbeeck MT. Comparison of patient characteristics and treatment approaches for femoral and inguinal hernias utilizing dynamic ultrasound at a single institution. Hernia 2023; 27:1245-1252. [PMID: 37253821 PMCID: PMC10533618 DOI: 10.1007/s10029-023-02810-2] [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: 03/18/2023] [Accepted: 05/21/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE To assess the differences in management approach to femoral versus inguinal hernias and to identify patient characteristics associated with each hernia type. METHODS Imaging studies for patients who had undergone dynamic ultrasound evaluation for the symptom of groin pain between January 1, 2010, and March 31, 2019, at a single institution Musculoskeletal Department were analyzed. Positive femoral hernia imaging studies were compared to studies for inguinal hernias and matching medical records for imaging studies were analyzed. Association of patient characteristics (age, sex, smoking, diabetes) with hernia type was assessed. Primary outcomes were surgical versus non-surgical approach, type of surgery, number of follow-up visits, and pain resolution. RESULTS A total of 1319 patients presented with groin pain and were assessed with dynamic ultrasound (534 female; 785 male; mean [± SD] age 48.2 ± 16.5). While 409 (31.0%) patients had a femoral hernia detected, 666 (50.6%) had an inguinal hernia detected (p < .05). Significantly more inguinal hernias were surgically repaired than femoral hernias (65.0% vs 53.9% p = .008), and more inguinal hernias than femoral hernias were treated with open surgery (71.0% vs 57.7%; p = .014). Patients with femoral hernias had significantly more follow-up clinic visits than patients with inguinal hernias (mean [± SD] 2.65 ± 4.80 vs 1.76 ± 1.27; p = .010). No difference in the percentage of patients who had pain resolution was observed (82.2% inguinal vs 75.0% femoral; p = .13). CONCLUSIONS Femoral hernias were managed more conservatively than inguinal hernias at our institution.
Collapse
Affiliation(s)
- M K Chiu
- University of Southern California, 1500 San Pablo St., 2nd Floor Imaging, Los Angeles, CA, 90033, USA.
| | - M O Hadied
- Department of Radiology, Henry Ford Health System, 2799 W. Grand Boulevard, Detroit, MI, 48202, USA
| | - C Klochko
- Department of Radiology, Henry Ford Health System, 2799 W. Grand Boulevard, Detroit, MI, 48202, USA
| | - M T van Holsbeeck
- Department of Radiology, Henry Ford Health System, 2799 W. Grand Boulevard, Detroit, MI, 48202, USA
| |
Collapse
|
2
|
Monib S, Hamad A, Habashy HF. Small Bowel Perforation as a Consequence of Strangulated Direct Inguinal Hernia. Cureus 2020; 12:e12181. [PMID: 33489592 PMCID: PMC7815260 DOI: 10.7759/cureus.12181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Inguinal hernia is probably one of the most common surgical conditions, with strangulation accounting for a good number of acute surgical admissions. It has always been known that direct hernias are less likely to strangulate due to wide hernial defects in comparison to indirect hernia. For that reason, some surgeons do not attempt repair of direct hernias in elderly patients. We present a relatively uncommon case of a 58-year-old gentleman who presented with clinical signs of an incarcerated inguinal hernia; which was found at exploration to be a strangulated direct hernia with small bowel perforation. We believe that direct inguinal hernia should always be included in the differential diagnosis of incarcerated or strangulated groin hernia.
Collapse
Affiliation(s)
- Sherif Monib
- Breast Surgery, West Hertfordshire Hospitals NHS Trust, St. Albans and Watford General Hospitals, London, GBR
| | - Ahmed Hamad
- Breast Surgery, University Hospitals of Derby & Burton, Derby, GBR
| | - Hany F Habashy
- Surgical Oncology, Faculty of Medicine Fayoum University, Faiyum, EGY
| |
Collapse
|
3
|
Sonographic "speech bubble/speech box sign" in clinically occult femoral hernias: ultrasound findings and anatomical basis. J Ultrasound 2020; 24:361-366. [PMID: 32504328 DOI: 10.1007/s40477-020-00484-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/20/2020] [Indexed: 12/14/2022] Open
Abstract
Femoral hernia is the protrusion of a peritoneal sac through the femoral ring into the femoral canal lying deep and inferior to the inguinal ligament. The hernia sac usually contains preperitoneal fat, omentum, bowel, or fluid. Ultrasound is recommended as the first-line investigation for diagnosing clinically occult femoral hernias in nonemergency settings, whereas CT is the imaging of choice in emergency settings. High accuracy of the ultrasound in clinically occult femoral hernia is further validated with further CT and MRI. In this article, we propose sonographic detection of the physiological peritoneal fluid herniating through capacious femoral ring manifesting as a "speech bubble/speech box appearance." This is a potentially invaluable sonographic sign for clinically occult femoral hernias, differentiating them from inguinal hernias and cysts of the canal of Nuck in females and preventing inadvertent attempts to aspirate.
Collapse
|
4
|
Simple, Frequent Indicator for Personal Identification-Postmortem and Antemortem Abdominal Computed Tomography Findings of a Charred Body. Am J Forensic Med Pathol 2020; 41:56-59. [PMID: 31929321 DOI: 10.1097/paf.0000000000000522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Postmortem personal identification in forensic science is performed using various methods. However, severely burnt bodies are hard to identify using odontological or skeletal features because of carbonization, and sometimes DNA profiling is impracticable because of the unavailability of the relatives. We present a case of a burn victim found after a house fire. Personal identification was attempted, but the body was heavily charred to the bones and the use of physical appearance was impracticable. There were no known relatives or personal belongings of the deceased for comparison of DNA typing. We obtained a series of abdominal computed tomography (CT) scans taken antemortem and found bilateral multiple renal cysts, left renal artery calcification, and a big right inguinal hernia, which matched the deceased's postmortem CT findings and autopsy findings. To date, studies of identification by CT have acted for a rise in precision, but they require complicated calculation or high graphical methods. Calcification of the arteries or renal cysts seen in our case are very common lesions present in many adults with abundant variation; thus, they may be helpful as simple indicators for identification.
Collapse
|
5
|
Gupta H, Subedi N, Robinson P. Effectiveness of Sonography in Detecting Clinically Occult Femoral Hernias. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1675-1679. [PMID: 27335438 DOI: 10.7863/ultra.15.09045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 11/13/2015] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the accuracy of sonography for femoral hernia diagnosis in patients with suspected hernias that were not evident on clinical examination. METHODS A retrospective analysis was performed for 39 consecutive patients with 40 clinically suspected but occult femoral hernias and subsequent positive sonographic findings for femoral hernias. Clinical records for all patients were reviewed for surgical outcomes and clinical follow-up. Surgical findings of a femoral hernia sac or widened femoral canal requiring repair, with symptomatic relief after the procedure, were considered positive for a femoral hernia. RESULTS Among the 40 femoral hernias examined by sonography, 33 of 40 groins underwent surgical exploration, with 32 true-positive findings and 1 false-positive finding on sonography. The false-positive case was an inguinal hernia at surgery. The accuracy of sonography was 96.9% for those with surgical correlations. The remaining 7 patients did not undergo surgery but had clinical follow-up. CONCLUSIONS This study confirms high diagnostic accuracy of sonography for nonpalpable femoral hernias in symptomatic groins compared to surgical findings.
Collapse
Affiliation(s)
- Harun Gupta
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, England
| | - Nawaraj Subedi
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, England
| | - Philip Robinson
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, England. Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, England
| |
Collapse
|
6
|
Wu JJ, Baldwin BC, Goldwater E, Counihan TC. Should we perform elective inguinal hernia repair in the elderly? Hernia 2016; 21:51-57. [PMID: 27438793 DOI: 10.1007/s10029-016-1517-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/03/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE Many surgeons are reluctant to offer elective inguinal and femoral hernia repair (IHR) to the elderly due to concerns of increased risk. The authors sought to evaluate the outcomes of elderly patients undergoing IHR compared to the general population. METHODS We performed a retrospective review of the 2011 NSQIP database evaluating 19,683 patients undergoing IHR. Patients were divided by age into three categories: <65, 65-79 and >80. Logistic regression analysis was used to assess impact of comorbid conditions and type of surgery on outcomes. Patients were analyzed for mortality and complications based on their age and the types of surgery (elective, urgent, emergent, laparoscopic versus open) and comorbid conditions. RESULTS There were 17,375 male patients (88 %). 92.7 % were elective. 70 % were performed using an open technique. Age distribution was 63.4 % < 65, 26.6 % 65-79, 10 % >80. Mortality was similar across age groups in elective repair. Mortality was increased in emergency repair in all age groups (p < 0.001). Mortality was increased in emergency surgery compared to elective surgery in patients >80 (OR = 57, p < 0.001). Mortality was similar between laparoscopic and open in <65 (OR = 0.96, p = 0.97) and unable to be assessed in other age groups. Dyspnea and COPD predicted higher mortality and complications with emergency surgery in the elderly (age 65-79 OR 15.3 and 14.9, respectively, age >80 OR 56.5 and 14.9, respectively). CONCLUSIONS Elective inguinal hernia repair carries a similar mortality in the elderly compared to the general population. Emergent IHR carries a very high risk of death in the elderly. The authors recommend considering elective IHR regardless of age.
Collapse
Affiliation(s)
- J J Wu
- Baystate Medical Center, 759 Chestnut Street, Springfield, MA, 01199, USA.
| | - B C Baldwin
- Berkshire Medical Center, 725 North Street, Pittsfield, MA, 01201, USA
| | - E Goldwater
- University of Massachusetts Amherst, Amherst, MA, USA
| | - T C Counihan
- Veteran Affairs Medical Center, White River Junction, VT, USA
| |
Collapse
|
7
|
Abstract
PURPOSE Although there is a high incidence of inguinal hernia in developed countries, few studies have been conducted to describe the symptoms, and these few only address the local symptoms, not those presenting at other levels. The aim of the present study is to conduct a detailed review of the symptoms, both inguinal and otherwise, of patients with inguinal hernia. METHODS A case-control study was designed to compare the symptoms presented by 231 patients diagnosed with inguinal hernia with those of a second group of 231 randomly-selected subjects. In the hernia group, the symptoms were also evaluated according to the location of the hernia (right, left, bilateral). RESULTS Significant differences (more symptomatology in patients with hernia) were found for the following items: groin pain, genital pain, urinary symptoms, abdominal pain, increased peristalsis and tenesmus. On the contrary, the control patients presented greater symptomatology with respect to back pain and diaphragm pain. CONCLUSIONS Patients with inguinal hernia present a wide variety of symptoms, and these are not restricted to the inguinal area. It is important to be aware of this fact to convey accurate information to the patient, especially with regard to postoperative expectations.
Collapse
|
8
|
|
9
|
Ischemia modified albumin can predict necrosis at incarcerated hernias. DISEASE MARKERS 2013; 35:807-10. [PMID: 24379518 PMCID: PMC3860091 DOI: 10.1155/2013/185425] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 10/25/2013] [Accepted: 11/07/2013] [Indexed: 11/29/2022]
Abstract
Purpose. To evaluate the predictive effect of IMA in incarcerated hernias. Methods. Three groups (n = 7) of rats were operated. Group I aimed to mimic incarceration, group II aimed the strangulation, and group III was the sham group. IMA and LDH measurements were made. Results. IMA levels were significantly higher in strangulation mimicking group and IMA levels were normal at postoperative 6th hour in incarceration mimicking group. LDH levels were significantly higher in both incarceration and strangulation mimicking groups. Conclusion. IMA seems to be an effective marker in incarcerated hernias to predict necrosis. But we need further studies to generalise this hypothesis.
Collapse
|
10
|
Hakiman H, Delibero J, Pham T, Dineen S, Huerta S. Coughing-induced bowel transection in a patient with an incarcerated inguinal hernia: a case report. J Med Case Rep 2013; 7:47. [PMID: 23414609 PMCID: PMC3582600 DOI: 10.1186/1752-1947-7-47] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 01/17/2013] [Indexed: 11/15/2022] Open
Abstract
Introduction Although blunt trauma to a hernia-containing bowel is known to cause bowel perforation, this report documents the first incident of a small bowel transection following a non-traumatic event. Case presentation We report the case of a 49-year-old African American man with a chronic incarcerated inguinal hernia awaiting elective repair. He presented to the Emergency Department with abdominal pain following an episode of coughing. On examination, he was found to have peritonitis. He underwent exploratory laparotomy, and had a complete small bowel transection. A bowel resection with primary anastomosis was performed, as well an inguinal hernia repair. Conclusion Chronic hernia incarceration can lead to weakening and ischemia of the bowel, and minimal trauma can lead to perforation of the weakened segment. In such presentations, bowel resection and repair of the defect with a biological material is safe and feasible.
Collapse
Affiliation(s)
- Hekmat Hakiman
- University of Texas Southwestern Medical Center Department of surgery, 5323 Harry Hines Blvd,, Dallas, TX, 75390-9159, USA.
| | | | | | | | | |
Collapse
|
11
|
Abi-Haidar Y, Sanchez V, Itani KMF. Risk factors and outcomes of acute versus elective groin hernia surgery. J Am Coll Surg 2011; 213:363-9. [PMID: 21680204 DOI: 10.1016/j.jamcollsurg.2011.05.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 05/10/2011] [Accepted: 05/16/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Hernia characteristics and patient factors associated with acute compared with elective groin hernia surgery are unknown. STUDY DESIGN A retrospective study of 1,034 consecutive groin hernia repair cases performed between 2001 and 2009 at a single Veterans Affairs Hospital was conducted. Patient variables, hernia characteristics, time to surgery, and morbidity and mortality outcomes were abstracted and compared between acute and elective hernia repairs. A Kaplan-Meier survival analysis for the two groups was also performed. Logistic regression analysis was conducted to identify associations between type of surgery, patient demographics, and hernia characteristics. RESULTS Compared with 971 elective repair patients, the 63 acute repair patients had a higher rate of femoral hernias (2.5% vs 7.4%, p = 0.03), a higher rate of scrotal hernias (16.2% vs 32.4%, p = 0.0006), and a higher rate of recurrent hernias (16.7% vs 30.9%, p = 0.0026). Patient age, femoral, scrotal, and recurrent hernias were significantly associated with acute hernia presentation on univariate and multivariable analyses. Complications occurred in 27% and 15.1% of acute and elective repair patients, respectively (p = 0.01). Intraoperative organ resection was required in 7 (11.1%) acute hernia repairs, and in 2 (0.2%) elective repairs (p < 0.0001). Three acute repair patients (4.8%) underwent reoperation within 30 days after surgery, compared with 15 elective repair patients (1.5%), p = 0.05. Age-adjusted Kaplan-Meier survival analysis revealed a shorter time to death among acute repair patients compared with elective repair patients (p < 0.0001). CONCLUSIONS Age, femoral, scrotal, and recurrent groin hernias are associated with increased risk for acute hernia surgery. Acute hernia repair carries a higher morbidity and lower survival.
Collapse
|
12
|
Mortality after groin hernia surgery: delay of treatment and cause of death. Hernia 2011; 15:301-7. [DOI: 10.1007/s10029-011-0782-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Accepted: 01/09/2011] [Indexed: 11/25/2022]
|
13
|
Akinci M, Ergül Z, Kulah B, Yilmaz KB, Kulacoğlu H. Risk factors related with unfavorable outcomes in groin hernia repairs. Hernia 2010; 14:489-93. [PMID: 20524024 DOI: 10.1007/s10029-010-0683-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Accepted: 05/15/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE Hernia repairs are a common surgical procedure, and are associated with a significant cost. Despite the acceptance of the advantages of early elective hernia repairs, the incidence of emergency admissions with complicated presentations remains high, and the natural history of an untreated hernia is not obvious. This study aimed to define risk factors related with unfavorable outcomes in groin hernia repairs. METHODS We analyzed the records of 685 elective or emergency repairs of groin hernias between December 2005 and June 2009. Patient age ranged from 17 to 85 years, with 240 (35%) of patients being older than 60 years of age. Indirect inguinal hernias were the most common hernia type in both sexes of patients. Coexisting cardiopulmonary problems were noted in 294 male and 33 female patients. American Society of Anaesthesiologists (ASA) grades 3 and 4 were encountered in 61 (9%) patients. Data were analyzed by chi-square test. RESULTS Significantly high incarceration and strangulation rates were found in females and femoral hernia type. The overall morbidity rate was 7%, major complications 3%. No mortality was observed in the series and postoperative complications were significantly more common in patients with high ASA score and severe coexisting cardiopulmonary problems. Advanced age, delayed admission, femoral type hernia and female sex were also linked with unfavorable outcomes. CONCLUSIONS The risk of complicated presentation and unfavorable outcome in patients with groin hernia is significant in the presence of factors such as advanced age, femoral hernia, female sex, delayed admission, severe coexisting cardiopulmonary problems and high ASA score. Although it is difficult to estimate the natural history of untreated hernia, hernia repairs of patients with the above-mentioned risk factors should be timely and elective.
Collapse
Affiliation(s)
- M Akinci
- Department of General Surgery, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey.
| | | | | | | | | |
Collapse
|
14
|
Tiernan JP, Katsarelis H, Garner JP, Skinner PP. Excellent outcomes after emergency groin hernia repair. Hernia 2010; 14:485-8. [DOI: 10.1007/s10029-010-0667-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 04/16/2010] [Indexed: 12/01/2022]
|
15
|
Babar M, Myers E, Matingal J, Hurley MJ. The modified Nyhus–Condon femoral hernia repair. Hernia 2010; 14:271-5. [DOI: 10.1007/s10029-009-0606-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Accepted: 12/04/2009] [Indexed: 11/24/2022]
|
16
|
Garg P, Ismail M. Laparoscopic total extraperitoneal repair in femoral hernia without fixation of the mesh. JSLS 2009; 13:597-600. [PMID: 20042125 PMCID: PMC3030798 DOI: 10.4293/108680809x12589999537995] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We report on laparoscopic total extraperitoneal repair without fixation of mesh for femoral hernia in 6 patients. METHODS During a 3-year period, laparoscopic total extraperitoneal repair of femoral hernia was performed without mesh fixation in 6 patients. The recurrence rate, pain scores, hospital stay, and other morbidity parameters were noted. Pain scores were 1=no pain, 2=mild pain, 3=moderate pain, 4=severe pain, and 5=intolerable pain. RESULTS All 6 patients were females and had unilateral hernias. Mean age was 33.8+/-18.6 years, and follow-up ranged from 12 months to 36 months. Four patients were operated on while under spinal anesthesia, and 2 patients were operated on while under general anesthesia. Mean operating time was 29.2+/-10.7 minutes. The mean pain scores 24 hours and the first week after operation were, respectively, 2.33+/-0.52 and 1.33+/-0.52. Mean hospital stay was 1.17+/-0.41 days, and mean days to resumption of normal activities were 8.5+/-2.1 days. No patient had urinary retention or seroma formation in the postoperative period. At follow-up, no hernia had recurred. CONCLUSIONS Laparoscopic femoral hernia repair without fixing the mesh is safe, feasible, and associated with minimal morbidity and recurrence rates.
Collapse
Affiliation(s)
- Pankaj Garg
- Moulana Hospital, Perintalmanna, India; MM Institute of Medical Sciences and Research, Mullana, Haryana, India.
| | | |
Collapse
|
17
|
European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009. [DOI: 10.1007/s10029-009-0529-7 or(1=1)-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
|
18
|
European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009; 13:343-403. [PMID: 19636493 PMCID: PMC2719730 DOI: 10.1007/s10029-009-0529-7] [Citation(s) in RCA: 820] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Accepted: 06/19/2009] [Indexed: 02/06/2023]
Abstract
The European Hernia Society (EHS) is proud to present the EHS Guidelines for the Treatment of Inguinal Hernia in Adult Patients. The Guidelines contain recommendations for the treatment of inguinal hernia from diagnosis till aftercare. They have been developed by a Working Group consisting of expert surgeons with representatives of 14 country members of the EHS. They are evidence-based and, when necessary, a consensus was reached among all members. The Guidelines have been reviewed by a Steering Committee. Before finalisation, feedback from different national hernia societies was obtained. The Appraisal of Guidelines for REsearch and Evaluation (AGREE) instrument was used by the Cochrane Association to validate the Guidelines. The Guidelines can be used to adjust local protocols, for training purposes and quality control. They will be revised in 2012 in order to keep them updated. In between revisions, it is the intention of the Working Group to provide every year, during the EHS annual congress, a short update of new high-level evidence (randomised controlled trials [RCTs] and meta-analyses). Developing guidelines leads to questions that remain to be answered by specific research. Therefore, we provide recommendations for further research that can be performed to raise the level of evidence concerning certain aspects of inguinal hernia treatment. In addition, a short summary, specifically for the general practitioner, is given. In order to increase the practical use of the Guidelines by consultants and residents, more details on the most important surgical techniques, local infiltration anaesthesia and a patient information sheet is provided. The most important challenge now will be the implementation of the Guidelines in daily surgical practice. This remains an important task for the EHS. The establishment of an EHS school for teaching inguinal hernia repair surgical techniques, including tips and tricks from experts to overcome the learning curve (especially in endoscopic repair), will be the next step. Working together on this project was a great learning experience, and it was worthwhile and fun. Cultural differences between members were easily overcome by educating each other, respecting different views and always coming back to the principles of evidence-based medicine. The members of the Working Group would like to thank the EHS board for their support and especially Ethicon for sponsoring the many meetings that were needed to finalise such an ambitious project.
Collapse
|
19
|
European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009. [DOI: 10.1007/s10029-009-0529-7 and 1=1#] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
20
|
European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009. [DOI: 10.1007/s10029-009-0529-7 or(1=2)-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
|
21
|
European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009. [DOI: 10.1007/s10029-009-0529-7 and 1=2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
22
|
Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009. [DOI: 10.1007/s10029-009-0529-7 and 1=2-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
|
23
|
Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009. [DOI: 10.1007/s10029-009-0529-7 and 1=2#] [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]
|
24
|
Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009. [DOI: 10.1007/s10029-009-0529-7 and 1=1-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
25
|
Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009. [DOI: 10.1007/s10029-009-0529-7 and 1=1] [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]
|
26
|
Abstract
INTRODUCTION Knowledge of the risk factors that may lead to complications after emergency hernia repair is of great importance, as much for the prioritisation of the elective surgery, as selecting those cases that require clinical follow up. OBJECTIVES To analyse the factors conditioning the morbidity and mortality of bowel resection associated to emergency hernia repair. PATIENTS AND METHOD A retrospective review was carried out on the clinical histories of patients who had emergency operations for hernia problems from January 2000 to December of 2005. The clinical results obtained were compared based on whether or not a bowel resection was required. RESULTS A total of 2367 patients were operated for hernia in this period, 362 of them (15.3%); for a complicated hernia (mean age 69.5 years; 146 males/216 females); 60 patients needed bowel resection. Complications appeared in 108 patients (29.8%) and 17 (4.7%) died after operation. The limit of 70 years discriminated a significantly greater mortality (> 70: 7% vs < 70 2%; p = 0.01). The group of patients who needed bowel resection showed differences in statistical analysis both in age (75.4 vs 68.3 years; p = 0.002), prevalence of complications (40.7% vs 6.2%; p < 0.0001), and mortality (20% vs 1.6%; p < 0.0001). The discriminant analysis identified bowel resection as the only predictive independent variable of mortality (lambda Wilks = 0.89; p = 0.0001; predictive value, 85%). CONCLUSIONS Morbidity and the mortality of urgent hernia surgery, when bowel resection was required, are elevated; especially in older patients, and in crural hernias.
Collapse
|
27
|
Duration of Groin Hernias and Accompanied Symptoms Before Beginning of Treatment of Hernias. POLISH JOURNAL OF SURGERY 2008. [DOI: 10.2478/v10035-008-0095-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
28
|
Oudhoff JP, Timmermans DRM, Knol DL, Bijnen AB, Van der Wal G. WAITING FOR ELECTIVE SURGERY: EFFECT ON PHYSICAL PROBLEMS AND POSTOPERATIVE RECOVERY. ANZ J Surg 2007; 77:892-8. [PMID: 17803558 DOI: 10.1111/j.1445-2197.2007.04268.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Long waiting times for elective surgery pose a threat to the quality of care. Our study aimed to assess (i) the physical symptoms and disabilities patients experience during the wait, (ii) the perceived improvements after surgery and (iii) whether problems increase during the wait or longer waits affect postoperative outcomes. METHODS A cross-sectional questionnaire study with postoperative follow up was held among patients waiting for surgery of varicose veins (n = 176), inguinal hernia (n = 201) and gallstones (n = 128) in 27 hospitals. RESULTS During the wait, each group reported increased levels of pain and impaired mobility (Nottingham Health Profile, P < 0.05). However, 15-41% of patients had no or mild symptoms, whereas 5% of inguinal hernia patients had severe pain and 17% of gallstone patients reported >or=1 colic attacks per week. Surgery resolved symptoms in 86-95% of patients. The length of the wait was not associated with problems during the wait or with postoperative outcomes (multilevel regression analysis, P > 0.01). CONCLUSIONS Waiting for general surgery primarily prolongs the suffering from symptoms, which are relieved by surgery. Although the prioritization of patients with more severe symptoms would reduce the overall burden of waiting, patients with minimal symptoms may be advised to refrain from surgery.
Collapse
Affiliation(s)
- Jurriaan P Oudhoff
- Department of Public and Occupational Health, Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands.
| | | | | | | | | |
Collapse
|
29
|
Oudhoff JP, Timmermans DRM, Knol DL, Bijnen AB, van der Wal G. Waiting for elective general surgery: impact on health related quality of life and psychosocial consequences. BMC Public Health 2007; 7:164. [PMID: 17640382 PMCID: PMC1959190 DOI: 10.1186/1471-2458-7-164] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Accepted: 07/19/2007] [Indexed: 11/15/2022] Open
Abstract
Background Long waiting times for elective surgical treatment threaten timely care provision in several countries. The purpose of this study was to assess the impact of waiting for elective general surgery on the quality of life and psychosocial health of patients. Methods A cross-sectional questionnaire study with postoperative follow-up was performed among patients on waiting lists for surgical treatment of varicose veins (n = 176), inguinal hernia (n = 201), and gallstones (n = 128) in 27 hospitals. Results In each group the waiting period involved worse general health perceptions (GHPQ), more problems in quality of life (EuroQoL), and raised levels of anxiety (STAI) as compared to after surgery (all differences: p < 0.05). Quality of life was not affected in 19–36% of patients. Emotional reactions to waiting were most negative among patients with gallstones. Prior information about the duration of the wait reduced the negativity of these reactions (p < 0.05). Social activities were affected in 39% to 48% of the patients and 18%-23% of employed patients reported problems with work during the wait. Having waited a longer time was associated with worse quality of life among patients with inguinal hernia. Longer waited times also engendered more negative reactions to waiting among patients with inguinal hernia and gallstones (multilevel regression analysis, p < 0.01). Conclusion Waiting for general surgery mainly involves a prolonged period of decreased health and an affected psychological and social life of the patient in waiting. Variation in the severity of these consequences across patients indicates that the prioritisation of patients could reduce the overall burden of waiting. Early information about the duration of the delay could further promote a patient's acceptance of waiting.
Collapse
Affiliation(s)
- JP Oudhoff
- Department of Public and Occupational Health, Institute for Research in Extramural Medicine, Free University Medical Centre, Amsterdam, The Netherlands
| | - DRM Timmermans
- Department of Public and Occupational Health, Institute for Research in Extramural Medicine, Free University Medical Centre, Amsterdam, The Netherlands
| | - DL Knol
- Department of Clinical Epidemiology and Biostatistics, Free University Medical Centre, Amsterdam, The Netherlands
| | - AB Bijnen
- Department of Surgery, Medical Centre Alkmaar, Alkmaar, The Netherlands
| | - G van der Wal
- Department of Public and Occupational Health, Institute for Research in Extramural Medicine, Free University Medical Centre, Amsterdam, The Netherlands
| |
Collapse
|
30
|
Davies M, Davies C, Morris-Stiff G, Shute K. Emergency presentation of abdominal hernias: outcome and reasons for delay in treatment - a prospective study. Ann R Coll Surg Engl 2007; 89:47-50. [PMID: 17316522 PMCID: PMC1963533 DOI: 10.1308/003588407x160855] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Emergency hernia surgery is associated with a higher postoperative complication and a less favourable outcome. The aim of this study was to audit emergency presentations of abdominal hernias prospectively in order to identify delays in patient treatment. PATIENTS AND METHODS Prospective audit was carried out between January and September 2003 of all patients presenting acutely with symptomatic hernias. In total, 55 patients presented, 39 of whom needed surgical intervention. The emergency repairs were compared with a cohort of elective repairs performed in the trust at the same time. RESULTS The median age was 77 years (range, 5-92 years; 35 male, 20 female). The distribution of the hernias, requiring surgery, was inguinal (19), para-umbilical (10), incisional (5) and femoral (5). The overall complication rate was 46.2% and the in-patient stay was 4 days (range, 1-49 days). Six patients required small bowel resection. Conservative management was identified as a key contributing factor in the delay of treatment. There was a significant increase in the in-patient stay, the early complication rate and the small bowel resection rate in the emergency repairs. DISCUSSION Patients with a symptomatic hernia should be offered elective, surgical repair. Non-operative management is inappropriate for the vast majority of cases, especially when many repairs may be performed with local anaesthetic infiltration. Clinicians should be aware of the high morbidity associated with the emergency repair of abdominal hernias in the elderly.
Collapse
Affiliation(s)
- Mark Davies
- Department of Surgery, Royal Gwent Hospital, Newport, Gwent, UK.
| | | | | | | |
Collapse
|
31
|
O'Dwyer PJ, Norrie J, Alani A, Walker A, Duffy F, Horgan P. Observation or operation for patients with an asymptomatic inguinal hernia: a randomized clinical trial. Ann Surg 2006; 244:167-73. [PMID: 16858177 PMCID: PMC1602168 DOI: 10.1097/01.sla.0000217637.69699.ef] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Many patients with an inguinal hernia are asymptomatic or have little in the way of symptoms from their hernia. Repair is often associated with long-term chronic pain and has a recurrence rate of 5% to 10%. Our aim was to compare operation with a wait-and-see policy in patients with an asymptomatic hernia. METHODS A total of 160 male patients 55 years or older were randomly assigned to observation or operation. Patients were assessed clinically and sent questionnaires at 6 months and 1 year. The primary endpoint was pain and general health status at 12 months; other outcome measures included costs to the health service and the rate of operation for a new symptom or complication. RESULTS At 12 months, there were no significant differences between the randomized groups of observation or operation, in visual analogue pain scores at rest, 3.7 mm versus 5.2 mm (mean difference, -1.6; 95% confidence interval (CI), -4.8 to 1.6, P = 0.34), or on moving, 7.6 mm versus 5.7 mm (mean difference, -1.9; 95% CI, -6.1 to 2.4, P = 0.39). Also, the number of patients 29 versus 24 (difference in proportion, 8%; 95% CI, -7% to 23%, P = 0.31), who recorded pain on moving and the number taking regular analgesia, 9 versus 17 (difference in proportion, -10%; 95% CI, -21% to 2%, P = 0.14) was similar. At 6 months, there were significant improvements in most of the dimensions of the SF-36 for the operation group, while at 12 months although the trend remained the same the differences were only significant for change in health (mean difference, 7.3; 95% CI, 0.4 to 14.3, P = 0.039). The rate of crossover from observation to operation 23 patients at a median follow-up of 574 days was higher than predicted. The observation group also suffered 3 serious hernia-related adverse events compared with none in the operation group. CONCLUSIONS Repair of an asymptomatic inguinal hernia does not affect the rate of long-term chronic pain and may be beneficial to patients in improving overall health and reducing potentially serious morbidity.
Collapse
|
32
|
Alimoglu O, Kaya B, Okan I, Dasiran F, Guzey D, Bas G, Sahin M. Femoral hernia: a review of 83 cases. Hernia 2005; 10:70-3. [PMID: 16283073 DOI: 10.1007/s10029-005-0045-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2005] [Accepted: 09/08/2005] [Indexed: 11/25/2022]
Abstract
We evaluate the factors that affect morbidity and mortality in patients who underwent surgery due to femoral hernia. The medical records of 83 patients who underwent femoral hernia repair between January 1996 and June 2004 were retrospectively analyzed. The femoral hernias were repaired either with McVay or mesh plug hernioplasty. Sex, age, surgical repair technique, presence of incarceration/strangulation, incarcerated/strangulated organs, postoperative complications, duration of hospitalization, recurrence rate, and factors that affect mortality and morbidity were studied. There were 83 patients with femoral hernia in our study. Patients' age ranged from 10 to 75 years (mean age was 46.84) with a predominance of female (71%). Thirty-six patients (40%) underwent emergency surgery with the diagnosis of strangulation or incarceration of femoral hernia. Seventeen patients had strangulation and underwent resection; eleven of these patients had omentum in the hernial sac, whereas six patients had intestines. Four of these patients underwent laparotomy. The remaining 19 patients had incarceration and underwent simple reduction of hernial sac content without resection. Forty-seven (60%) patients underwent elective surgery. McVay technique was used for 79 patients, while the other four patients were treated with mesh-plug. Twelve patients (15%) developed a variety of complications (nine patients (25%) in emergency, three patients (6%) in elective group). There was one mortality. Recurrences occurred in two patients. Femoral hernia is an important surgical pathology with high rates of incarceration/strangulation and intestinal resection. Emergency surgery can increase morbidity and mortality especially in the elderly. Early elective surgery may reduce complication.
Collapse
Affiliation(s)
- O Alimoglu
- First Department of Surgery, Vakif Gureba Training Hospital, Mevlana Mah. Hekim Suyu Cad., Dostluk Sitesi D 1 Blok D:13, 34080, Kucukkoy, Istanbul, Turkey.
| | | | | | | | | | | | | |
Collapse
|
33
|
Alani A, Page B, O'Dwyer PJ. Prospective study on the presentation and outcome of patients with an acute hernia. Hernia 2005; 10:62-5. [PMID: 16273307 DOI: 10.1007/s10029-005-0043-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2005] [Accepted: 09/05/2005] [Indexed: 10/25/2022]
Abstract
Recent advances in hernia surgery should help to make operation more acceptable to patients and their doctors. The aim of this study was to prospectively assess the presentation and management of patients with an acute hernia in light of these changes. Data on all patients admitted with an acute hernia between March 2001 and February 2004 was entered on a prospective database. During the 3 year study period, of the 91 patients admitted with an acute hernia, 41 were ventral, 24 femoral, 24 inguinal and 2 parastomal. Forty-six had a previous medical assessment, 18 of these had been declared unfit for operation at that assessment; ten were ASA4 (ASA, American Society of Anaesthesiology), five ASA3 and three ASA2. Eleven patients were on the waiting list for operation, three of whom had a previous acute hospital admission. For 30 patients this hospital admission was the first indication that they had a hernia while the remaining were aware that they had a hernia but did not seek medical advice. Of the five patients who died, two while being assessed for operation and three postoperatively, three were ASA4 and had a ventral hernia while two were ASA3 with a femoral hernia. Despite advances in hernia surgery there is still room for improvement in preoperative assessment of patients presenting with an acute hernia.
Collapse
Affiliation(s)
- A Alani
- University Department of Surgery, Western Infirmary, Glasgow, G11 6NT, UK
| | | | | |
Collapse
|
34
|
Alvarez-Pérez JA, Baldonedo-Cernuda RF, García-Bear I, Suárez-Solís JA, Alvarez-Martínez P, Jorge-Barreiro JI. Presentación y evolución clínica de las hernias externas incarceradas en pacientes adultos. Cir Esp 2005; 77:40-5. [PMID: 16420882 DOI: 10.1016/s0009-739x(05)70802-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine the clinical presentation and outcome of incarcerated external hernias in adults, as well as to identify the factors that might have some influence on outcome. PATIENTS AND METHOD A retrospective study of 230 adult patients who underwent emergency surgical repair of incarcerated external hernias from 1992 to 2001 was performed. The characteristics of clinical presentation, type of anesthesia, surgical procedures, complications and mortality were studied. To determine clinical factors that might have some influence on outcome, an univariate analysis was also performed. RESULTS There were 77 femoral hernias, 70 inguinal, 43 umbilical and 40 incisional hernias. Seventy-four patients (32.2%) presented after 48 h of symptom onset. Significant associated diseases were found in 135 patients (58.7%). General anesthesia was used in 140 patients (60.9%), spinal anesthesia in 86 patients and local anesthesia in four patients. The most commonly used procedures were anatomic repair and tension-free hernioplasty. Bowel resection was required in 31 patients (13.5%). Overall and major morbidity and mortality were 37.8%, 10% and 3.9%, respectively. Factors that were significantly associated with unfavorable outcome were longer duration of symptoms, late hospitalization, concomitant diseases, and a high ASA class. CONCLUSIONS External hernias produce elevated morbidity and mortality if treatment is undertaken as an emergency. Thus, early diagnosis and elective repair of uncomplicated hernias should be performed in adults.
Collapse
|
35
|
Oudhoff JP, Timmermans DRM, Bijnen AB, van der Wal G. Waiting for elective general surgery: physical, psychological and social consequences. ANZ J Surg 2004; 74:361-7. [PMID: 15144258 DOI: 10.1111/j.1445-1433.2004.02998.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Long surgical waiting lists are common and receive serious consideration. To evaluate the positive and negative effects of waiting lists, insight into the consequences of waiting is needed. The present study aims to assess what insight the current literature provides into the effects of delayed surgery for varicose veins, inguinal hernia in adults, gallstones, and breast cancer in terms of physical, psychological and social aspects. METHODS Searches of Medline and Embase, for the period January 1985-September 2003, were performed to identify articles providing direct or indirect insight into the consequences of waiting for surgery for each disorder. Reference lists of retrieved reports were examined for relevant articles. RESULTS Seven studies were identified with direct data on consequences of delay in elective surgery. Relevant indirect data were found in 32 reports. Results indicated that delayed varicose vein surgery or inguinal hernia repair involves marginal physical, psychological or social suffering, and that severe deterioration is unlikely. The impact of delayed cholecystectomy seems more profound by suffering on all three health aspects. Complications while waiting do occur, with a higher risk for patients with previous complications. Longer delays for breast cancer surgery seem to adversely affect prognosis, although it is unclear which interval is associated with such an effect. Moreover, having breast cancer undoubtedly affects psychological health. CONCLUSIONS There is a remarkable paucity of studies addressing the consequential impact of waiting for elective surgery on patients' health for each of the four studied disorders. Current literature permits merely general estimation of this consequential impact. As specific assessment of these consequences is important for daily practice and for policy, further research is required.
Collapse
Affiliation(s)
- Jurriaan P Oudhoff
- Department of Social Medicine, Institute for Research in Extramural Medicine, VU University Medical Centre, Amsterdam, The Netherlands.
| | | | | | | |
Collapse
|
36
|
Malek S, Torella F, Edwards PR. Emergency repair of groin herniae: outcome and implications for elective surgery waiting times. Int J Clin Pract 2004; 58:207-9. [PMID: 15055870 DOI: 10.1111/j.1368-5031.2004.0097.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Patients with groin herniae do not always seek medical advice and, when listed for surgery, often wait many months for elective repair. We audited our emergency admissions for complicated groin herniae to establish whether a change in policy for elective surgery could lower their incidence. We performed a retrospective review of all admissions for complicated groin herniae from 1 January 2000 to 31 December 2001. Besides outcome, we recorded patients' awareness of their diagnosis before admission and whether they had been listed for elective surgery. We identified 19 patients (16 men and three women) with an inguinal and 19 (four men and 15 women) with a femoral hernia. Sixteen (42%) knew of their hernia before admission (11 inguinal and five femoral), but only three had been awaiting surgical repair for 1, 7 and 26 weeks, respectively. The median (interquartile range) age was 70 (54-84) years in inguinal and 79 (64-88) years in femoral herniae. Surgery was performed in all but an 84-year-old man who died pre-operatively. Two patients with inguinal and 11 with femoral herniae required a laparotomy (p = 0.006). Bowel resection was necessary in one patient with an inguinal and 12 with femoral herniae (p = 0.001). Complications occurred in 12 cases (31%). Four patients, all with femoral herniae, died post-operatively, for an overall mortality of 13% (5/38). Morbidity and mortality for complicated groin hernia, particularly femoral, remain high. As most patients were elderly and unaware of their diagnosis, reducing waiting times for elective repair is unlikely to influence the incidence of complicated herniae.
Collapse
Affiliation(s)
- S Malek
- Department of Surgery, Countess of Chester Hospital, Liverpool Road, Chester, UK
| | | | | |
Collapse
|
37
|
José Álvarez A, Ricardo Baldonedo F, García I, José Suárez A, Álvarez P, José Jorge I. Hernias externas incarceradas en pacientes octogenarios. Cir Esp 2004. [DOI: 10.1016/s0009-739x(04)78941-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
38
|
Abstract
Inguinal hernias are a common problem but often present with diagnostic dilemmas, in part as a result of the complex anatomy of the region. A simplified analogy is put forward in the hope of increasing the understanding of the anatomy and some guidance given in an endeavor to differentiate direct and indirect hernias, with significance to their possible complication rates.
Collapse
Affiliation(s)
- Charles A Perrott
- Department of General Surgery, University of Chicago, Illinois 60637, USA.
| |
Collapse
|
39
|
Estudio prospectivo de las complicaciones de la cirugía de la hernia en función de la edad de los pacientes. Cir Esp 2004. [DOI: 10.1016/s0009-739x(04)72297-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
40
|
Abstract
In the past decade hernia surgery has been challenged by two new technologies: by laparoscopy, which has attempted to change the traditional open operative techniques, and by prosthetic mesh, which has achieved much lower recurrence rates. The demand by health care providers for increasingly efficient and cost-effective surgery has resulted in modifications to pathways of care to encourage more widespread adoption of day case, outpatient surgery, and local anaesthesia. In addition, the UK National Institute for Clinical Excellence has recommended strategies for bilateral and recurrent hernias. Here, we discuss these strategies and review some neglected aspects of hernia management such as trusses, antibiotic cover, return to work and activity, and emergency surgery. Many of the principles of management apply equally to inguinal and incisional hernias. We recommend that the more difficult and complex of the procedures be referred to specialists.
Collapse
|
41
|
Abstract
In the past decade hernia surgery has been challenged by two new technologies: by laparoscopy, which has attempted to change the traditional open operative techniques, and by prosthetic mesh, which has achieved much lower recurrence rates. The demand by health care providers for increasingly efficient and cost-effective surgery has resulted in modifications to pathways of care to encourage more widespread adoption of day case, outpatient surgery, and local anaesthesia. In addition, the UK National Institute for Clinical Excellence has recommended strategies for bilateral and recurrent hernias. Here, we discuss these strategies and review some neglected aspects of hernia management such as trusses, antibiotic cover, return to work and activity, and emergency surgery. Many of the principles of management apply equally to inguinal and incisional hernias. We recommend that the more difficult and complex of the procedures be referred to specialists.
Collapse
|
42
|
Page B, Paterson C, Young D, O'Dwyer PJ. Pain from primary inguinal hernia and the effect of repair on pain. Br J Surg 2002; 89:1315-8. [PMID: 12296904 DOI: 10.1046/j.1365-2168.2002.02186.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Background
No previous study has attempted to quantify pain from a primary inguinal hernia. The aim of this study was to quantify patients' pain from inguinal hernia at rest and on moving, and to assess the effect of hernia repair on the pain.
Methods
Linear analogue pain scores at rest and on moving were recorded before operation and at 1 year after surgery in a consecutive series of patients undergoing elective repair of a primary inguinal hernia.
Results
During the study period 323 patients underwent inguinal hernia repair. Eighty-six patients (26·6 per cent) recorded no pain at rest from the hernia, and 174 (53·9 per cent) had mild pain only (score less than 10). On moving, 53 patients (16·4 per cent) had no pain and 137 (42·4 per cent) had mild pain on moving. Only 1·5 per cent experienced severe pain (score greater than 50) at rest, and 10·2 per cent had severe pain on moving. There was no association between pain and hernia type, direct or indirect, or patient occupation. One year after operation only 24·5 per cent of patients had no pain from the hernia repair site at rest, and 21·6 per cent had no pain from the site on moving. Overall there was a significant reduction in pain score at rest (mean(s.e.m.) decrease from baseline −2·9(1·2), P = 0·019) and on moving (−9·2(1·8), P = 0·001) compared with preoperative values, and this was due mainly to the large effect observed in patients with high preoperative values. Patients who had no pain at rest before operation had significant pain scores at rest at 1 year (P = 0·001).
Conclusion
Clinical trials are required to evaluate hernia repair in patients with an asymptomatic inguinal hernia. Results from such trials should help to determine whether repair is the treatment of choice for these patients.
Collapse
Affiliation(s)
- B Page
- University Department of Surgery, Western Infirmary and Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | | | | | | |
Collapse
|
43
|
Hair A, Paterson C, Wright D, Baxter JN, O'Dwyer PJ. What effect does the duration of an inguinal hernia have on patient symptoms? J Am Coll Surg 2001; 193:125-9. [PMID: 11491441 DOI: 10.1016/s1072-7515(01)00983-8] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Despite the fact that repair of an inguinal hernia is one of the most common operations performed in general surgery, we have very little information on the natural history of the untreated hernia. The aim of this study was to evaluate the association between hernia symptoms and the duration the patients had their hernias before presentation to a surgical outpatient department for an elective or emergency operation. STUDY DESIGN Data were gathered prospectively on a consecutive series of 699 patients admitted to two University Departments of Surgery for scheduled operations for an inguinal hernia. RESULTS More than one third (267) of patients had their hernias for 1 year or longer, up to 65 years, before presentation. The most common symptom on presentation was pain or discomfort at the hernia site, which occurred in 457 (66%) patients. The cumulative probability of pain increased with time to almost 90% at 10 years. The hernia had become irreducible in 48 patients (6.9%). The cumulative probability of irreducibility increased from 6.5% (95% confidence interval 4% to 9%) at 12 months to 30% (95% confidence interval 18% to 42%) at 10 years. Leisure activities were affected in 29% of patients although only 13% of patients had to take time off work because of hernia-related symptoms. Only two patients (0.3%) required resection of infarcted bowel or omentum. CONCLUSIONS Because many patients with an inguinal hernia are asymptomatic or mildly symptomatic, prospective clinical trials to assess the role of operations for such hernias are required.
Collapse
Affiliation(s)
- A Hair
- University Department of Surgery, Western Infirmary, Glasgow, UK
| | | | | | | | | |
Collapse
|
44
|
Sánchez Llorente F, Menchén Trujillo B, García Muñoz-Nájar A, Alcaide Matas F, Campano Cruz I, Fernández Monge C, Garrote Nieto E, Quadros Borrajo M, Sierra García A. Hernia crural. Resultados tras 10 años de tratamiento mediante plug de Lichtenstein. Cir Esp 2001. [DOI: 10.1016/s0009-739x(01)71682-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
45
|
Rai S, Chandra SS, Smile SR. A study of the risk of strangulation and obstruction in groin hernias. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1998; 68:650-4. [PMID: 9737262 DOI: 10.1111/j.1445-2197.1998.tb04837.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Complications that develop in groin hernias, such as irreducibility and obstruction, with or without strangulation may make an easily treatable condition a life-threatening one. Identification of risk factors that may predict development would help place the patient in a high-risk group. Priority admission and early elective surgery for such a patient would avoid significant mortality and morbidity. METHODS This is a 10-year combined prospective and retrospective study of children and adults. Records of complicated groin hernias were identified from July 1985 to July 1995 from the outpatient department and available inpatient medical records. The same number of controls of simple uncomplicated hernias were then chosen using random number tables from among the large number belonging to the same time period. These two groups were then compared and analysed using statistical methods for age, sex, side of hernia, site of hernia (inguinal/femoral), duration of hernia, length of the waiting list for elective surgery, and contents of the hernial sac along with some other parameters to identify patients with high-risk factors. RESULTS Age was found to be a significant risk factor and predicted complications in both elderly adults and very young children. Sex of the patient (male) and side of hernia (right) were significant risk factors in children only. Site of hernia was an important risk factor and adults with femoral hernia were most likely to experience complications. Duration of hernia for less than a year proved to be the most important risk factor for both children and adults. The majority of patients with complicated hernias had not presented earlier in the outpatient department, which implies that most hernias that become complicated do so within a very short time before patient referral. Mortality was high in patients with coexisting diseases, while morbidity was affected by viability of contents of the hernial sac which in turn was directly affected by duration of irreducibility or delay in presentation. CONCLUSIONS The risk factors useful in predicting complications in an adult patient with groin hernia were age (older age group), duration of hernia (short duration), type of hernia (femoral more than inguinal) and coexisting medical illness. In children, the risk factors were age (very young), gender (male), short duration of hernia and side (right side).
Collapse
Affiliation(s)
- S Rai
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
| | | | | |
Collapse
|
46
|
Hutchinson R, Gardner RD. External intestinal strangulation with a recurrent inguinoscrotal hernia. Br J Surg 1991; 78:1446-7. [PMID: 1773321 DOI: 10.1002/bjs.1800781212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- R Hutchinson
- Department of Surgery, Royal Shrewsbury Hospital, Shropshire, UK
| | | |
Collapse
|
47
|
Abstract
Although the elective repair of groin hernias is advised to prevent strangulation, the likelihood of this complication occurring is unknown. To quantify this risk, the cumulative probability of strangulation in relation to the length of history has been calculated for inguinal and femoral hernias presenting to this hospital between 1987 and 1989. Of 476 hernias (439 inguinal, 37 femoral), there were 34 strangulations (22 inguinal, 12 femoral). After 3 months the cumulative probability of strangulation for inguinal hernias was 2.8 per cent, rising to 4.5 per cent after 2 years. For femoral hernias the cumulative probability of strangulation was 22 per cent at 3 months and 45 per cent at 21 months. The rate at which the cumulative probability of strangulation increased was in both cases greatest in the first 3 months, suggesting that patients with a short history of herniation should be referred urgently to hospital and given priority on the waiting list.
Collapse
Affiliation(s)
- N C Gallegos
- Department of Surgery, University College and Middlesex School of Medicine
| | | | | | | |
Collapse
|