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Shi H, Li S, Lin Y, Yang D, Dong W, Song Z, Song H, Gu Y. Suture repair versus mesh repair in elderly populations with incarcerated or strangulated groin hernia. Updates Surg 2024:10.1007/s13304-023-01745-8. [PMID: 38512634 DOI: 10.1007/s13304-023-01745-8] [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: 08/24/2023] [Accepted: 12/29/2023] [Indexed: 03/23/2024]
Abstract
Tension-free hernia repair is the gold standard for groin hernia repair. However, the optimal surgical treatment for incarcerated or strangulated groin hernia in elderly populations is controversial. The aim of this study is to compare the clinical efficacy of mesh repair and suture repair in the treatment of incarcerated or strangulated groin hernia in elderly patients. Patients ≥ 65 years who underwent urgent surgical repair for incarcerated or strangulated groin hernia from January 2012 to June 2022 were included. Patients' demographic data and postoperative outcomes were retrospectively analyzed. Patients with limited life expectancy were screened from the elderly population for subgroup analysis. A total of 103 patients (median age: 84 years old, range 65-96; mean follow-up time: 36.8 ± 24.8 months) were included, involving 42 cases in the suture repair group and 61 cases in the mesh repair group. Suture repair and mesh repair had similar lengths of ICU and hospital stay, and rates of small bowel resection, chronic pain, surgical site infection, and surgical-related death. However, suture repair had a significantly higher recurrence rate than mesh repair (7% vs. 2%, P = 0.04). In our subgroup analysis, for patients with limited life expectancy (41 patients; median age: 88 years old, range: 80-96), suture repair had no statistical difference in postoperative outcomes compared with mesh repair. Mesh repair is suitable for elderly patients with acutely incarcerated or strangulated groin hernias. However, for elderly patients with limited life expectancy, suture repair and mesh repair showed similar clinical outcomes.
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Affiliation(s)
- Hekai Shi
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, No. 221, West Yan'an Road, Jing'an District, Shanghai, 200040, People's Republic of China
| | - Shaochun Li
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, No. 221, West Yan'an Road, Jing'an District, Shanghai, 200040, People's Republic of China
| | - Yiming Lin
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, No. 221, West Yan'an Road, Jing'an District, Shanghai, 200040, People's Republic of China
| | - Dongchao Yang
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, No. 221, West Yan'an Road, Jing'an District, Shanghai, 200040, People's Republic of China
| | - Wenpei Dong
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, No. 221, West Yan'an Road, Jing'an District, Shanghai, 200040, People's Republic of China
| | - Zhicheng Song
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, No. 221, West Yan'an Road, Jing'an District, Shanghai, 200040, People's Republic of China
| | - Heng Song
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, No. 221, West Yan'an Road, Jing'an District, Shanghai, 200040, People's Republic of China
| | - Yan Gu
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, No. 221, West Yan'an Road, Jing'an District, Shanghai, 200040, People's Republic of China.
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Zhou J, Yuan X. Establishment of a risk prediction model for bowel necrosis in patients with incarcerated inguinal hernia. BMC Med Inform Decis Mak 2024; 24:39. [PMID: 38321399 PMCID: PMC10845797 DOI: 10.1186/s12911-024-02440-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/25/2024] [Indexed: 02/08/2024] Open
Abstract
INTRODUCTION Incarceration occurred in approximately 5% to 15% of inguinal hernia patients, with around 15% of incarcerated cases progressing to intestinal necrosis, necessitating bowel resection surgery. Patients with intestinal necrosis had significantly higher mortality and complication rates compared to those without necrosis.The primary objective of this study was to design and validate a diagnostic model capable of predicting intestinal necrosis in patients with incarcerated groin hernias. METHODS We screened the clinical records of patients who underwent emergency surgery for incarcerated inguinal hernia between January 1, 2015, and December 31, 2022. To ensure balanced representation, the enrolled patients were randomly divided into a training set (n = 180) and a validation set (n = 76) using a 2:1 ratio. Logistic regression analysis was conducted using the rms package in R software, incorporating selected features from the LASSO regression model, to construct a predictive model. RESULTS Based on the results of the LASSO regression analysis, a multivariate logistic regression model was developed to establish the predictive model. The predictors included in the model were Abdominal effusion, Hernia Sac Effusion, and Procalcitonin. The area under the receiver operating characteristic (ROC) curve for the nomogram graph in the training set was 0.977 (95% CI = 0.957-0.992). In the validation set, the AUC for the nomogram graph was 0.970. Calibration curve and decision curve analysis (DCA) verified the accuracy and practicability of the nomogram graph in our study. CONCLUSION Bowel necrosis in patients with incarcerated inguinal hernia was influenced by multiple factors. The nomogram predictive model constructed in this study could be utilized to predict and differentiate whether incarcerated inguinal hernia patients were at risk of developing bowel necrosis.
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Affiliation(s)
- Jiajie Zhou
- Department of General Surgery, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu Province, China.
| | - Xiaoming Yuan
- Department of General Surgery, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu Province, China
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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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Marcolin P, Mazzola Poli de Figueiredo S, Moura Fé de Melo V, Walmir de Araújo S, Mota Constante M, Mao RMD, Villasante-Tezanos A, Lu R. Mesh repair versus non-mesh repair for incarcerated and strangulated groin hernia: an updated systematic review and meta-analysis. Hernia 2023; 27:1397-1413. [PMID: 37679548 DOI: 10.1007/s10029-023-02874-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/28/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Mesh repair in incarcerated or strangulated groin hernia is controversial, especially when bowel resection is required. We aimed to perform a meta-analysis comparing mesh and non-mesh repair in patients undergoing emergency groin hernia repair. METHODS We performed a literature search of databases to identify studies comparing mesh and primary suture repair of patients with incarcerated or strangulated inguinal or femoral hernias who underwent emergency surgery. Postoperative outcomes were assessed by pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. Heterogeneity was assessed with I2 statistics. RESULTS 1095 studies were screened and 101 were thoroughly reviewed. Twenty observational studies and four randomized controlled trials comprising 12,402 patients were included. We found that mesh-based repair had reduced recurrence (OR 0.36; 95% CI 0.19, 0.67; P = 0.001; I2 = 35%), length of hospital stay (OR - 1.02; 95% CI - 1.87, - 0.17; P = 0.02; I2 = 94%) and operative time (OR - 9.21; 95% CI - 16.82, - 1.61; P = 0.02; I2 = 95%) without increasing surgical site infection, mortality or postoperative complications such as seroma, chronic, ileus or urinary retention. In the subgroup analysis of patients that underwent bowel resection, we found that mesh repair was associated with an increased risk of surgical site infection (OR 1.74; 95% CI 1.04, 2.91; P = 0.04; I2 = 9%). CONCLUSIONS Mesh repair for incarcerated and strangulated groin hernias reduces recurrence without an increase in postoperative complications and should be considered in clean cases. However, in the setting of bowel resection, mesh repair might increase the incidence of surgical site infection.
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Affiliation(s)
- P Marcolin
- School of Medicine, Universidade Federal da Fronteira Sul, 20 Capitão Araújo St, Passo Fundo, RS, 99010121, Brazil.
| | | | | | - Sérgio Walmir de Araújo
- Department of Vascular Surgery, Hospital Regional Hans Dieter Schimidt, Joinville, SC, Brazil
| | | | - Rui-Min Diana Mao
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA
| | - A Villasante-Tezanos
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Galveston, TX, USA
| | - R Lu
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA
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Sæter AH, Fonnes S, Li S, Rosenberg J, Andresen K. Mesh versus non-mesh for emergency groin hernia repair. Cochrane Database Syst Rev 2023; 11:CD015160. [PMID: 38009575 PMCID: PMC10680123 DOI: 10.1002/14651858.cd015160.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND A groin hernia is a collective name for inguinal and femoral hernias, which can present acutely with incarceration or strangulation of the hernia sac content, requiring emergency treatment. Timely repair of emergency groin hernias is crucial due to the risk of reduced blood supply and thus damage to the bowel, but the optimal surgical approach is unclear. While mesh repair is the standard treatment for elective hernia surgery, using mesh for emergency groin hernia repair remains controversial due to the risk of surgical site infection. OBJECTIVES To assess the benefits and harms of mesh compared with non-mesh in emergency groin hernia repair in adult patients with an inguinal or femoral hernia. SEARCH METHODS On 5 August 2022, we searched the following databases: CENTRAL, MEDLINE Ovid, and Embase Ovid, as well as two trial registers for ongoing and completed trials. Additionally, we performed forward and backward citation searches for the included trials and relevant review articles. We searched without any language or publication restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing mesh with non-mesh repair in emergency groin hernia surgery in adults. We included any mesh and any non-mesh repairs. All studies fulfilling the study, participant, and intervention criteria were included irrespective of reported outcomes. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology. We presented dichotomous data as risk ratios (RR) with 95% confidence intervals (CI). We based missing data analysis on best- and worst-case scenarios. For outcomes with sufficiently low heterogeneity, we performed meta-analyses using the random-effects model. We analysed subgroups when feasible, including the degree of contamination. We used RoB 2 for risk of bias assessment, and summarised the certainty of evidence using GRADE. MAIN RESULTS We included 15 trials randomising 1241 participants undergoing emergency groin hernia surgery with either mesh (626 participants) or non-mesh hernia repair (615 participants). The studies were conducted in China, the Middle East, and South Asia. Most patients were men, and most participants had an inguinal hernia (41 participants had femoral hernias). The mean/median age in the mesh group ranged from 35 to 70 years, and from 41 to 69 years in the non-mesh group. All studies were performed in a hospital emergency setting (tertiary care) and lasted for 11 to 139 months, with a median study duration of 31 months. The majority of the studies only included participants with clean to clean-contaminated surgical fields. For all outcomes, we considered the certainty of the evidence to be very low, mainly downgraded due to high risk of bias (due to deviations from intended intervention and missing outcome data), indirectness, and imprecision. Mesh hernia repair may have no effect on or slightly increase the risk of 30-day surgical site infections (RR 1.66, 95% CI 0.96 to 2.88; I² = 21%; 2 studies, 454 participants) when compared with non-mesh hernia repair, but the evidence is very uncertain. The evidence is also very uncertain about the effect of mesh hernia repair compared with non-mesh hernia repair on 30-day mortality (RR 1.38, 95% CI 0.58 to 3.28; 1 study, 208 participants). In summary, the results showed 70 more (from 5 fewer to 200 more) surgical site infections and 29 more (from 32 fewer to 175 more) deaths within 30 days of mesh hernia repair per 1000 participants compared with non-mesh hernia repair. The evidence is very uncertain about 90-day surgical site infections after mesh versus non-mesh hernia repair (RR 1.00, 95% CI 0.15 to 6.64; 1 study, 60 participants; very low-certainty evidence). No 30-day recurrences were recorded, and mesh hernia repair may not reduce recurrence within one year (RR 0.19, 95% CI 0.04 to 1.03; I² = 0%; 2 studies, 104 participants; very low-certainty evidence). Within 30 days of hernia repair, no meshes were removed from clean to clean-contaminated fields, but 6.7% of meshes (1 study, 208 participants) were removed from contaminated to dirty surgical fields. Among the four studies reporting 90-day mesh removal, no events occurred. We were not able to identify any studies reporting complications classified according to the Clavien-Dindo Classification or reoperation for complications within 30 days of repair. AUTHORS' CONCLUSIONS Our results show that in terms of 30-day surgical site infections, 30-day mortality, and hernia recurrence within one year, the evidence for the use of mesh hernia repair compared with non-mesh hernia repair in emergency groin hernia surgery is very uncertain. Unfortunately, firm conclusions cannot be drawn due to very low-certainty evidence and meta-analyses based on small-sized and low-quality studies. There is a need for future high-quality RCTs or high-quality registry-based studies if RCTs are unfeasible.
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Affiliation(s)
- Ann Hou Sæter
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, Herlev, Denmark
| | - Siv Fonnes
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, Herlev, Denmark
| | - Shuqing Li
- Evidence-based Medicine Research Center, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Jacob Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, Herlev, Denmark
| | - Kristoffer Andresen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, Herlev, Denmark
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Kim J, Harper B, Turner A, Gonzalez IA, Andrade A. Incarcerated native orthotopic kidney through an inguinal hernia: a case report and literature review. J Surg Case Rep 2023; 2023:rjad378. [PMID: 37448882 PMCID: PMC10337659 DOI: 10.1093/jscr/rjad378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/16/2023] [Indexed: 07/15/2023] Open
Abstract
This is a case report of a 66-year-old male with an incarcerated inguinal hernia that contained native orthotopic kidney causing obstructive uropathy. The patient presented to the hospital due to intractable right groin pain, and CT imaging showed herniation of the right kidney in the right inguinal hernia with the upper pole squeezed in the inguinal canal. The patient underwent surgery to reduce the hernia contents and hernia repair with mesh. He was discharged on postoperative day 3 without complication. To the best of our knowledge, this is the first reported case of an incarcerated native orthotopic kidney without anatomic abnormality that had to undergo surgical intervention.
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Affiliation(s)
- Jisoo Kim
- Correspondence address. Department of Surgery, Texas Tech University Health Sciences Center – El Paso, 4800 Alberta Ave, El Paso, TX 79905, USA. Tel: (915) 545-6872; Fax: (915) 215-8605; E-mail:
| | - Brittany Harper
- Department of Surgery, Texas Tech University Health Sciences Center, 4800 Alberta Ave, El Paso, TX 79905, USA
| | - Alisan Turner
- Department of Surgery, Texas Tech University Health Sciences Center, 4800 Alberta Ave, El Paso, TX 79905, USA
| | - Irving Alvarado Gonzalez
- Department of Surgery, Texas Tech University Health Sciences Center, 4800 Alberta Ave, El Paso, TX 79905, USA
| | - Alonso Andrade
- Department of Surgery, Texas Tech University Health Sciences Center, 4800 Alberta Ave, El Paso, TX 79905, USA
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Chang HM, Chen CC, Feng TY, Wang RT. Nonmesh laparoscopic repair of incarcerated obturator hernia. JOURNAL OF MEDICAL SCIENCES 2023. [DOI: 10.4103/jmedsci.jmedsci_338_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Rodrigues-Gonçalves V, Verdaguer M, Moratal M, Blanco R, Bravo-Salva A, Pereira-Rodíguez JA, López-Cano M. Open Emergent Groin Hernia Repair: Anterior or Posterior Approach? JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2022; 1:10586. [PMID: 38314156 PMCID: PMC10831659 DOI: 10.3389/jaws.2022.10586] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/23/2022] [Indexed: 02/06/2024]
Abstract
Introduction: The current literature has not yet provided a definitive conclusion on the best emergency groin hernia repair. The aim of this study was first to compare the short and long-term outcomes between open preperitoneal and anterior approach in emergency groin hernia repair and second to identify risk factors for postoperative complications, mortality, and recurrence. Materials and Methods: This retrospective cohort study included patients who underwent emergency groin hernia repair between January 2010 and December 2018. Short and long-term outcomes were analyzed comparing approach and repair techniques. The predictors of complications and mortality were investigated using multivariate logistic regression. Cox regression multivariate analysis were used to explore risk factors of recurrence. Results: A total of 316 patients met the inclusion criteria. The most widely used surgical techniques were open preperitoneal mesh repair (34%) and mesh plug (34%), followed by Lichtenstein (19%), plug and patch (7%) and tissue repair (6%). Open preperitoneal mesh repair was associated with lower rates of recurrence (p = 0.02) and associated laparotomies (p < 0.001). Complication and 90-day mortality rate was similar between the techniques. Multivariable analysis identified patients aged 75 years or older (OR, 2.08; 95% CI, 1.14-3.80; p = 0.016) and preoperative bowel obstruction (OR, 2.11; 95% CI, 1.20-3.70; p = 0.010) as risk factors for complications and Comprehensive Complication Index ≥26.2 as risk factor for 90-day mortality (OR, 44.76; 95% CI, 4.51-444.59; p = 0.01). Female gender was the only risk factor for recurrence. Conclusion: Open preperitoneal mesh repair may be superior to other techniques in the emergency setting, because it can avoid the morbidity of associated laparotomies, with a lower long-term recurrence rate.
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Affiliation(s)
- V. Rodrigues-Gonçalves
- Abdominal Wall Surgery Unit, General Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - M. Verdaguer
- Abdominal Wall Surgery Unit, General Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - M. Moratal
- Abdominal Wall Surgery Unit, General Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - R. Blanco
- Abdominal Wall Surgery Unit, General Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - A. Bravo-Salva
- General Surgery, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Department de Ciéncies Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - J. A. Pereira-Rodíguez
- General Surgery, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Department de Ciéncies Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - M. López-Cano
- Abdominal Wall Surgery Unit, General Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
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Pavithira GJ, Dutta S, Sundaramurthi S, Nelamangala Ramakrishnaiah VP. Outcomes of Emergency Abdominal Wall Hernia Repair: Experience Over a Decade. Cureus 2022; 14:e26324. [PMID: 35911260 PMCID: PMC9311230 DOI: 10.7759/cureus.26324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 11/30/2022] Open
Abstract
Background Abdominal wall hernias are a common surgical entity encountered by the general surgeon. Approximately 10% of abdominal wall hernia patients require emergency surgery. However, these surgeries are associated with a high rate of postoperative morbidity and mortality. This study aimed to analyze the morbidity and mortality in patients undergoing emergency abdominal wall hernia repair and to determine the factors associated with surgical site infection (SSI) and recurrence in these patients attending a tertiary care hospital in south India. Methodology Our study was a single-centered, 10-year retrospective and a one-year prospective study conducted in a tertiary care center in India. All patients who underwent emergency abdominal wall hernia repair between April 2009 and May 2020 were included. Patients’ demographic details, comorbidities, intraoperative findings, 30-day surgical outcomes including SSI, and recurrence were studied. Results Out of 383 patients in our study, 63.9% had an inguinal hernia, and 54% of the patients underwent tissue repair. SSI was the most common morbidity (21.9%). Postoperative sepsis was the only independent factor associated with perioperative mortality according to the logistic regression analysis (odds ratio = 22.73, p = 0.022). Conclusions Tissue repair for emergency hernia surgery has better outcomes than mesh repair in clean-contaminated cases.
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Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows:
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Carmona M, Singares ES. A novel laparoscopic non-resective technique for the management of strangulated Richter's hernia. Int J Surg Case Rep 2022; 96:107335. [PMID: 35753232 PMCID: PMC9240795 DOI: 10.1016/j.ijscr.2022.107335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 05/30/2022] [Accepted: 06/18/2022] [Indexed: 02/07/2023] Open
Affiliation(s)
- Marleny Carmona
- Elson S. Floyd College of Medicine, Washington State University, United States of America
| | - Eduardo Smith Singares
- Elson S. Floyd College of Medicine, Washington State University, United States of America,Division of Trauma & Emergency Surgical Services, Kadlec Medical Center, United States of America,Corresponding author at: Elson S. Floyd College of Medicine, Washington State University, 800 Swift Boulevard, Corrado Building Suite 160, Richland, WA, United States of America.
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Cirocchi R, Burini G, Avenia S, Tebala G, Palumbo P, Cianci MC, Morabito A, Bruzzone P. Asymptomatic inguinal hernia: does it need surgical repair? A systematic review and meta-analysis. ANZ J Surg 2022; 92:2433-2441. [PMID: 35338686 DOI: 10.1111/ans.17594] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/25/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The aim of this review is to compare the outcomes of surgical repair versus watchful waiting in asymptomatic or minimally symptomatic inguinal hernias. METHODS Preferred reporting items for systematic reviews and meta-analyses guidelines were employed. We analysed primary outcomes: pain, quality of life, pain during daily activities and visual analogue scale (VAS that measures pain at rest and on movement) and secondary outcomes: postoperative complications and recurrence. RESULTS Pain and quality of life were not comparable due to differences in the parameters used in different articles. Pain interfering with normal daily activity was evaluated in one study and appears more favourable in the post-repair group respect to the watchful waiting (WW) group (5.1% versus 2.2%). VAS, measured in one study, at 6 months was more favourable in the surgery group (37% versus 44%). After 12 months the outcome was better in the control group than in the repair group (28% versus 30%). Conversion rate of the patient cohorts from watchful waiting to elective surgery was between 35.03% and 57.8%. The meta-analysis did not find significant statistical differences in the two groups examined for postoperative complications [RR = 0.95, 95% CI (0.50, 1.80), P = 0.88], as for hernia recurrence [RR = 1.01, 95% CI (0.50, 2.02), P = 0.98]. CONCLUSION WW seems to be an acceptable option for the patient with asymptomatic or minimally symptomatic inguinal hernias. Delaying surgical repair until symptoms appear is safe. Acute hernia incarcerations are not particularly frequent. The incidence of chronic pain after the repair is high. Physicians must select patients carefully and explain to them the risks and benefits of surgery.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, S. Maria Hospital, University of Perugia, Terni, Italy
| | - Gloria Burini
- Deparment of General and Emergency Surgery, General and Emergency Surgical Clinic of Ancona, Ancona, Italy
| | - Stefano Avenia
- Department of Medicine and Surgery, S. Maria Hospital, University of Perugia, Terni, Italy
| | - Giovanni Tebala
- Surgical Emergency Unit, John Radcliffe Hospital, Oxford University NHS Foundation Trust, Oxford, UK
| | - Piergaspare Palumbo
- Department of Surgical Sciences, "Sapienza" University of Rome, Azienda Policlinico Umberto I Viale del Policlinico, Rome, Italy
| | - Maria Chiara Cianci
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Antonino Morabito
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Paolo Bruzzone
- Department of General and Specialist Surgery "Paride Stefanini", Sapienza University, Azienda Policlinico Umberto I Viale del Policlinico, Rome, Italy
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Zhang X, Hou A, Cao J, Liu Y, Lou J, Li H, Ma Y, Song Y, Mi W, Liu J. Association of Diabetes Mellitus With Postoperative Complications and Mortality After Non-Cardiac Surgery: A Meta-Analysis and Systematic Review. Front Endocrinol (Lausanne) 2022; 13:841256. [PMID: 35721703 PMCID: PMC9204286 DOI: 10.3389/fendo.2022.841256] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/12/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Although a variety of data showing that diabetes mellitus (DM) (Type 1 or Type 2) is associated with postoperative complication, there is still a lack of detailed studies that go through the specific diabetic subgroups. The goal of this meta-analysis is to assess the relationship between DM and various complications after non-cardiac surgery. METHODS We searched articles published in three mainstream electronic databases (PubMed, EMBASE, Web of science) before November, 2020. A random effects model was conducted since heterogeneity always exist when comparing results between different types of surgery. RESULTS This paper included 125 studies with a total sample size of 3,208,776 participants. DM was a risk factor for any postoperative complication (Odds ratio (OR)=1.653 [1.487, 1.839]). The risk of insulin-dependent DM (OR=1.895 [1.331, 2.698]) was higher than that of non-insulin-dependent DM (OR=1.554 [1.061, 2.277]) for any postoperative complication. DM had a higher risk of infections (OR=1.537 [1.322, 1.787]), wound healing disorders (OR=2.010 [1.326, 3.046]), hematoma (OR=1.369 [1.120, 1.673]), renal insufficiency (OR=1.987 [1.311, 3.013]), myocardial infarction (OR=1.372 [0.574, 3.278]). Meanwhile, DM was a risk factor for postoperative reoperation (OR=1.568 [1.124, 2.188]), readmission (OR=1.404 [1.274, 1.548]) and death (OR=1.606 [1.178, 2.191]). CONCLUSIONS DM is a risk factor for any postoperative complications, hospitalization and death after non-cardiac surgery. These findings underscore the importance of preoperative risk factor assessment of DM for the safe outcome of surgical patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Weidong Mi
- *Correspondence: Jing Liu, ; Weidong Mi,
| | - Jing Liu
- *Correspondence: Jing Liu, ; Weidong Mi,
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14
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Peksöz R, Karaıslı S, Erözkan K, Ağırman E. The role of basic blood parameters in determining the viability of intestinal tissue in incarcerated hernias. Int J Clin Pract 2021; 75:e14664. [PMID: 34328252 DOI: 10.1111/ijcp.14664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Abdominal hernia repair is a common surgery, with incarcerated hernias accounting for 15% of all cases. In these cases, early diagnosis of intestinal ischaemia and necrosis is crucial to prevent mortality and morbidity. Biomarkers that can predict ischaemic or necrotic status are of vital importance. The aim of this study was to reveal the roles of basic blood parameters in determining ischaemic or necrotic status. METHODS Patients were divided into three groups. Group I included 24 patients with normal bowels, Group II included 31 patients with intestinal ischaemia without necrosis, and Group III included 10 patients who underwent bowel resection for necrosis. Patients' demographic characteristics and blood parameters were retrospectively analysed. RESULTS A total of 65 patients were operated for incarcerated abdominal hernias. There was no significant difference between the groups in terms of age, sex, comorbidity or complications (P > .05). Group III had the longest length of hospital stay (P < .001). There were significant differences between the groups in terms of serum white blood cell (WBC), neutrophil, lymphocyte (LYM), neutrophil-lymphocyte ratio (NLR), urea, creatinine, total bilirubin, indirect bilirubin, lipase, C-reactive protein (CRP) and lymphocyte-to-C-reactive protein (CRP) ratio (LCR) values (P < .05). CONCLUSION Blood parameters combining with clinical symptoms and radiological examination may contribute to predicting intestinal resection. Preoperative WBC, neutrophil, NLR, urea, creatinine and total bilirubin levels can contribute to predict the onset of intestinal ischaemia. Serum creatinine, total bilirubin, indirect bilirubin, phosphorus, lactate dehydrogenase (LDH) and lipase levels can contribute to deciding on bowel resection.
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Affiliation(s)
- Rıfat Peksöz
- Department of General Surgery, Atatürk University Research Hospital, Erzurum, Turkey
| | - Serkan Karaıslı
- Department of General Surgery, İzmir Kâtip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Kamil Erözkan
- Department of General Surgery, Muş State Hospital, Muş, Turkey
| | - Enes Ağırman
- Department of General Surgery, Faculty of Medicine, Atatürk University, Erzurum, Turkey
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15
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Sakamoto T, Fujiogi M, Ishimaru M, Matsui H, Fushimi K, Yasunaga H. Comparison of postoperative infection after emergency inguinal hernia surgery with enterectomy between mesh repair and non-mesh repair: a national database analysis. Hernia 2021; 26:217-223. [PMID: 34138368 DOI: 10.1007/s10029-021-02439-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/07/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Synthetic non-absorbable mesh is used for elective inguinal hernia repair but is not commonly used for incarcerated or strangulated inguinal hernia requiring enterectomy to reduce the risk of surgical-site infection. This study aimed to evaluate the safety of synthetic non-absorbable mesh repair in patients with incarcerated or strangulated inguinal hernia requiring enterectomy versus non-mesh repair. METHODS We analyzed patients with incarcerated or strangulated inguinal hernia with enterectomy from April 2012 to March 2017 using a nationwide inpatient database in Japan. We conducted overlap propensity score-weighted analyses to compare surgical-site infection (SSI), duration of anesthesia, antibiotic use at > 3 days after surgery, postoperative hospital stay, and 30 day readmission. Two sensitivity analyses were performed. First, we compared the proportions of patients requiring wound culture at ≥ 3 days after surgery. Second, we performed overlap propensity score-weighted logistic regression analyses for surgical-site infection. RESULTS We identified 668 eligible patients, comprising 223 patients with mesh repair and 445 with non-mesh repair. Overlap propensity score-weighted analyses showed no significant differences between the mesh repair and non-mesh repair groups for SSI (2.5 vs. 2.8%, P = 0.79). Secondary outcomes did not differ significantly between the groups. Proportion of wound culture at ≥ 3 days after surgery was similar in the two groups (11.1 vs. 14.6%, P = 0.18). Logistic regression analysis showed no significant association between mesh repair and SSI (odds ratio, 0.93; 95% confidence interval, 0.34-2.57). CONCLUSION Synthetic non-absorbable mesh use may be safe for incarcerated or strangulated inguinal hernia requiring enterectomy.
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Affiliation(s)
- T Sakamoto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan.
| | - M Fujiogi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - M Ishimaru
- Department of Health Services Research, Faculty of Medicine, Institutes of Medicine, University of Tsukuba, Ibaraki, Japan
| | - H Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - K Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - H Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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16
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Surgical site infection in mesh repair for ventral hernia in contaminated field: A systematic review and meta-analysis. Ann Med Surg (Lond) 2021; 63:102173. [PMID: 33680450 PMCID: PMC7907974 DOI: 10.1016/j.amsu.2021.02.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 01/14/2023] Open
Abstract
Background Given the risk of surgical site infection (SSI), the use of mesh in contaminated ventral hernia repair (VHR) is not standardized and still a clinical dilemma. This meta-analysis aimed to assess whether mesh use increased the risk of SSI in patients following VHR in contaminated field. Methods We performed a systematic review of published literature. Studies comparing the mesh repair and anatomic repair, the use of mesh in different Center for Disease Control and Prevention (CDC) wound classes and mesh repair with synthetic mesh or other type of meshes to treat complicated and contaminated VHR were considered for analysis. The main outcome was SSI incidence. Results Six studies compared mesh and suture repairs. No significant difference in SSI incidence was observed between patients with complicated VHR in the mesh and suture repair groups.Five studies analyzed mesh repair in patients by field contamination level. There was no significant difference between the use of mesh in clean-contaminated, contaminated and dirty field versus clean wound class. Moreover, there was no significant difference between the use of mesh in clean-contaminated and contaminated cases.Four studies compared mesh repair technique with synthetic mesh or other type of meshes were included. The incidence of SSI was significantly lower in the synthetic mesh group. Conclusions The use of mesh repair in the management of complicated VHR compared to suture repair is not associated with an increased incidence of SSI even in potentially contaminated fields.
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17
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Liu J, Shen Y, Nie Y, Zhao X, Wang F, Chen J. If laparoscopic technique can be used for treatment of acutely incarcerated/strangulated inguinal hernia? World J Emerg Surg 2021; 16:5. [PMID: 33549139 PMCID: PMC7866747 DOI: 10.1186/s13017-021-00348-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/27/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Laparoscopic treatment for acutely incarcerated/strangulated inguinal hernias is uncommon and controversial. In the present study, we assessed the safety and feasibility of transabdominal preperitoneal (TAPP) repair for the treatment of acutely incarcerated/strangulated inguinal hernias. Methods Patients with acutely incarcerated/strangulated inguinal hernias who underwent TAPP repair at the Department of Hernia and Abdominal Wall Surgery (Beijing Chaoyang Hospital) from January 2017 to December 2019 were retrospectively reviewed. Patients’ characteristics, operation details, and postoperative complications were retrospectively analyzed. Results In total, 94 patients with acutely incarcerated/strangulated inguinal hernias underwent TAPP repair. The patients comprised 85 men and 9 women (mean age, 54.3 ± 13.6 years; mean operating time, 61.6 ± 17.7 min; mean hospital stay, 3.9 ± 2.2 days). No patients were converted to open surgery. Hernia reduction was successfully performed in all patients. The morbidity of complications was 20.2% (19/94). Two bowel resections were performed endoscopically. Nine (9.6%) patients avoided unnecessary bowel resections during laparoscopic procedures. All patients recovered well without severe complications. No recurrence or infection was recorded during a mean follow-up period of 26.8 ± 9.8 months. Conclusions TAPP appears to be safe and feasible for treatment of patients with acutely incarcerated/strangulated inguinal hernias. However, it requires performed by experienced surgeons in laparoscopic techniques.
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Affiliation(s)
- Jing Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Number 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| | - Yingmo Shen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Number 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China.
| | - Yusheng Nie
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Number 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| | - Xuefei Zhao
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Number 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| | - Fan Wang
- Department of Hernia and Abdominal Wall Surgery, 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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Sanna A, Felicioni L, Cola R, Polistina F. Desarda Repair for Incarcerated Groin Hernia: A Case Series Analysis. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02313-9] [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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19
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Sakon R, Hara Y, Tomizawa Y, Ishiyama Y, Ito S, Oneyama M, Amiki M, Narita K, Tachimori Y, Goto M. Successful one-stage laparoscopic procedure for de Garengeot hernia: a totally extraperitoneal repair-first approach. J Surg Case Rep 2021; 2021:rjaa586. [PMID: 33542813 PMCID: PMC7850006 DOI: 10.1093/jscr/rjaa586] [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: 11/24/2020] [Accepted: 12/17/2020] [Indexed: 11/13/2022] Open
Abstract
The de Garengeot hernia is a femoral hernia in which the appendix migrates into the hernia sac. It is usually diagnosed intraoperatively due to its rarity and lack of clinical presentation typical to acute appendicitis. Although most cases need emergency operation due to incarceration, no standard procedure exists. We report the case of a 49-year-old woman who was diagnosed with a de Garangeot hernia preoperatively by contrast-enhanced computed tomography. She underwent one-stage laparoscopic surgery via a totally extraperitoneal approach followed by laparoscopic appendectomy. She recovered uneventfully and was discharged on postoperative Day 3. Generally, hernioplasty and appendectomy are required for the de Garengeot hernia treatment. Avoiding a peritoneal incision around the herniation and performing a mesh repair prior to appendectomy is expected to carry a lower infectious risk than other laparoscopic procedures. With accurate diagnosis, this procedure could be a useful modality for de Garengeot hernia.
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Affiliation(s)
- Ryota Sakon
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki-city, Kanagawa, Japan
| | - Yoshiaki Hara
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki-city, Kanagawa, Japan
| | - Yuki Tomizawa
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki-city, Kanagawa, Japan
| | - Yasuhiro Ishiyama
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki-city, Kanagawa, Japan
| | - Shingo Ito
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki-city, Kanagawa, Japan
| | - Masataka Oneyama
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki-city, Kanagawa, Japan
| | - Manabu Amiki
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki-city, Kanagawa, Japan
| | - Kazuhiro Narita
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki-city, Kanagawa, Japan
| | - Yuji Tachimori
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki-city, Kanagawa, Japan
| | - Manabu Goto
- Department of Surgery, Kawasaki Saiwai Hospital, Kawasaki-city, Kanagawa, Japan
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20
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Lin YT, Weng TY, Tam KW. Effectiveness and Safety of Mesh Repair for Incarcerated or Strangulated Hernias: A Systematic Review and Meta-Analysis. World J Surg 2021; 44:2176-2184. [PMID: 32086555 DOI: 10.1007/s00268-020-05430-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Hernia repair with mesh in patients with incarcerated or strangulated hernias is controversial. Moreover, the use of mesh for hernia repair with concomitant bowel resection poses a great dilemma. This study compared the outcomes of mesh and anatomic repairs in patients with acutely incarcerated or strangulated hernias. METHODS PubMed, Embase, and Cochrane databases were searched for studies published before November 2019. Randomized controlled trials (RCTs) and prospective studies were included. We conducted meta-analyses using a random-effects model. The treatment outcome was measured by the incidence of surgical site infection (SSI), seroma formation, and hernia recurrence postoperatively. RESULTS Two RCTs and six prospective studies with 978 patients were included. No significant difference in SSI incidence was observed between patients with incarcerated hernia from the mesh and anatomic repair groups. Recurrence was significantly lower in mesh repair group than in anatomic repair group (odds ratio, 0.08; 95% confidence interval, 0.01-0.45). Only two patients needed to have mesh explantation due to mesh infection. In the setting of hernia repair with concomitant bowel resection, the SSI rate with mesh repair was slightly higher, but most cases of infections were well controlled with conservative antibiotic therapy. CONCLUSIONS Mesh repair for incarcerated or strangulated hernias was feasible with a great benefit of lower recurrence rates. However, due to limited data, drawing conclusions regarding the use of mesh for hernia repair with concomitant bowel resection was difficult. Further studies with preset criteria for evaluating patients undergoing concomitant bowel resection may help elucidate this issue.
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Affiliation(s)
- Yu-Te Lin
- Department of General Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Tzu-Yu Weng
- Department of Dermatology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Ka-Wai Tam
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan. .,Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
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21
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Gaitanidis A, Breen K, Naar L, Mikdad S, El Moheb M, Kongkaewpaisan N, El Hechi M, Kaafarani HMA. Performance of the Emergency Surgery Score (ESS) Across Different Emergency General Surgery Procedures. J Surg Res 2021; 261:152-158. [PMID: 33429224 DOI: 10.1016/j.jss.2020.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/02/2020] [Accepted: 12/08/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND The Emergency Surgery Score (ESS) has been previously validated as a reliable tool to predict postoperative outcomes in emergency general surgery (EGS). The purpose of this study is to assess the differential performance of the ESS in specific EGS procedures. METHODS The American College of Surgeons' National Surgical Quality Improvement Program database was retrospectively analyzed for patients undergoing EGS between 2007 and 2017. Patients who underwent the following EGS procedures were identified: laparoscopic appendectomy, laparoscopic cholecystectomy, surgery for small bowel obstruction (SBO), colectomy, and incarcerated ventral or inguinal hernia repair. The performance of the ESS in predicting mortality in each procedure was assessed using receiver operating characteristic analyses. RESULTS A total of 467,803 patients underwent EGS (mean age 50 ± 19.9 y, females 241,330 [51.6%]), of which 191,930 (41%) underwent laparoscopic appendectomy, 40,353 (8.6%) underwent laparoscopic cholecystectomy, and 35,152 (7.5%) patients underwent surgery for SBO. The ESS correlated extremely well with mortality for patients who underwent laparoscopic appendectomy (area under the curve (AUC) 0.91), laparoscopic cholecystectomy (AUC 0.91), lysis of adhesions for SBO (AUC 0.83), colectomy (AUC 0.83), and incarcerated hernia repair (AUC 0.85). CONCLUSIONS ESS performance accurately predicts mortality across a wide range of EGS procedures, and its use should be encouraged for preoperative patient counseling and for nationally benchmarking the quality of care of EGS.
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Affiliation(s)
- Apostolos Gaitanidis
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Kerry Breen
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Leon Naar
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Sarah Mikdad
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Mohamad El Moheb
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Napaporn Kongkaewpaisan
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Majed El Hechi
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts.
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22
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Ninomiya S, Fujita S, Ogawa T, Ueda Y, Shiraishi N, Inomata M, Shimoda K. Incarcerated femoral hernia treated with elective totally extraperitoneal repair: a case report. J Surg Case Rep 2020; 2020:rjaa158. [PMID: 32577212 PMCID: PMC7297550 DOI: 10.1093/jscr/rjaa158] [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] [Received: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 12/27/2022] Open
Abstract
Incarcerated groin hernia is a common surgical emergency. However, reports of incarcerated femoral hernia treated with elective totally extraperitoneal repair are extremely rare. A 62-year-old woman visited our hospital with lower abdominal pain and bulging from a right groin lesion. The patient was diagnosed as having right incarcerated femoral hernia containing greater omentum by computed tomography. As there were no clear findings of intestinal obstruction and peritonitis, elective surgery was performed. Intraoperatively, the hernia sac had herniated into the right femoral canal. We could release the hernia sac using laparoscopic forceps. After reduction of the hernia sac, polypropylene mesh was placed in the preperitoneal space and fixed to Cooper's ligament. The patient's postoperative course was uneventful, and she was discharged 3 days after surgery. We consider elective totally extraperitoneal repair for incarcerated femoral hernia to be an effective procedure for selected patients who have been diagnosed accurately.
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Affiliation(s)
- Shigeo Ninomiya
- Department of Surgery, Cosmos Hospital, Usuki, Japan.,Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Yufu, Japan
| | | | - Tadashi Ogawa
- Department of Surgery, Cosmos Hospital, Usuki, Japan
| | - Yoshitake Ueda
- Department of Comprehensive Surgery for Community Medicine, Oita University Faculty of Medicine, Yufu, Japan
| | - Norio Shiraishi
- Department of Comprehensive Surgery for Community Medicine, Oita University Faculty of Medicine, Yufu, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Yufu, Japan
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23
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Chen P, Yang W, Zhang J, Wang C, Yu Y, Wang Y, Yang L, Zhou Z. Analysis of risk factors associated bowel resection in patients with incarcerated groin hernia. Medicine (Baltimore) 2020; 99:e20629. [PMID: 32502042 PMCID: PMC7306359 DOI: 10.1097/md.0000000000020629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Incarcerated groin hernia (IGH) is a common surgical emergency. However, there are few accurate and applicable predictors for differentiating patients with strangulated groin hernia from those with IGH. In this study, we aimed to identify the independent risk factors for bowel resection in patients with IGH. METHODS We retrospectively collected 323 patients who underwent emergency hernia repair surgery for IGH between January 2010 and October 2019. The patients were categorized into those who received bowel resection and those who did not require bowel resection. The receiver-operating characteristic curve was used to identify the best cutoff values for continuous variables. Following this, univariate and multivariate analyses were performed to identify potential risk factors for bowel resection in these patients. RESULTS Univariate analysis identified 6 variables that were significantly associated with bowel resection among patients with IGH. On multivariate analysis, neutrophil-to-lymphocyte ratio (NLR) (odds ratio [OR] = 3.362, 95% confidence interval [CI] 1.705-6.628, P = .000) and bowel obstruction (OR = 3.191, 95% CI 1.873-5.437, P = 0.000) were identified as independent risk factors for bowel resection among patients with IGH. CONCLUSION In this study, an elevated NLR and those with bowel obstruction are associated with an increased risk of bowel resection among patients with IGH. Based on our findings, surgeons should prioritize prompt emergency surgical repair for patients who present with elevated NLR and bowel obstruction concurrent with IGH.
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Affiliation(s)
- Peng Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
| | - Wenming Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
| | - Jianhao Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
| | - Cun Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University, Chengdu
| | - Yongyang Yu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University, Chengdu
| | - Yong Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University, Chengdu
| | - Lie Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University, Chengdu
- Department of General Surgery, West China-Ziyang Hospital of Sichuan University/The First People's Hospital of Ziyang, Ziyang, Sichuan Province, China
| | - Zongguang Zhou
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital of Sichuan University, Chengdu
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24
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Papaconstantinou D, Garoufalia Z, Kykalos S, Nastos C, Tsapralis D, Ioannidis O, Michalinos A, Chatzimavroudis G, Schizas D. Implications of the presence of the vermiform appendix inside an inguinal hernia (Amyand's hernia): a systematic review of the literature. Hernia 2020; 24:951-959. [PMID: 32451789 DOI: 10.1007/s10029-020-02215-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/06/2020] [Indexed: 12/08/2022]
Abstract
PURPOSE To identify and sum all available evidence pertaining to the management of Amyand's hernia (AH). METHODS A systematic search of the MedLine, Scopus, and Google Scholar databases was performed for studies published until January 2020. RESULTS In total, 111 studies incorporating 161 patients were identified, 96 (86.4%) being case reports, 11 (9.9%) case series, and 4 (3.7%) retrospective patient cohorts. Mean patient age was 58.5 ± 19.6 years with 136 (83.9%) being males and 25 (16.1%) females. Furthermore, 149 (92.5%) cases were right-sided hernias while 12 (7.5%) cases were left-sided. Overall, 62.3% of patients presented emergently and 77.3% of patients' cohort were eventually diagnosed with incarcerated AH. Preoperative diagnosis of AH was established in 23.1% of patients and was achieved either by ultrasound (25%) or CT scan (75%). Operative findings consisted of normal appendix in 73 (45.4%) cases, uncomplicated appendicitis in 62 (38.5%) patients, and perforated appendix in 26 (16.1%). Regarding patients with appendicitis, mesh placement was reported for 17 (21.2%), herniorrhaphy was performed for 51 (63.7%) while 12 (15.1%) patients did not undergo hernia repair during the initial operation. Mesh utilization rates were significantly higher in patients with a normal appendix. Seven cases involved AH containing appendiceal neoplasms. Thirteen cases (8.6%) of postoperative complications were documented and a single case of postoperative death. CONCLUSION AH is a rare type of inguinal hernia usually complicated by appendicitis. Hernia reconstruction should be tailored to each patient individually according to the extent of inguinal canal inflammation.
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Affiliation(s)
- D Papaconstantinou
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Rimini 1 Str., Chaidari, 12462, Athens, Greece.
| | - Z Garoufalia
- Second Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - S Kykalos
- Second Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - C Nastos
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Rimini 1 Str., Chaidari, 12462, Athens, Greece
| | - D Tsapralis
- Surgical Department, General Hospital of Ierapetra, Ierapetra, Greece
| | - O Ioannidis
- Fourth Department of Surgery, Aristotle University of Thessaloniki, General Hospital George Papanikolaou, Thessaloniki, Greece
| | - A Michalinos
- Department of Anatomy, European University of Cyprus, Nicosia, Cyprus
| | - G Chatzimavroudis
- Second Department of Surgery, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
| | - D Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Yanari S, Suto T, Fujiwara H, Ariyoshi Y, Umemura A, Sasaki A. Intraperitoneal onlay mesh repair (IPOM) plus technique using a hybrid procedure of open laparotomy and laparoscopic approach (hybrid IPOM plus) for incarceration of umbilical hernia in a severely obese patient: a case report. Surg Case Rep 2020; 6:83. [PMID: 32337655 PMCID: PMC7183571 DOI: 10.1186/s40792-020-00845-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/15/2020] [Indexed: 12/03/2022] Open
Abstract
Background A standard procedure for the treatment of incarcerated umbilical hernia among severely obese patients has yet to be established. We used the hybrid intraperitoneal onlay mesh repair (IPOM) plus method, which combines open and laparoscopic surgery to treat incarcerated umbilical hernia in a severely obese patient. Case presentation A 46-year-old man presented in our department with a chief complaint of a painful mass in the umbilical region. Incarcerated umbilical hernia was diagnosed on the basis of abdominal computed tomography, and the decision was made to perform emergency surgery. The patient was severely obese (body mass index, 53.8 kg/m2), and the incarcerated portion of the hernia was therefore first addressed by open surgery. As bowel resection was unnecessary, the risk of infection was considered low, and after direct closure of the hernia orifice, IPOM was performed laparoscopically using the hybrid IPOM plus method. Conclusion Among severely obese patients, first trocar insertion is difficult and the wound site tends to come under strain, meaning that simple closure of the hernia orifice results in a high recurrence rate. The hybrid IPOM plus method used in this case combines open surgery and laparoscopy and appears useful for treating uninfected incarcerated umbilical hernia in severely obese patients safely and with an anticipated low rate of postoperative recurrence.
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Affiliation(s)
- Shingo Yanari
- Department of Surgery, Morioka Municipal Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan
| | - Takayuki Suto
- Department of Surgery, Morioka Municipal Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan.
| | - Hisataka Fujiwara
- Department of Surgery, Morioka Municipal Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan
| | - Yu Ariyoshi
- Department of Surgery, Morioka Municipal Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan
| | - Akira Umemura
- Department of Surgery, Iwate Medical University School of Medicine, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University School of Medicine, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
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Pérez-Köhler B, Benito-Martínez S, García-Moreno F, Rodríguez M, Pascual G, Bellón JM. Preclinical bioassay of a novel antibacterial mesh for the repair of abdominal hernia defects. Surgery 2020; 167:598-608. [DOI: 10.1016/j.surg.2019.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/30/2019] [Accepted: 10/14/2019] [Indexed: 01/13/2023]
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Chen F, Liu M, Jin C, Wang F, Shen Y, Zhao F, Chen J. Tension-Free Mesh Repair for Incarcerated Groin Hernia: A Comparative Study. Surg Innov 2020; 27:352-357. [PMID: 31994450 DOI: 10.1177/1553350620901392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Management of emergent groin hernias remains challenging, due to limited consensus in surgical approach and repair options (eg, mesh vs nonmesh, biological mesh, and polypropylene [PP] mesh). Methods. A 5-year retrospective study was conducted on 118 patients who received emergency incarcerated groin hernia repair in Beijing Chaoyang Hospital. The incidence of surgical site infection (SSI), preoperative mortality, sepsis, and ileus was noted. In the follow-up, postoperative foreign body sensation, chronic pain, seroma/hematoma, and recurrence were recorded. The outcomes of different surgical procedures (with mesh/without mesh, biological mesh/PP mesh, transabdominal preperitoneal (TAPP)/Lichtenstein repair) were compared and analyzed. Results. Out of the 118 patients, 14 cases received suture repair (as group A); 104 cases had TAPP repair (n = 44) or Lichtenstein repair (n = 60) with meshes, including 23 cases of biological mesh (as group B); and 81 cases had repair with PP mesh (group C). There were no significant differences between the 3 groups regarding SSI, mortality, sepsis, and ileus. After 20.5 months of follow-up (range from 6 to 65 months), 21.4% of group A developed recurrence, a rate significantly higher than that of group B (4.3%) and group C (0). The incidence of seroma/hematoma in group B was higher than that in group A (7.1%) and group C (7.4%). The results between TAPP group and Lichtenstein group were comparable. Conclusion. Tension-free mesh repair in the treatment of emergency incarcerated groin hernia is safe and effective, which can reduce hernia recurrence without increasing infection risk. The results of biological mesh and PP mesh were comparable.
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Affiliation(s)
- Fuqiang Chen
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Min Liu
- The Third Clinical Medical College, Capital Medical University, Beijing, China
| | - Cuihong Jin
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Fan Wang
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yingmo Shen
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Fenglin Zhao
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jie Chen
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Emergency repair of complicated abdominal wall hernias: WSES guidelines. Hernia 2019; 24:359-368. [PMID: 31407109 DOI: 10.1007/s10029-019-02021-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 08/04/2019] [Indexed: 01/29/2023]
Abstract
PURPOSE In July 2013, the World Society of Emergency Surgery (WSES) held the first Consensus Conference on emergency repair of abdominal wall hernias in adult patients with the intention of producing evidence-based guidelines to assist surgeons in the management of complicated abdominal wall hernias. Guidelines were updated in 2017 in keeping with varying clinical practice: benefits resulting from the increased use of biological prosthesis in the emergency setting were highlighted, as previously published in the World Journal of Emergency Surgery. This executive summary is intended to consolidate knowledge on the emergency management of complicated hernias by providing the broad readership with a practical and concise version of the original guidelines. METHODS This executive manuscript summarizes the WSES guidelines reporting on the emergency management of complicated abdominal wall hernias; statements are highlighted focusing the readers' attention on the main concepts presented in the original guidelines. CONCLUSIONS Emergency repair of complicated abdominal hernias remains one of the most common and challenging surgical emergencies worldwide. WSES aims to provide an essential version of the evidence-based guidelines focusing on the timing of intervention, laparoscopic approach, surgical repair following the Centers for Disease Control and Prevention (CDC) wound classification, antimicrobial prophylaxis and anesthesia in the emergency setting.
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Liu J, Chen J, Shen Y. The results of open preperitoneal prosthetic mesh repair for acutely incarcerated or strangulated inguinal hernia: a retrospective study of 146 cases. Surg Endosc 2019; 34:47-52. [PMID: 30945058 DOI: 10.1007/s00464-019-06729-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 03/06/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Tension-free hernia repair has been regarded as the gold-standard treatment for selected inguinal hernias, but the use of prosthetic mesh in acutely incarcerated or strangulated inguinal hernias is controversial. Our aim was to evaluate the safety and efficacy of open prosthetic mesh repairs for emergency inguinal hernias. METHODS Patients with acutely incarcerated or strangulated inguinal hernias who underwent open preperitoneal prosthetic mesh repairs during 2013 to 2016 at our department were included. Patients' characteristics, operative details, results, and complications were retrospectively analyzed. RESULTS During a 4-year period, 146 cases who met the inclusion criteria were enrolled in our study. There were 127 males and 19 females of median age 75 years (range 19-95 years). The hernia was indirect inguinal in 104 (71.2%) patients, direct inguinal in 18 (12.3%), and femoral hernia in 24 (16.5%). Bowel resection was necessary in 20 patients (13.7%). Complications occurred in 15 (10.3%) patients, including wound infection in 6 (4.1%), scrotal hematoma in 2 (1.4%), bleeding in 1 (0.7%), deep vein thrombosis (DVT) in 2 (1.4%), and chest infection in 4 (2.7%). No mesh-related infections were detected. There were 2 mortalities. During the median follow-up of 26 months (range 6-53 months) 2 recurrences occurred, but there were no deaths or further infections. CONCLUSION Open preperitoneal prosthetic mesh repair can be safely performed in patients with incarcerated or strangulated inguinal hernia without contaminated hernia content. Mesh repair is not contraindicated in patients with bowel resection.
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Affiliation(s)
- Jing Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100043, China
| | - Jie Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100043, China
| | - Yingmo Shen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100043, China.
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Liu J, Zhai Z, Chen J. The Use of Prosthetic Mesh in the Emergency Management of Acute Incarcerated Inguinal Hernias. Surg Innov 2019; 26:344-349. [PMID: 30734633 DOI: 10.1177/1553350619828900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Tension-free hernia repair has been regarded as a gold standard treatment for selected inguinal hernias, but the use of prosthetic mesh in acute incarcerated inguinal hernias is controversial. Our study focused on evaluating the safety and efficacy of the prosthetic mesh repair for emergency cases. METHODS Patients with acute incarcerated inguinal hernias who underwent emergency prosthetic mesh repair during 2009 to 2014 at our department were included. Patient characteristics, operative approaches and results, and complications were retrospectively analyzed. RESULTS A total of 167 patients were included in our study. One hundred and twenty-two patients underwent open surgery while the remaining 45 patients underwent transabdominal preperitoneal laparoscopic approach. The hernia was indirect inguinal in 133 patients (79.6%), direct inguinal in 15 patients (9.0%), and femoral in 19 patients (11.4%). The overall wound infection rate of these patients was 3%. Nonviable intestinal resection was performed in 25 patients (8.4%), only 2 of whom underwent wound infection. Another 3 patients who developed wound infection had viable hernia content. There was no mesh-related infection. There was no statistically significant difference in wound infection rates between patients with viable hernia contents and those with nonviable contents ( P < .05). CONCLUSION The use of the prosthetic mesh in the treatment of acute incarcerated inguinal hernia is safe and effective. Nonviable intestinal resection cannot be regarded as a contradiction of the mesh repair.
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Affiliation(s)
- Jing Liu
- 1 Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhiwei Zhai
- 1 Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jie Chen
- 1 Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Tastaldi L, Krpata DM, Prabhu AS, Petro CC, Ilie R, Haskins IN, Alkhatib H, Tu C, Rosenblatt S, Rosen MJ. Emergent groin hernia repair: A single center 10-year experience. Surgery 2019; 165:398-405. [DOI: 10.1016/j.surg.2018.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/27/2018] [Accepted: 08/01/2018] [Indexed: 11/26/2022]
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Dai W, Chen Z, Zuo J, Tan J, Tan M, Yuan Y. Risk factors of postoperative complications after emergency repair of incarcerated groin hernia for adult patients: a retrospective cohort study. Hernia 2018; 23:267-276. [PMID: 30421299 PMCID: PMC6456471 DOI: 10.1007/s10029-018-1854-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 11/08/2018] [Indexed: 11/12/2022]
Abstract
Purpose This study aimed to explore risk factors of postoperative complications for adult patients with incarcerated groin hernia (IGH). Methods From January 2010 to December 2017, consecutive patients undergoing emergency hernia repair for IGH in our center were retrospectively reviewed. Postoperative complications, such as surgical site infection, seroma, hernia recurrence and mortality, were investigated, with risk factors for such complications analyzed using univariate and multivariate regressions. Results Sixty-four patients were included, with 51 males and 13 females (mean age 65.1, range 25–98 years). Ten patients (15.6%) underwent resection of necrotic bowel and anastomosis. 43 patients (67.2%) received open tension-free herniorrhaphy with polypropylene mesh, whereas the rest (32.8%) received herniorrhaphy without mesh. The overall postoperative complication rate was 40.6% (26/64), with an incisional complication rate of 31.2% (20/64) and an infection rate of 6.2% (4/64). At a median follow-up of 32 months, hernia recurrence and mortality were recorded in five cases each (7.8%). Mesh repair was associated with decreased recurrence rate compared with non-mesh repair (2.3% vs. 19.0%, p = 0.019). Diabetes mellitus (OR 8.611, 95%CI 1.292–57.405; p = 0.026) was an independent risk factor of postoperative complications, together with chronic obstructive pulmonary disease (COPD; OR 14.365, 95%CI 1.652–127.767, p = 0.016), intestinal necrosis (OR 14.260, 95%CI 1.079–188.460, p = 0.044), and general anesthesia (OR 14.543, 95%CI 1.682–125.711, p = 0.015) as risk for incisional complications after surgery. Conclusions Diabetes mellitus was an independent risk factor of postoperative complications for IGH, along with COPD, intestinal necrosis and general anesthesia associated with incisional complications. The use of polypropylene mesh did not increase infection or recurrence rate in this cohort.
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Affiliation(s)
- W Dai
- Center of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, People's Republic of China.,Center of Hernia and Abdominal Wall Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Z Chen
- Center of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, People's Republic of China.,Center of Hernia and Abdominal Wall Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - J Zuo
- Center of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, People's Republic of China.,Center of Hernia and Abdominal Wall Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - J Tan
- Center of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, People's Republic of China.,Center of Hernia and Abdominal Wall Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - M Tan
- Center of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, People's Republic of China. .,Center of Hernia and Abdominal Wall Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, People's Republic of China.
| | - Y Yuan
- Center of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, People's Republic of China. .,Center of Hernia and Abdominal Wall Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, People's Republic of China.
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Zhao F, Liu M, Chen J, Jin C, Chen F, Cao J, Liu Y. Clinical effects of prosthetic mesh in the treatment of incarcerated groin hernias. MINERVA CHIR 2018; 74:458-464. [PMID: 30334396 DOI: 10.23736/s0026-4733.18.07824-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Incarcerated groin hernias are a common presentation as surgical emergencies. Other surgical treatment modalities are becoming more widely accepted including the use of prosthetic mesh and laparoscopy for assessment of hernia content viability and for repair. The aim of this study was to report our current experience with the use of prosthetic mesh in the treatment of incarcerated hernias and to compare the effects of different operative approaches. METHODS This retrospective study included 219 consecutive patients who underwent herniorrhaphy for incarcerated hernia between January 2013 and December 2017 in Beijing Chao-Yang Hospital. Twenty patients who were not used mesh were excluded. Patients who died in the postoperative period due to systemic complications, as well as those who were lost during the follow-up period, were excluded from the study. Demographics, surgical details, short term and long-term outcomes were collected. Mann-Whitney U-test and χ2 test were used for statistical analysis. RESULTS A total of 156 patients (78.4%) presented with inguinal hernias, 42 with femoral hernia (21.1%), and one with mixed hernia (0.5%), respectively. Mesh was placed in 199 patients (100%), including 15 patients with concomitant bowel resection. Four patients (2.0%) developed surgical site infections (SSI), four patients (2.0%) had foreign body sensation, one patient (0.5%) had hernia recurrence, two patients (1.0%) had chronic pain, 22 patients (11.1%) had seroma, and the mortality was 2.0%. No significant difference was noted concerning the development of surgical site infection, postoperative recurrence, chronic pain, foreign body sensation, and mortality rates between the transabdominal preperitoneal (TAPP) repair and open mesh repair. There was statistically significant difference in the postoperative incidence of seroma between two groups (12 of 49 [24.5%] vs. 10 of 150 [6.7%]; P=0.001). CONCLUSIONS Our experience demonstrates that acutely incarcerated or strangulated groin hernia in adults is a serious neglected problem. The use of mesh could become current practice even in case of bowel resection. There was no statistically significant difference in the postoperative complications between TAPP repair and open mesh repairs except seroma.
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Affiliation(s)
- Fenglin Zhao
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Min Liu
- The Third Clinical Medical School of Capital Medical University, Beijing, China
| | - Jie Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China -
| | - Cuihong Jin
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Fuqiang Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jinxin Cao
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yuchen Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Birindelli A, Sartelli M, Di Saverio S, Coccolini F, Ansaloni L, van Ramshorst GH, Campanelli G, Khokha V, Moore EE, Peitzman A, Velmahos G, Moore FA, Leppaniemi A, Burlew CC, Biffl WL, Koike K, Kluger Y, Fraga GP, Ordonez CA, Novello M, Agresta F, Sakakushev B, Gerych I, Wani I, Kelly MD, Gomes CA, Faro MP, Tarasconi A, Demetrashvili Z, Lee JG, Vettoretto N, Guercioni G, Persiani R, Tranà C, Cui Y, Kok KYY, Ghnnam WM, Abbas AES, Sato N, Marwah S, Rangarajan M, Ben-Ishay O, Adesunkanmi ARK, Lohse HAS, Kenig J, Mandalà S, Coimbra R, Bhangu A, Suggett N, Biondi A, Portolani N, Baiocchi G, Kirkpatrick AW, Scibé R, Sugrue M, Chiara O, Catena F. 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias. World J Emerg Surg 2017; 12:37. [PMID: 28804507 PMCID: PMC5545868 DOI: 10.1186/s13017-017-0149-y] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 07/31/2017] [Indexed: 02/08/2023] Open
Abstract
Emergency repair of complicated abdominal wall hernias may be associated with worsen outcome and a significant rate of postoperative complications. There is no consensus on management of complicated abdominal hernias. The main matter of debate is about the use of mesh in case of intestinal resection and the type of mesh to be used. Wound infection is the most common complication encountered and represents an immense burden especially in the presence of a mesh. The recurrence rate is an important topic that influences the final outcome. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013 with the aim to define recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel. In 2016, the guidelines have been revised and updated according to the most recent available literature.
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Affiliation(s)
| | | | | | - Federico Coccolini
- Department of General Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Luca Ansaloni
- Department of General Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Gabrielle H van Ramshorst
- Department of Surgery, Red Cross Hospital Beverwijk, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Vladimir Khokha
- Department of General Surgery, Mozyr City Hospital, Mazyr, Belarus
| | | | - Andrew Peitzman
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - George Velmahos
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | | | - Ari Leppaniemi
- Department of Abdominal Surgery, University Hospital Meilahti, Helsinki, Finland
| | | | - Walter L Biffl
- Department of Surgery, University of Hawaii, Honolulu, HI USA
| | - Kaoru Koike
- Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Gustavo P Fraga
- Division of Trauma Surgery, Hospital de Clinicas, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Carlos A Ordonez
- Department of Surgery, Universidad del Valle, Fundacion Valle del Lili, Cali, Colombia
| | - Matteo Novello
- Department of Surgery, University of Bologna, Bologna, Italy
| | | | - Boris Sakakushev
- General Surgery Clinic, University Hospital St. George/Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Igor Gerych
- Department of Surgery 1, Lviv Regional Hospital, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Imtiaz Wani
- Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | | | - Carlos Augusto Gomes
- Federal University of Juiz de Fora (UFJF), Juiz de Fora, MG Brazil.,Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Juiz de Fora, MG Brazil
| | - Mario Paulo Faro
- Department of General Surgery, Trauma and Emergency Surgery Division, ABC Medical School, Santo André, SP Brazil
| | - Antonio Tarasconi
- Department of Emergency Surgery, Maggiore Parma Hospital, Parma, Italy
| | - Zaza Demetrashvili
- Department of Surgery, Tbilisi State Medical University, Tbilisi, Georgia
| | - Jae Gil Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Nereo Vettoretto
- Department of Surgery, Montichiari Hospital, ASST Spedali Civili Brescia, Brescia, Italy
| | | | | | - Cristian Tranà
- Department of Surgery, Macerata Hospital, Macerata, Italy
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Kenneth Y Y Kok
- Department of Surgery, RIPAS Hospital, Bandar Seri Begawan, Brunei
| | - Wagih M Ghnnam
- Department of Surgery Mansoura, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ashraf El-Sayed Abbas
- Department of Surgery Mansoura, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Norio Sato
- Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sanjay Marwah
- Department of Surgery, Pt. BDS Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Muthukumaran Rangarajan
- Department of Laparoscopic and Bariatric Surgery, Health City Cayman Islands, Grand Cayman, Cayman Islands
| | - Offir Ben-Ishay
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Abdul Rashid K Adesunkanmi
- Department of Surgery, College of Health Sciences, Obafemi Awolowo University Hospital, Ile-Ife, Nigeria
| | - Helmut Alfredo Segovia Lohse
- II Cátedra de Clínica Quirúrgica, Hospital de Clínicas, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Jakub Kenig
- 3rd Department of General Surgery, Jagiellonian University Collegium Medium, Krakow, Poland
| | - Stefano Mandalà
- Department of Surgery, G. Giglio Hospital Cefalù, Palermo, Italy
| | - Raul Coimbra
- Department of Surgery, Division of Trauma, Surgical Care, Burns and Acute Care Surgery, UC San Diego Medical Center, San Diego, CA USA
| | - Aneel Bhangu
- Academic Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Edgabaston, Birmingham, UK
| | - Nigel Suggett
- Department of Colorectal Surgery, New Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
| | | | | | | | - Andrew W Kirkpatrick
- Departments of Critical Care Medicine and Surgery, Foothills Medical Centre, Calgary, AB Canada
| | - Rodolfo Scibé
- Department of Surgery, Macerata Hospital, Macerata, Italy
| | | | | | - Fausto Catena
- Department of Emergency Surgery, Maggiore Parma Hospital, Parma, Italy
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Berger D. Evidence-Based Hernia Treatment in Adults. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 113:150-7; quiz 158. [PMID: 26987468 DOI: 10.3238/arztebl.2016.0150] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 01/19/2016] [Accepted: 01/19/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Inguinal hernia repair is the most common general surgical procedure in industrialized countries, with a frequency of about 200 operations per 100 000 persons per year. Suture- and mesh-based techniques can be used, and the procedure can be either open or minimally invasive. METHODS This review is based on a selective search of the literature, with interpretation of the published findings according to the principles of evidence-based medicine. RESULTS Inguinal hernia is diagnosed by physical examination. Surgery is not necessarily indicated for a primary, asymptomatic inguinal hernia in a male patient, but all inguinal hernias in women should be operated on. For hernias in women, and for all bilateral hernias, a laparoscopic or endoscopic procedure is preferable to an open procedure. Primary unilateral hernias in men can be treated either by open surgery or by laparoscopy/endoscopy. Patients treated by laparoscopy/endoscopy develop chronic pain less often than those treated by open surgery. A mesh-based repair is generally recommended; this seems reasonable in view of the pathogenesis of the condition, which involves an abnormality of the extracellular matrix. CONCLUSION The choice of procedure has been addressed by international guidelines based on high-level evidence. Surgeons should deviate from their recommendations only in exceptional cases and for special reasons. Guideline conformity implies that hernia surgeons must master both open and endoscopic/laparoscopic techniques.
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Affiliation(s)
- Dieter Berger
- Clinic of Abdominal, Thoracic and Pediatric Surgery, Klinikum Mittelbaden/Balg, Baden-Baden
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Martis G, Rózsahegyi M, Deák J, Damjanovich L. Incarcerated and eventrated abdominal wall hernia reconstruction with autologous double-layer dermal graft in the field of purulent peritonitis-A case report. Int J Surg Case Rep 2016; 30:126-129. [PMID: 28012327 PMCID: PMC5192031 DOI: 10.1016/j.ijscr.2016.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 12/02/2016] [Accepted: 12/04/2016] [Indexed: 11/20/2022] Open
Abstract
This is the first applied autologous dermal graft for eventrated hernia in an emergency case. Terminal ileum and ascending colon were perforated into the hernia sac causing dirty operating field. It was impossible to close the 223 cm2 gap with sutures, biological mesh was not available. Specially prepared grafts were applied to reconstruct the gap in a double- layer tension free fashion. No hernia recurrency was observed 8 months after the surgery.
Introduction Double-layer dermal grafts are used for the management of complicated abdominal wall hernias in obese, high risk patients. The method has not yet been used in case of emergency in septic/dirty environment. Case report A 76-year old female patient (BMI 36.7 kg/m2) was admitted with mechanical bowel obstruction and sepsis caused by a third time recurred, incarcerated and eventrated abdominal wall hernia. During the emergency surgery perforation of the terminal ileum and the ascending colon was detected, along with a feculent peritonitis and extended abdominal wall necrosis. Extended right hemicolectomy and necrectomy of the abdominal wall were performed. The surgery resulted in an abdominal wall defect measuring 223 cm2, for the management of which direct closure was not possible. Using a specific method, an autologous dermal graft was prepared from the redundant skin. The first dermal graft was placed under the abdominal wall with 5 cm overlap, and the second layer was placed onto the first layer with 3 cm overlap in a perforated fashion. The operating time was 250 min. No significant intra-abdominal pressure elevation was measured. No reoperation was performed. On the fifth postoperative day, the patient was mobilised. She was discharged in satisfactory general condition on the 18th postoperative day. There is no recurrent hernia 8 months after the surgery. Discussion Abdominal wall reconstruction was possible in a necrotic, purulent environment by using a de-epithelised autologous double layer dermal graft, without synthetic or biological graft implantation. The advantage of the procedure was cost-effectivity, and the disadvantage was that only in an obese patient is the sufficient quantity of dermal graft available. Conclusion A homogeneous internal and perforated outer dermal graft was suitable for bridging the abdominal gap in the case of an obese, high risk patient. Autologous dermal grafts can be a safe and feasible alternative to biological meshes in emergency abdominal wall surgeries. Evaluation of a case series can be the next cornerstone of the method described above.
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Affiliation(s)
- Gábor Martis
- University of Debrecen, Clinical and Health Science Center, Department of Surgery, Debrecen, 4032, Móricz Zsigmond út 22, Hungary.
| | - Máté Rózsahegyi
- University of Debrecen, Clinical and Health Science Center, Department of Surgery, Debrecen, 4032, Móricz Zsigmond út 22, Hungary
| | - János Deák
- University of Debrecen, Clinical and Health Science Center, Department of Surgery, Debrecen, 4032, Móricz Zsigmond út 22, Hungary
| | - László Damjanovich
- University of Debrecen, Clinical and Health Science Center, Department of Surgery, Debrecen, 4032, Móricz Zsigmond út 22, Hungary
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