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Li DL, Zhu L, Liu SL, Wang ZB, Liu JN, Zhou XM, Hu JL, Liu RQ. Machine learning-based radiomic nomogram from unenhanced computed tomography and clinical data predicts bowel resection in incarcerated inguinal hernia. World J Gastrointest Surg 2025; 17:106155. [DOI: 10.4240/wjgs.v17.i6.106155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2025] [Revised: 04/05/2025] [Accepted: 05/12/2025] [Indexed: 05/30/2025] Open
Abstract
BACKGROUND Early identification of bowel resection risks is crucial for patients with incarcerated inguinal hernia (IIH). However, the prompt detection of these risks remains a significant challenge. Advancements in radiomic feature extraction and machine learning algorithms have paved the way for innovative diagnostic approaches to assess IIH more effectively.
AIM To devise a sophisticated radiomic-clinical model to evaluate bowel resection risks in IIH patients, thereby enhancing clinical decision-making processes.
METHODS This single-center retrospective study analyzed 214 IIH patients randomized into training (n = 161) and test (n = 53) sets (3:1). Radiologists segmented hernia sac-trapped bowel volumes of interest (VOIs) on computed tomography images. Radiomic features extracted from VOIs generated Rad-scores, which were combined with clinical data to construct a nomogram. The nomogram’s performance was evaluated against standalone clinical and radiomic models in both cohorts.
RESULTS A total of 1561 radiomic features were extracted from the VOIs. After dimensionality reduction, 13 radiomic features were used with eight machine learning algorithms to develop the radiomic model. The logistic regression algorithm was ultimately selected for its effectiveness, showing an area under the curve (AUC) of 0.828 [95% confidence interval (CI): 0.753-0.902] in the training set and 0.791 (95%CI: 0.668-0.915) in the test set. The comprehensive nomogram, incorporating clinical indicators showcased strong predictive capabilities for assessing bowel resection risks in IIH patients, with AUCs of 0.864 (95%CI: 0.800-0.929) and 0.800 (95%CI: 0.669-0.931) for the training and test sets, respectively. Decision curve analysis revealed the integrated model’s superior performance over standalone clinical and radiomic approaches.
CONCLUSION This innovative radiomic-clinical nomogram has proven to be effective in predicting bowel resection risks in IIH patients and has substantially aided clinical decision-making.
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Affiliation(s)
- Da-Lue Li
- Department of Emergency, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Ling Zhu
- Shandong Key Laboratory of Digital Medicine and Computer Assisted Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Shun-Li Liu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Zhi-Bo Wang
- Department of General Surgery, Weifang People’s Hospital, Weifang 261000, Shandong Province, China
| | - Jing-Nong Liu
- Department of Gastroenterological Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Xiao-Ming Zhou
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Ji-Lin Hu
- Department of Gastroenterological Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Rui-Qing Liu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
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Zhou Z, Tong C, Li Y, Aili A, Maimaitiming M, Hong T, Maimaiti M, Tusuntuoheti Y, Abudureyimu K, Yan L. SHapley Additive exPlanations (SHAP)-based, multivariate machine-learning techniques with external validation: Construction of a preoperative interpretable predictive model for intestinal resection of incarcerated inguinal hernia. Surgery 2025; 184:109406. [PMID: 40367731 DOI: 10.1016/j.surg.2025.109406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2025] [Revised: 03/12/2025] [Accepted: 04/06/2025] [Indexed: 05/16/2025]
Abstract
BACKGROUND Currently, there are a lack of effective tools for preoperative risk assessment of intestinal resection in patients with inguinal incarcerated hernia. The purpose of this study is to investigate the variable characteristics associated with intestinal resection and develop an interpretable preoperative prediction model, aiming to assist clinicians in preoperative risk for intestinal resection in patients with inguinal incarcerated hernia. METHODS The data from 2 medical institutions were retrospectively collected, and they were grouped according to whether intestinal resection was performed intraoperatively and the pathologic results. Lasso and multifactor logistic regression screened variables, and 10 machine-learning algorithms built and validated the model, with evaluation using the confusion matrix and SHapley Additive exPlanations value. RESULTS Lasso regression and multifactorial logistic regression analyses showed that peritonitis, intestinal obstruction, neutrophil count, C-reactive protein, and preoperative total protein were the key characteristic variables. The area under curve of models constructed by 10 algorithms in the external validation set were all above 0.8, and the k-nearest neighbor algorithm had the most comprehensive model performance. The constructed model exhibits good predictive performance on the external validation set. CONCLUSION Accurate preoperative prediction of intraoperative intestinal ischemia in patients with incarcerated inguinal hernia is crucial. This study identified peritonitis, intestinal obstruction, neutrophil count, C-reactive protein, and preoperative total protein as characteristic variables for predicting intraoperative intestinal ischemia in these patients. The constructed prediction model can assist clinicians in more accurately assessing intestinal viability during surgery, offering valuable insights for evaluating intestinal resection risk.
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Affiliation(s)
- Zheqi Zhou
- Department of Minimally Invasive Surgery, Hernias and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Cong Tong
- Department of Gynecology, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Yiliang Li
- Department of Minimally Invasive Surgery, Hernias and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Aikebaier Aili
- Department of Minimally Invasive Surgery, Hernias and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China; Xinjiang Clinical Research Center for Gastroesophageal Refux Disease and Bariatric Metabolic Surgery, Urumqi, China; Research Institute of General and Minimally Invasive Surgery, Urumqi, China
| | - Maimaitiaili Maimaitiming
- Department of Minimally Invasive Surgery, Hernias and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China; Xinjiang Clinical Research Center for Gastroesophageal Refux Disease and Bariatric Metabolic Surgery, Urumqi, China; Research Institute of General and Minimally Invasive Surgery, Urumqi, China
| | - Tao Hong
- Department of Minimally Invasive Surgery, Hernias and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Mirezati Maimaiti
- Department of Minimally Invasive Surgery, Hernias and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Yusujiang Tusuntuoheti
- Department of Minimally Invasive Surgery, Hernias and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Kelimu Abudureyimu
- Department of Minimally Invasive Surgery, Hernias and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China; Xinjiang Clinical Research Center for Gastroesophageal Refux Disease and Bariatric Metabolic Surgery, Urumqi, China; Research Institute of General and Minimally Invasive Surgery, Urumqi, China.
| | - Likun Yan
- Department of Gynecology, Shaanxi Provincial People's Hospital, Xi'an, China
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Wei W, Ferrara J. Lacunar Ligament Release for Emergent Repair of Strangulated Femoral Hernia. Am Surg 2025; 91:915-917. [PMID: 40152872 DOI: 10.1177/00031348251329483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2025]
Affiliation(s)
- Wei Wei
- LewisGale Medical Center - HCA Healthcare, Salem, VA, USA
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Jiang X, Sun R, Huang W, Yao J. Prospective comparison of two surgical approaches for incarcerated and strangulated inguinal hernia: preperitoneal hernioplasty through the lower abdominal median incision and laparoscope (TAPP). Updates Surg 2024; 76:2603-2610. [PMID: 39014056 DOI: 10.1007/s13304-024-01944-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 07/08/2024] [Indexed: 07/18/2024]
Abstract
The optimal surgical approach of incarcerated and strangulated inguinal hernia is controversial. Retrospective studies showed that surgical approaches through lower abdominal median incision or laparoscopic are superior to the oblique inguinal incision, respectively. Whether transabdominal laparoscopic approach is superior to the lower abdominal median incision approach needs prospective research.Prospective comparative study of patients with incarcerated and strangulated groin hernia admitted to Jinshan hospital for emergency surgery from January 2018 to June 2022. They were divided into two groups according to different surgical approach. The open preperitoneal repair group (OPR) was operated through the lower abdominal median incision. Laparoscopic preperitoneal repair group (TAPP) was completed under transabdominal laparoscope. The perioperative complications and long-term results of the two groups were compared and analyzed. Eighty-two patients met the inclusion criteria, 40 in OPR group and 42 in TAPP group. Baseline data of the two groups were comparable. Thirteen cases (15.9%) of the two groups underwent intestinal resection and anastomosis. Seventy cases (90.2%) underwent the 1st stage mesh repair, including 5 cases of preperitoneal hernioplasty after intestinal resection. The average operation time of TAPP group was 13 min longer (60.7 ± 13.7 min vs 47.8 ± 19.8 min P < 0.001), and the visual analogue scale pain score at 24 h after operation was lower (3.5 ± 1.2 vs 4.4 ± 1.7 P = 0.019) than that of OPR group. There was 1 case of bladder injury (2.5%) in OPR group and 1 case of inferior abdominal artery injury (2.4%) in TAPP group. There was no difference in the rate of the 1st stage hernioplasty between the two groups. In OPR group, 2 cases (5%) extended the incision for more than 2 cm, while in TAPP group, 1 case (2.4%) converted to laparotomy. The time of hospital stay (3.2 ± 1.8 d vs 4.3 ± 2.7 d, P = 0.036) and return to normal activities (7.9 ± 2.7 d vs 11.0 ± 4.4 d, P < 0.001) were shorter in TAPP group. The rate of total postoperative complications including chronic pain, surgical-site infection, seroma, hernia recurrence and so on was 11.9% in TAPP group, which was not significantly different from 25% in OPR group (P = 0.212). There were no cases of mesh related infection and death within 30 days in both groups.TAPP is safe and feasible for the operation of acute incarcerated inguinal hernia. TAPP had better comfort and faster recovery over open preperitoneal repair for the appropriate patients with incarcerated/strangulated inguinal hernia, which can reduce acute pain, shorten hospital stay and return to normal activities earlier.
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Affiliation(s)
- Xiaoming Jiang
- Department of General Surgery, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China
| | - Rongxun Sun
- Department of General Surgery, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China.
| | - Wenhai Huang
- Department of General Surgery, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China.
| | - Junliang Yao
- Department of General Surgery, Jinshan Hospital of Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China
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5
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Romano L, Fiasca F, Mattei A, Di Donato G, Venturoni A, Schietroma M, Giuliani A. Recurrence Rates after Primary Femoral Hernia Open Repair a Systematic Review. Surg Innov 2024; 31:555-562. [PMID: 39096064 DOI: 10.1177/15533506241273398] [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: 08/04/2024]
Abstract
PURPOSE Femoral hernia accounts for 22% of groin hernia operations in women and for 1.1% in men. Numerous surgical approaches have been reported but there is no consensus. Many of the recurrence rates are reported in old literature, while recent reports are scarce. The aim of the present study was to review rates of recurrences in patients who underwent open repair of a primary femoral hernia. METHODS We conducted a systematic search in the electronic literature, using the search terms "femoral hernia" and "recurrence". We included studies published from 2002 that had as primary or secondary endpoint to evaluate the recurrence after surgery. Risk of bias was assessed by the Cochrane risk of bias tool for RCT and by the Newcastle-Ottawa Scale for cohort studies. RESULTS Fifteen eligible articles were included in our systematic review. A total of 1087 procedures were performed according to the defined criteria. The metanalytic evaluation highlighted a higher probability of recurrence for non-mesh than mesh repairs (6.5% vs 1.9%; RR 0.924, 95% CI: 0.857 - 0.996). In patients treated in emergency settings the rate of recurrences was 3.7%; in patients who received elective repairs it was 0.71%. Six studies reported that most of recurrences occurred within the first post-operative year. CONCLUSION We found that crude recurrence rate after open repair of a primary femoral hernia is about 4%. This rate is higher in case of non-mesh techniques and in emergency surgery. Our results support the recommendation that femoral hernias should be repaired with mesh techniques.
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Affiliation(s)
- Lucia Romano
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Fabiana Fiasca
- Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonella Mattei
- Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giada Di Donato
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Andrea Venturoni
- Department of General Surgery, San Salvatore Hospital, L'Aquila, Italy
| | - Mario Schietroma
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonio Giuliani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Beji H, Bouassida M, Chtourou MF, Zribi S, Laamiri G, Kallel Y, Mroua B, Mighri MM, Touinsi H. Predictive factors of bowel necrosis in patients with incarcerated femoral hernia. Hernia 2023; 27:1491-1496. [PMID: 36943519 DOI: 10.1007/s10029-023-02776-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/12/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE Intestinal necrosis is a frequent complication in patients with incarcerated femoral hernias (IFH). Knowing the low incidence of IFH, few series with large samples studied predictive factors of intestinal necrosis. The main objectives of our study were to determine the predictive preoperative factors of intestinal necrosis in patients with IFH and to compare its morbidity with that related to incarcerate inguinal hernias (IIH). METHODS We conducted a retrospective observational cohort study in which we included patients with incarcerated groin hernias (IGH). This is a single-center study between January 2004 and December 2021. Patients were divided into two groups: group A (admitted for IFH) and group B (admitted for IIH). Intestinal necrosis was confirmed intraoperatively. RESULTS 383 patients with IGH were included in the study: 91 patients had IFH (23.76%) and 282 patients had IIH (76.24%). In patients with IFH, the median age was 67 years. We had 60 females (66%) and 31 males (34%). Bowel ischemia was present in 29 patients (32%). Bowel necrosis was present in 14 patients (16%). We identified three independent variables predicting bowel necrosis in patients with IFH: Duration from symptoms to surgery, NLR (Neutrophil to Lymphocyte ratio), and urea. Bowel ischemia and bowel necrosis were significantly higher in patients with IFH compared to those with IIH. CONCLUSIONS In summary, we found that duration from symptoms to surgery, NLR, and urea were significantly predictive of intestinal necrosis in patients with IFH.
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Affiliation(s)
- H Beji
- Department of General Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
| | - M Bouassida
- Department of General Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - M F Chtourou
- Department of General Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - S Zribi
- Department of General Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - G Laamiri
- Department of General Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Y Kallel
- Department of General Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - B Mroua
- Department of General Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - M M Mighri
- Department of General Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - H Touinsi
- Department of General Surgery, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
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7
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Stabilini C, van Veenendaal N, Aasvang E, Agresta F, Aufenacker T, Berrevoet F, Burgmans I, Chen D, de Beaux A, East B, Garcia-Alamino J, Henriksen N, Köckerling F, Kukleta J, Loos M, Lopez-Cano M, Lorenz R, Miserez M, Montgomery A, Morales-Conde S, Oppong C, Pawlak M, Podda M, Reinpold W, Sanders D, Sartori A, Tran HM, Verdaguer M, Wiessner R, Yeboah M, Zwaans W, Simons M. Update of the international HerniaSurge guidelines for groin hernia management. BJS Open 2023; 7:zrad080. [PMID: 37862616 PMCID: PMC10588975 DOI: 10.1093/bjsopen/zrad080] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/05/2023] [Accepted: 07/16/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Groin hernia repair is one of the most common operations performed globally, with more than 20 million procedures per year. The last guidelines on groin hernia management were published in 2018 by the HerniaSurge Group. The aim of this project was to assess new evidence and update the guidelines. The guideline is intended for general and abdominal wall surgeons treating adult patients with groin hernias. METHOD A working group of 30 international groin hernia experts and all involved stakeholders was formed and examined all new literature on groin hernia management, available until April 2022. Articles were screened for eligibility and assessed according to GRADE methodologies. New evidence was included, and chapters were rewritten. Statements and recommendations were updated or newly formulated as necessary. RESULTS Ten chapters of the original HerniaSurge inguinal hernia guidelines were updated. In total, 39 new statements and 32 recommendations were formulated (16 strong recommendations). A modified Delphi method was used to reach consensus on all statements and recommendations among the groin hernia experts and at the European Hernia Society meeting in Manchester on October 21, 2022. CONCLUSION The HerniaSurge Collaboration has updated the international guidelines for groin hernia management. The updated guidelines provide an overview of the best available evidence on groin hernia management and include evidence-based statements and recommendations for daily practice. Future guideline development will change according to emerging guideline methodology.
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Affiliation(s)
| | - Nadine van Veenendaal
- Department of Anaesthesiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Eske Aasvang
- Department of Anaesthesiology, The Centre for Cancer and Organ Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ferdinando Agresta
- Department of Surgery, Vittorio Veneto General Hospital, Vittorio Veneto, Italy
| | - Theo Aufenacker
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Ine Burgmans
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - David Chen
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Andrew de Beaux
- Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Barbora East
- Department of Surgery, Fakultní Nemocnice v Motole, Prague, Czech Republic
| | | | - Nadia Henriksen
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital–Herlev and Gentofte, Herlev, Denmark
| | - Ferdinand Köckerling
- Vivantes Hospital Berlin, Academic Teaching Hospital of Charité University Medicine, Berlin, Germany
| | - Jan Kukleta
- Department of Surgery, Klinik Im Park, Zurich, Zurich, Switzerland
| | - Maarten Loos
- SolviMáx Centre of Excellence for Abdominal Wall and Groin Pain, Eindhoven, The Netherlands
- Department of General Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Manuel Lopez-Cano
- Department of Surgery, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Ralph Lorenz
- Department of Surgery, Hernia Center 3+CHIRURGEN, Berlin, Germany
| | - Marc Miserez
- Department of Surgery, KU Leuven–University Hospital Leuven, Leuven, Belgium
| | | | | | - Chris Oppong
- Department of Surgery, Derriford Hospital Plymouth, Plymouth, UK
| | - Maciej Pawlak
- North Devon Comprehensive Hernia Centre, North Devon District Hospital, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | - Mauro Podda
- Department of Surgery, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Wolfgang Reinpold
- Department of Surgery, Gross-Sand Hospital Hamburg, Hamburg, Germany
| | - David Sanders
- North Devon Comprehensive Hernia Centre, North Devon District Hospital, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | - Alberto Sartori
- Department of Surgery, Ospedale Civile di Montebelluna, Montebelluna, Italy
| | - Hanh Minh Tran
- Westmead Clinical School, Sydney Medical School, University of Sydney, New Galles, Australia
| | - Mireia Verdaguer
- Department of Surgery, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Reiko Wiessner
- Department of Surgery, Bodden-Kliniken Ribnitz-Damgarten GmbH, Ribnitz-Damgarten, Germany
| | - Michael Yeboah
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, P.M.B., Kumasi, West Africa
| | - Willem Zwaans
- SolviMáx Centre of Excellence for Abdominal Wall and Groin Pain, Eindhoven, The Netherlands
- Department of General Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Maarten Simons
- Department of Surgery, Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, The Netherlands
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Comparison of mesh repair and suture repair for the treatment of incarcerated femoral hernia: a retrospective, single-center study. Surg Endosc 2023; 37:466-470. [PMID: 35999313 DOI: 10.1007/s00464-022-09488-0] [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: 03/16/2022] [Accepted: 07/16/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Femoral hernias often present with incarceration or strangulation that requires emergency surgery. However, recommendations vary regarding optimal approaches for incarcerated femoral hernia. The aim of this study is to compare clinical efficacy between mesh repair and suture repair for the treatment of incarcerated femoral hernia. METHODS Retrospective, single-center analysis of the clinical data from 48 patients with incarcerated femoral hernia, including 16 patients who underwent mesh repair (mesh repair group) and 32 patients who underwent traditional suture repair (suture repair group). RESULTS The mean age, body mass index, incarceration duration, hernia sac size, operation duration, and the rates of postoperative incision infection, recurrence, chronic pain, and mortality were not significantly different between the suture repair and mesh repair groups (P > 0.05 for all). In contrast, the female/male ratio; the rates of bowel obstruction, coexisting diseases, and nighttime operation; and the American Society of Anesthesiologists grade were higher and the rate of prophylactic antibiotic use and the mean cost of hospitalization were lower in the suture repair group than in the mesh repair group (P < 0.05 for all). CONCLUSION The surgical approach should be chosen based on the patient's condition. Mesh repair for the emergency treatment of incarcerated femoral hernia is safe and effective, whereas suture repair is suitable for elderly patients, those with more coexisting diseases, and those with limited life expectancy.
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Ahmad KS, Alenazi NA, Essa MS. Groin abscess, a rare complication of strangulated femoral hernia: Case report. SAGE Open Med Case Rep 2021; 9:2050313X211036769. [PMID: 34484790 PMCID: PMC8411615 DOI: 10.1177/2050313x211036769] [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: 05/01/2021] [Accepted: 07/12/2021] [Indexed: 12/03/2022] Open
Abstract
Femoral hernias account for 8%–11% of all groin hernias and 3%–5% of all anterior
abdominal wall hernias. While groin hernias are more common in males, femoral hernias are
developed more commonly in female, accounting for 22%–34% of all groin hernias compared
with 1.1% in male. The lifetime risk of developing groin hernia in male is approximately
25% but in female less than 5%, so in all female patients with groin hernias, femoral
hernias should be included in the differential diagnosis until proven otherwise. The main
concern of a femoral hernia is the higher risk of bowel strangulation, presenting
emergently in 32%–39% of patients. We report a case of strangulated femoral hernia in a
78-year-old female who was presented to emergency department with groin abscess based on
ultrasound image; patient was then diagnosed as having strangulated femoral hernia and
taken to the operating theater, where she was found having strangulated segment of small
intestine, so the patient underwent bowel resection and anastomosis with repair of the
defect extraperitoneally, and ultimately, the patient improved and discharged from the
hospital. Strangulated femoral hernia can present with groin abscess. Furthermore, femoral
hernia should be ruled out in elderly patient presented with groin abscess, especially
female patients.
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Affiliation(s)
- Khaled S Ahmad
- Department of General Surgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudia Arabia
| | - Naif A Alenazi
- Department of General Surgery, Ad Diriyah Hospital, ArRihab, Riyadh, Saudia Arabia
| | - Mohamed S Essa
- Department of General Surgery, Faculty of Medicine, Benha University, Benha, Egypt
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