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Purkayastha DS, Mallick AA, Das G, Purkayastha SS. Inguinal hernia mesh infections: Chronic challenges, atypical pathogens and lessons in sterilisation. Trop Doct 2025; 55:134-138. [PMID: 39801280 DOI: 10.1177/00494755241313152] [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: 04/29/2025]
Abstract
Chronic mesh infections after inguinal hernia repair present significant clinical challenges due to biofilm-mediated resistance, involvement of multidrug-resistant and atypical pathogens, and gaps in preventive strategies. Our case series of four patients highlights critical research gaps, including the overlooked role of atypical pathogens such as Mycobacterium tuberculosis, diagnostic challenges in detecting slow-growing or resistant organisms and perioperative sterilisation lapses, especially inconsistent Glutaraldehyde use during late-day operations. Many patients suffered with persistent sinuses and recurrent hernias months after surgery. Microbiological analyses identified Pseudomonas aeruginosa, Klebsiella pneumoniae, Mycobacterium tuberculosis and mixed flora. Complete mesh removal and culture-directed antimicrobial therapy resolved all cases within 8-12 months. Our study underscores the need for robust sterilisation protocols, advanced diagnostic measures and biofilm-resistant biomaterials.
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Affiliation(s)
- Debaraj S Purkayastha
- Junior Resident, Department of General Surgery, IPGMER and SSKM Hospital, Kolkata, India
| | - Anowar A Mallick
- Associate Professor, Department of General Surgery, IPGMER and SSKM Hospital, Kolkata, India
| | - Gautam Das
- Professor, Department of General Surgery, IPGMER, and SSKM Hospital, Kolkata, India
| | - Satakshi S Purkayastha
- Junior Resident, Department of General Medicine, Silchar Medical College and Hospital, Assam, India
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2
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Pérez-Köhler B, Benito-Martínez S, Rivas-Santos C, Gómez-Gil V, García-Moreno F, Pascual G. Potentiality of Antibacterial Gels for the Prophylactic Coating of Hernia Repair Prosthetic Materials. Gels 2024; 10:687. [PMID: 39590043 PMCID: PMC11593720 DOI: 10.3390/gels10110687] [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: 08/27/2024] [Revised: 10/21/2024] [Accepted: 10/22/2024] [Indexed: 11/28/2024] Open
Abstract
Prosthetic mesh infection constitutes one of the major postsurgical complications following abdominal hernia repair. Antibacterial coatings represent a prophylactic strategy to reduce the risk of infection. This study assessed the in vitro response of two antibacterial gels made of 1% carboxymethylcellulose (CMC) functionalized with an antiseptic (chlorhexidine, CHX) or an antibiotic (rifampicin, RIF), developed for the coating of polypropylene (PP) meshes for hernia repair. Fragments of a lightweight PP mesh (1 cm2) presoaked in the unloaded or drug-loaded CMC (0.05% CHX; 0.13 mg/mL RIF) were challenged with 106 CFU/mL Staphylococcus aureus (Sa) and methicillin-resistant S. aureus (MRSA). Agar diffusion tests, sonication, turbidimetry, crystal violet staining, scanning electron microscopy and cell viability assays (fibroblasts, mesothelial cells) were performed to evaluate the response of the gels. Both compounds-especially the RIF-loaded gel-exerted a biocidal effect against gram-positive bacteria, developing wide inhibition halos, precluding adhesion to the mesh surface, and hampering bacterial survival in culture. The antibiotic gel proved innocuous, while lower viability was found in cells exposed to the antiseptic (p < 0.05). Together with their fast, affordable, convenient processing and easy application, the results suggest the potential effectiveness of these drug-loaded CMC gels in providing meshes with an antibacterial coating exhibiting great biocide performance.
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Affiliation(s)
- Bárbara Pérez-Köhler
- Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28805 Alcalá de Henares, Spain; (B.P.-K.); (S.B.-M.); (C.R.-S.)
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain; (V.G.-G.); (F.G.-M.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
| | - Selma Benito-Martínez
- Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28805 Alcalá de Henares, Spain; (B.P.-K.); (S.B.-M.); (C.R.-S.)
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain; (V.G.-G.); (F.G.-M.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
| | - Celia Rivas-Santos
- Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28805 Alcalá de Henares, Spain; (B.P.-K.); (S.B.-M.); (C.R.-S.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
| | - Verónica Gómez-Gil
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain; (V.G.-G.); (F.G.-M.)
- Departamento de Ciencias Biomédicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28805 Alcalá de Henares, Spain
| | - Francisca García-Moreno
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain; (V.G.-G.); (F.G.-M.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
| | - Gemma Pascual
- Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28805 Alcalá de Henares, Spain; (B.P.-K.); (S.B.-M.); (C.R.-S.)
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain; (V.G.-G.); (F.G.-M.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
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Ekwesianya AC, Ayantunde A, Nour HM. Assessing the Safety of Mesh Repair in Strangulated Groin Hernias: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e70496. [PMID: 39479102 PMCID: PMC11523024 DOI: 10.7759/cureus.70496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2024] [Indexed: 11/02/2024] Open
Abstract
The use of mesh in emergency repair of complicated groin hernias has been a subject of discussion for decades. While it is now generally accepted that mesh could safely be used in incarcerated (irreducible) and obstructed hernias (without strangulation), with wound infection rates comparable to suture repairs, the use of mesh in strangulated hernias involving bowel resection is still controversial. The aim of this study, therefore, was to analyse the safety of mesh use in strangulated hernias with ischaemic bowel at the time of surgery. A literature search was carried out using relevant keywords. The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 framework anddata analysis was done using the Review Manager version 5.4 (The Cochrane Collaboration, Oxford, UK) meta-analysis software. Seven studies comprising 1,159 patients who had emergency surgery for strangulated groin hernias were analysed. A pooled random effect meta-analysis did not show any significant difference in the surgical site infection rate (odds ratio (OR) = 0.88, 95% confidence interval (CI) = 0.39-1.96, p = 0.75), seroma formation (OR = 3.39; 95% CI = 0.70-16.43; p = 0.13), and hernia recurrence (OR = 0.33; CI = 0.05-2.22; p = 0.26) between the two groups. The long-held concern that mesh could not be safely used in strangulated groin hernias has not been validated by the results obtained from this systematic review and meta-analysis. However, more randomised controlled trials in this clinical area would need to be carried out to further validate the results of this study.
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Affiliation(s)
- Andrew C Ekwesianya
- Department of General and Colorectal Surgery, Southend University Hospital, Southend, GBR
| | - Abraham Ayantunde
- Department of General and Colorectal Surgery, Southend University Hospital, Southend, GBR
| | - Hussameldin M Nour
- Department of General Surgery, Royal Lancaster Infirmary, Lancaster, GBR
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4
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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; 76:1453-1460. [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] [MESH Headings] [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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Salazar-Rios E, Cruz Olascoaga A. The "Little-Old-Lady's Hernia", Obturator Hernia: A Case Report and Literature Review. Case Rep Surg 2024; 2024:1039438. [PMID: 39015132 PMCID: PMC11250703 DOI: 10.1155/2024/1039438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/05/2024] [Accepted: 06/08/2024] [Indexed: 07/18/2024] Open
Abstract
Obturator hernias, though rare, are clinically significant abdominal hernias, predominantly affecting elderly, thin women, with an estimated prevalence of less than 1%. The primary treatment involves surgical intervention to reduce and repair the defect, either through laparotomy or laparoscopy, with bowel resection needed in up to 75% of patients. Here, we present the case of an 83-year-old woman presenting with abdominal pain and a history of constipation. An abdominal computed tomography scan demonstrated a left obturator hernia with small bowel obstruction. Successful reduction of the hernia was achieved, albeit requiring intestinal resection via an open surgical approach. Subsequently, the patient achieved complete recovery.
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Affiliation(s)
- Enrique Salazar-Rios
- División de Estudios de PosgradoFacultad de MedicinaUniversidad Nacional Autónoma de México, México City, Mexico
- Departamento de GastrocirugíaHospital de Especialidades “Dr. Bernardo Sepúlveda Gutiérrez” Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social, México City, Mexico
| | - Alexa Cruz Olascoaga
- Unidad Médica de Alta EspecialidadHospital de Gineco Obstetricia No. 3 “Dr. Víctor Manuel Espinosa de los Reyes Sánchez” Centro Médico Nacional la RazaInstituto Mexicano del Seguro Social, México City, Mexico
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Sbacco V, Petrucciani N, Lauteri G, Cossa A, Portinari M, Brescia A, Garulli G. Management of groin hernias in emergency setting: differences in indications and outcomes between laparoscopic and open approach. A single-center retrospective experience. Langenbecks Arch Surg 2024; 409:48. [PMID: 38277083 PMCID: PMC10817833 DOI: 10.1007/s00423-024-03238-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Abstract
PURPOSE The use of minimally invasive groin hernia repair techniques in an emergency setting is still debated and its widespread is limited. The aim of this study is to evaluate the safety and efficacy of the laparoscopic transabdominal preperitoneal (TAPP) technique in the treatment of inguinal and femoral hernias in emergency setting based on our experience, comparing indications and outcomes with the open technique. METHODS A retrospective analysis was performed including all patients with incarcerated and/or strangulated groin hernia who underwent emergency surgery from November 2019 to September 2022. Perioperative variables and short- and long-term outcomes were examined. Statistical analysis was performed using chi-square test for nominal variables and Student's t test for continuous ones. A p value < 0.05 was considered statistically significant. RESULTS Sixty-six patients were included: 29 patients were treated with TAPP technique (Tapp group) and 37 with open technique plus diagnostic laparoscopy (Open group). Patients in the TAPP group were younger, had less severe clinical scenarios, and had a trend for lower Charlson Comorbidity Index, whereas ASA score and BMI were similar. The small bowel was more frequently herniated in the open group. Bilateral hernia repair was performed in 20.69% of patients in the Tapp group versus 0% in the Open group (p = 0.004). Bowel resection was more frequent in the open group (48.65% vs 0% of the Tapp group, p < 0.001) length of surgery was comparable in the two groups. In the Tapp group, the length of hospitalization was significantly shorter (2.59 ± 2.28 days vs. 9.08 ± 14.48 days; p = 0.023). Postoperative complications, according to Clavien-Dindo, were more severe in Open group where there were two deaths. There were no differences in the number of readmission and re-operations at 30 days and in the recurrence rate. CONCLUSIONS Emergency repair of inguinal and femoral hernias using TAPP is a valuable option, safe and feasible in selected patients. In this series, indications for TAPP were reserved to younger patients with less comorbidities and less severe clinical scenario. Future randomized studies are needed to compare TAPP with open emergency hernia surgery in all settings. Potential advantages of TAPP are the reduction of postoperative complications, earlier recovery, and the possibility of bilateral treatment.
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Affiliation(s)
- V Sbacco
- Department of Medical and Surgical Sciences and Translational Medicine, Unit of Colorectal Oncologic Surgery, "Sant'Andrea" University Hospital, Sapienza University of Rome, Rome, Italy
- Unit of General and Emergency Surgery, Infermi Hospital, Rimini, Italy
| | - N Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, Unit of Colorectal Oncologic Surgery, "Sant'Andrea" University Hospital, Sapienza University of Rome, Rome, Italy.
| | - G Lauteri
- Department of Medical and Surgical Sciences and Translational Medicine, Unit of Colorectal Oncologic Surgery, "Sant'Andrea" University Hospital, Sapienza University of Rome, Rome, Italy
| | - A Cossa
- Department of Medical and Surgical Sciences and Translational Medicine, Unit of Colorectal Oncologic Surgery, "Sant'Andrea" University Hospital, Sapienza University of Rome, Rome, Italy
| | - M Portinari
- Unit of General and Emergency Surgery, Infermi Hospital, Rimini, Italy
| | - A Brescia
- Department of Medical and Surgical Sciences and Translational Medicine, Unit of Colorectal Oncologic Surgery, "Sant'Andrea" University Hospital, Sapienza University of Rome, Rome, Italy
| | - G Garulli
- Unit of General and Emergency Surgery, Infermi Hospital, Rimini, Italy
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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: 7] [Impact Index Per Article: 3.5] [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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Takamoto N, Konishi T, Fujiogi M, Kutsukake M, Morita K, Hashimoto Y, Matsui H, Fushimi K, Yasunaga H, Fujishiro J. Outcomes Following Laparoscopic Versus Open Surgery for Pediatric Intussusception: Analysis Using a National Inpatient Database in Japan. J Pediatr Surg 2023; 58:2255-2261. [PMID: 37507337 DOI: 10.1016/j.jpedsurg.2023.07.004] [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] [Received: 02/20/2023] [Revised: 06/25/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Laparoscopic surgery for pediatric intussusception has recently become more common as an alternative to open surgery. However, the differences in outcomes between laparoscopic and open surgery remain unclear. Thus, this study aimed to compare short-term surgical outcomes and recurrence rates between patients treated with laparoscopic and open surgery for pediatric intussusception. METHODS Patients aged <18 years who underwent laparoscopic (n = 192) and open (n = 416) surgery for intussusception between April 2016 and March 2021 were retrospectively identified using a Japanese nationwide inpatient database. Propensity-score overlap weighting analyses were conducted to compare the outcomes between the laparoscopic and open surgery groups. The outcomes included in-hospital morbidity, reoperation, readmission for intussusception, bowel resection, the diagnosis of Meckel's diverticulum, duration of anesthesia, postoperative length of hospital stay, and total hospitalization costs. RESULTS The laparoscopic surgery group was older, heavier, and had fewer congenital malformations and emergency admissions than the open surgery group did. Overlap weighting analyses showed no significant differences in in-hospital morbidity (odds ratio [95% confidence interval], 0.88 [0.35-2.23]), reoperation (1.88 [0.24-14.9]), readmission for intussusception within 30 days (0.80 [0.12-5.30]) and 1 year (0.90 [0.28-2.93]), bowel resection (0.69 [0.46-1.02]), the diagnosis of Meckel's diverticulum (0.97 [0.50-1.90]), duration of anesthesia (difference, 11 [-1-24] minutes), postoperative length of stay (difference, -1.9 [-4.2-0.4] days), or total hospitalization costs (difference, 612 [ -746-1970] US dollars) between the groups. CONCLUSIONS In this large nationwide cohort, no significant differences in outcomes were observed between laparoscopic and open surgery. Laparoscopic surgery is an acceptable treatment option for pediatric intussusception. LEVELS OF EVIDENCE Level III.
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Affiliation(s)
- Naohiro Takamoto
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Takaaki Konishi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Michimasa Fujiogi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Mai Kutsukake
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kaori Morita
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Yohei Hashimoto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Jun Fujishiro
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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Kulacoglu H. Current opinions in inguinal hernia emergencies: A comprehensive review of related evidences. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2023; 6:136-158. [DOI: 10.4103/ijawhs.ijawhs_30_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/14/2023] [Indexed: 01/03/2025] Open
Abstract
Abstract
INTRODUCTION:
Groins hernia emergencies are evaluated under two definitions: incarceration that is defined as a hernia in which its content becomes irreducible at the passage in the abdominal wall and strangulation that compromises the blood supply to the omentum and/or intestines within the hernia sac. The purpose of this paper was to determine the latest knowledge about groin hernia emergencies.
MATERIALS AND METHODS:
PubMed and Google Scholar searches were done by using combinations of “inguinal hernia” and “emergency”, and “groin hernia” and “emergency” keywords at first. More detailed searches were performed to enrich the “Surgical treatment” part of the paper by using “emergency hernia” and “mesh”, “emergency hernia,” and “laparoscopic versus open” keywords afterward.
RESULTS:
Approximately 5%–10% of all inguinal repairs are performed in emergency settings. Both lateral and medial inguinal hernias can get incarcerated or strangulated, whereas the risk for femoral hernias is higher. Manual reduction of incarcerated inguinal hernias is successful in approximately 60% of the cases. The prediction of bowel ischemia due to strangulation may be possible with some blood tests and imaging studies like ultrasound and computed tomography. It has been shown that the longer the duration of incarceration the higher the risk of bowel ischemia. Bowel resection which is more frequently necessary in patients with advanced age, female gender, and femoral hernia, is associated with an increased risk of perioperative mortality. Some surgeons still use tissue-suture repairs in an emergency setting; however, mesh repairs have been shown to be safe unless there is an overt contamination.
CONCLUSION:
Early treatment of complicated groin hernias is the key to favorable outcomes. The need for bowel resection and advanced age are the most prominent factors for morbidity and mortality. Mesh repairs are safe in most cases. Minimally invasive approaches promise good results in experienced centers.
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Konish T, Ono S, Okada A, Matsui H, Tanabe M, Seto Y, Yasunaga H. Comparison of bleeding following gastrointestinal endoscopic biopsy in patients treated with and without direct oral anticoagulants. Endosc Int Open 2023; 11:E52-E59. [PMID: 36644535 PMCID: PMC9839429 DOI: 10.1055/a-1981-2946] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022] Open
Abstract
Background and study aims Despite the widespread use of direct oral anticoagulants (DOACs), the association between DOAC use and complications (e. g., bleeding) following gastrointestinal endoscopic biopsy remains unclear. This study aimed to evaluate complications after biopsy in patients treated with DOACs in Japan, where biopsies would be generally performed without DOAC withdrawal based on guideline recommendations. Patients and methods Using a Japanese nationwide database, we identified patients taking DOACs who underwent gastrointestinal endoscopic biopsy (n = 2,769, DOAC group) and those not taking DOACs (n = 129,357, control group) from April 2015 to November 2020. We conducted 1:4 propensity score (PS) matching and overlap PS-weighting analyses with adjustment for background characteristics to compare occurrence of post-procedure hemorrhage and stroke within 1 week after biopsy, and thrombin use on the day of biopsy without a diagnosis of hemorrhage. Results In total, 578 patients (0.44 %) developed post-procedure hemorrhage, and 13 patients (0.01 %) developed stroke. The DOAC group had more comorbidities than the control group. The PS matching analysis revealed no significant differences in post-procedure hemorrhage (odds ratio, 1.52 [95 % confidential interval, 0.96-2.41]) or stroke (1.00 [0.21-4.71]), whereas the DOAC group received thrombin more often than the control group (1.60 [1.30-1.95]). The results were equivalent in the overlap PS-weighting analysis. Conclusions The PS analyses showed no significant differences in complications following gastrointestinal endoscopic biopsy between DOAC users and non-users. These results suggest the safety of endoscopic biopsy without DOAC withdrawal although the need for careful hemostasis remains.
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Affiliation(s)
- Takaaki Konish
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan,Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Sachiko Ono
- Department of Eat-loss Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Masahiko Tanabe
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan,Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Evaluating the Role of Glove Changing Before Mesh Application During Herniorrhaphy Surgery to Reduce Surgical Site Infections. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2022. [DOI: 10.5812/archcid-128082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Prevention of surgical site infection (SSI) in hernia repair with mesh remains the main concern. Many risk factors have been proposed; however, the role of changing the glove remains to be elucidated. Methods: This longitudinal study was conducted on adult inguinal hernia cases referred to elective repair using mesh reconstruction. Two hundred cases were enrolled and classified into two groups, including the group that surgeon and his assistants changed the glove and the group in which the gloves remained unchanged. Age, gender, surgery duration, and the side of hernia were compared between those who developed SSI and those without this complication. Moreover, the infection rate was compared between the two study groups. Results: One hundred and two males (51.0%) and 98 females (49.0%) with a mean age of 42.60 ± 15.79 years old were enrolled in the study. None of the variables showed a significant difference between SSI cases and non-SSI cases. Moreover, the rate of infection was not significantly different between the two study groups. Conclusions: Glove changing before mesh application indicates no considerable role in reducing SSI rate; however, further studies are needed to confirm these findings.
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Konishi T, Takamoto T, Fujiogi M, Hashimoto Y, Matsui H, Fushimi K, Tanabe M, Seto Y, Yasunaga H. Laparoscopic versus open distal pancreatectomy with or without splenectomy: A propensity score analysis in Japan. Int J Surg 2022; 104:106765. [PMID: 35811012 DOI: 10.1016/j.ijsu.2022.106765] [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: 03/10/2022] [Revised: 06/21/2022] [Accepted: 07/03/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although the laparoscopic approach has been applied to distal pancreatectomy, its benefits with regard to the short-term outcomes of distal pancreatectomy remain unclear. MATERIALS AND METHODS Using a Japanese nationwide inpatient database, we identified patients who underwent laparoscopic (n = 6647) and open (n = 21,843) distal pancreatectomy between July 2012 and March 2020. We conducted a 1:2 propensity score-matched analysis with adjustment for background characteristics (e.g., comorbidities, preoperative diagnosis, and hospital background) to compare in-hospital morbidity and mortality, reoperation requirement, duration of anesthesia and drainage, postoperative length of stay, and total hospitalization costs. For sensitivity analyses, we performed overlap propensity score-weighted analysis, instrumental variable analysis, and subgroup analyses for hospital volume, patients with benign tumors, and those with malignant tumors that required splenectomy. RESULTS In-hospital morbidity and mortality were 27% and 0.7%, respectively. The 1:2 propensity score-matched analysis showed that compared to open surgery, laparoscopic surgery was significantly associated with lower in-hospital morbidity (odds ratio [95% confidence interval]: 0.78 [0.73 to 0.84]) and mortality (0.26 [0.14 to 0.50]), lower occurrence of postoperative pancreatic fistula (0.78 [0.72 to 0.85]), postoperative bleeding (0.59 [0.51 to 0.69]), and reoperation (0.65 [0.58 to 0.75]), longer duration of anesthesia (difference, 59 [56 to 63] minutes), shorter duration of drainage (difference, -4.0 [-4.5 to -3.6] days) and postoperative length of stay (difference, -4.4 [-4.9 to -3.9] days), and lower total hospitalization costs (difference, -1510 [-1776 to -1243] US dollars). The sensitivity analyses showed compatible results with those from the main analysis. CONCLUSION In this large nationwide cohort, laparoscopic distal pancreatectomy showed lower in-hospital morbidity, mortality, and total hospitalization costs than open distal pancreatectomy. Laparoscopic distal pancreatectomy may be a favorable procedure in terms of both complications and costs.
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Affiliation(s)
- Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan.
| | - Takeshi Takamoto
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Japan
| | - Michimasa Fujiogi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan; Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Japan
| | - Yohei Hashimoto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Japan
| | - Masahiko Tanabe
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Japan
| | - Yasuyuki Seto
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
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Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows:
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Abstract
OBJECTIVES Cases of acute pancreatitis (AP) are increasing worldwide, and mortality remains high in severe cases. In 2015, the Japanese guidelines for the management of AP were revised. We aimed to clarify the clinical practice of AP in Japan and its trend during the revision of the guidelines using a Japanese nationwide administrative database. METHODS We retrospectively analyzed 102,119 patients with AP who were hospitalized between April 2014 and March 2018. The study period was divided into the first period (the time before the revision: fiscal years 2014 and 2015) and second period (after the revision: 2016 and 2017). RESULTS Severe cases of AP accounted for 27.7% of total cases. The in-hospital mortality in severe cases was 5.7%. The mortality within 14 days of admission improved from 3.2% in the first period to 2.6% in the second period (P = 0.022). Referred patients had more severe diseases and a higher mortality. The mortality in patients who underwent endoscopic ultrasound-guided fistuloplasty for local complications (11.6%) was lower than that in patients who underwent percutaneous drainage (23.4%) or AP surgery (22.6%) (P < 0.001). CONCLUSIONS We clarified the clinical practice of AP including the improved mortality after the revision of the guidelines.
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