Comparison of open and laparoscopic inguinal-hernia repair in octogenarians

System dynamics modeling to predict hospitalization costs in adults with inguinal hernia: a single-centre study

BACKGROUND

This research aims to develop a novel methodology and provide innovative insights for accurately forecasting hospitalization expenses by developing an appropriate system dynamics model to predict hospital costs and simulate future trends. The findings are meant to serve as a guide for creating effective policies and measures to curb the growth in hospitalization costs.

METHODS

We selected adults who had inguinal hernia surgery at Beijing Chaoyang Hospital from January 2015 to December 2023 according to the inclusion and exclusion criteria. We identified the primary factors that influence hospitalization costs and conceptualized them as interconnected subsystems within the broader hospitalization cost system. We develop a system dynamics model of hospitalization costs using the stock-flow tree modeling framework based on flow-rate variables.

RESULTS

This study included a total of 23,696 adult patients who had inguinal hernia surgery. The simulation results for the period 2016 to 2033 were generated by running the model in Vensim simulation software. The forecast for 2033 predicts that hospitalization costs for adult inguinal hernia patients at Beijing Chaoyang Hospital will reach 81.28 million RMB. The number of surgeries will rise to 7,913, with 65% (5,104 surgeries) being outpatient procedures. The average cost per hospitalization will be 10,271.35 RMB. The elderly population among surgical patients is expected to increase to 5,323. For every 1,000 laparoscopic surgeries, 454 will be performed. For every 1,000 surgeries, 437 will involve the use of degradable mesh implants. The number of patients with severe comorbidities is expected to reach 6,403, and medication costs are forecasted to be 1.44 million RMB.

CONCLUSIONS

The system dynamics model for hospitalization costs effectively captures the relationships between multiple influencing factors and hospital expenses. The model's reliability and predictive results' credibility are indicated by the high alignment between simulated historical data and actual historical values. Hospitalization costs are projected to increase annually, while per capita hospitalization costs are expected to decrease. Factors such as an aging population, improved cost control policies, and the promotion of outpatient surgeries exert significant influence in this trend.

Optimal surgical and anesthetic approaches for inguinal hernia repair in octogenarians and nonagenarians: a multicenter cohort study in Japan

PURPOSE

We aimed to develop treatment strategies for older patients with inguinal hernia considering adequate adjustment for operative risks and a comparison that accounts for differences in surgical and anesthetic approaches.

METHODS

This retrospective cohort study included 1935 patients aged ≥ 80 years diagnosed with inguinal hernia at 21 facilities in Japan between January 2019 and December 2023. We compared surgical approaches performed under general anesthesia and separately analyzed anesthetic approaches in patients who underwent open surgery. Analysis was conducted using the inverse probability of treatment weighting method to adjust for confounding factors.

RESULTS

Of the 1935 patients, 841 underwent laparoscopic surgery (LS), while 1094 underwent open surgery (OS) with general anesthesia (GA) in 373, spinal anesthesia (SA) in 401, and local anesthesia (LA) in 320. Overall postoperative complication rates of Clavien-Dindo Grade II or higher were comparable between surgical approaches under GA (LS: 3.8% vs. OS: 3.4%; risk ratio [RR]: 1.10; 95% confidence interval [CI]: 0.57, 2.10). Comparisons of anesthetic approaches among patients with OS showed that complication rates were lower in the LA group ([LA: 1.5% vs. GA: 3.5%; RR: 0.43; 95% CI: 0.13, 1.42] and [LA: 1.1% vs. SA: 3.6%; RR: 0.29; 95% CI: 0.10, 0.90]). The LS group had a lower incidence of chronic pain than that in the OS group (LS: 1.7% vs. OS: 3.2%; RR: 0.53; 95% CI: 0.21, 1.30).

CONCLUSION

Laparoscopic inguinal hernia repair is a feasible option for octogenarians and nonagenarians. When general anesthesia is avoided, open surgery using local anesthesia is preferred.

Management and Outcomes for Peritoneal Dialysis Patients Diagnosed with Abdominal Hernias

BACKGROUND/OBJECTIVES

The success of peritoneal dialysis is highly dependent on the integrity of the abdominal wall. Therefore, routine examination and treatment of abdominal hernias can prevent peritoneal dialysis (PD) failure, discontinuation, and conversion to hemodialysis. In this present study, we present our examination protocol for patients proposed for PD and our attitude in treating parietal defects in patients on peritoneal dialysis.

OBJECTIVES

highlight whether PD is a risk factor for the occurrence of ventral hernias, the relationship between associated pathologies and the occurrence of hernias and the need for an HD switch in the postoperative period.

METHODS

Between January 2016 and December 2022, a group of 133 patients proposed for insertion of a PD catheter were evaluated according to the protocol established by our hospital. Routine examination for the diagnosis of abdominal hernias and repair before starting the DP is part of the procedure. We included patients with a 3 year minimum follow-up after insertion and evaluated the incidence of parietal defects that appeared during PD treatment.

RESULTS

Nine patients were diagnosed and operated on for abdominal hernia before starting peritoneal dialysis and none of them had a recurrence of hernia during PD. Twelve patients were diagnosed with abdominal hernias during dialysis treatment (9% incidence) and the median length of time at which parietal defects occur during PD is 12.5 months [range 2-48]. Median BMI is 27.12 [range 22.3-31.24], with a female-male ratio of 2:1 Five patients were transferred to HD, three permanently and two patients temporarily. No patient abandoned PD treatment due to the presence of an abdominal parietal defect.

CONCLUSIONS

Diagnosis of ventral hernias prior to the time of catheterization for PD leads to a decrease in the incidence of parietal defects during PD and is mandatory in patients who are candidates for PD. Open alloplastic surgical procedures are safe procedures with a low recurrence rate in PD patients. The postoperative continuation of PD is feasible but the decision is to be made by the multidisciplinary team and individualized for each patient.

Comparison of laparoscopic and open inguinal-hernia repair in elderly patients: the experience of two comprehensive medical centers over 10 years

PURPOSE

The safety of laparoscopic inguinal-hernia repair must be carefully evaluated in elderly patients. Very little is known regarding the safety of the laparoscopic approach in elderly patients under surgical and medical co-management (SMC). Therefore, this study evaluated the safety of the laparoscopic approach in elderly patients, especially patients with multiple comorbidities under SMC.

METHODS

From January 2012 to December 2021, patients aged ≥ 65 years who underwent open or laparoscopic inguinal-hernia repair during hospitalization were consecutively enrolled. Postoperative outcomes included major and minor operation-related complications, and other adverse events. To reduce potential selection bias, propensity score matching was performed between open and laparoscopic groups based on patients' demographics and comorbidities.

RESULTS

A total of 447 elderly patients who underwent inguinal-hernia repair were enrolled, with 408 (91.3%) underwent open and 39 (8.7%) laparoscopic surgery. All postoperative outcomes were comparable between open and laparoscopic groups after 1:1 propensity score matching (all p > 0.05). Moreover, compared to the traditional care group (n = 360), a higher proportion of the SMC group (n = 87) was treated via the laparoscopic approach (18.4% vs. 6.4%, p = 0.00). In the laparoscopic approach subgroup (n = 39), patients in the SMC group (n = 16) were older with multiple comorbidities but were at higher risks of only minor operation-related complications, compared to those in the traditional care group.

CONCLUSIONS

Laparoscopic inguinal-hernia repair surgery is safe for elderly patients, especially those with multiple comorbidities under SMC.

Factors Influencing Recurrence Following Transabdominal Preperitoneal Repair for Inguinal Hernias

BACKGROUND

Inguinal hernia repair, a globally prevalent surgical procedure, has witnessed the widespread adoption of the transabdominal preperitoneal (TAPP) approach, promising reduced postoperative pain, faster recovery, and lower recurrence rates. However, hernia recurrence remains a persistent challenge, necessitating a comprehensive exploration of influencing factors specific to TAPP repair.

OBJECTIVE

The objective of this study is to identify and analyze key factors contributing to inguinal hernia recurrence post-TAPP repair Materials and methods: This is a retrospective cohort study involving 152 patients undergoing TAPP repair at Hayatabad Medical Complex Peshawar, from November 2020 to October 2023. Demographic, preoperative, and postoperative data were meticulously collected. Statistical analysis employed IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States).

RESULTS

An 8.5% recurrence rate was observed, with influencing factors including insufficient myopectineal orifice (MPO) dissection in three cases (23%), smaller mesh size in two cases (15.4%), infected mesh in two cases (15.4%), mesh dislodgement in one case (20%), and missed sac in one case (20%). Clinical examination and imaging studies diagnosed recurrences in 30.8% and 69.2% of cases, respectively.

CONCLUSION

Despite the advantages of TAPP repair, hernia recurrence persists, emphasizing the need for ongoing refinement of surgical techniques. This study identifies critical influencing factors, notably insufficient MPO dissection, guiding efforts to enhance the efficacy of TAPP repair and improve patient outcomes.

Assessment of Surgical and Quality-of-Life Outcomes Between Laparoscopic Versus Open Inguinal Hernia Repair in Geriatric Patients

Introduction: Inguinal hernia repair is a common surgery, especially in the elderly population. However, the decision to perform surgery in elderly patients can be challenging due to higher complication rates. Laparoscopic inguinal hernia surgery is less commonly used in the elderly population despite its advantages. In this study, we aimed to investigate the safety and advantages of laparoscopic inguinal hernia surgery in elderly patients. Methods: We retrospectively compared the preoperative and postoperative (PO) data and Short Form-36 (SF-36) forms of elderly patients who underwent laparoscopic transabdominal preperitoneal and open inguinal hernia surgery. The primary outcomes were PO pain scores and complication rates. Results: A total of 79 patients with an age range between 65 and 86 years, who presented with inguinal hernias to Cekirge State Hospital's General Surgery Department between January 2017 and November 2019, were included. Seventy-nine patients underwent laparoscopic transabdominal preperitoneal technique and Lichtenstein hernia repair. The laparoscopic group had a lower rate of PO complications and less analgesic medication consumption and usage time compared with the open group. Furthermore, compared with the open group, the laparoscopic group had lower PO pain scores and higher SF-36 scores for physical function, physical role, pain, and general health at the 30th and 90th days after surgery. Conclusion: Our study suggests that laparoscopic inguinal hernia surgery can be safely performed in elderly patients with lower complication rates and faster recovery times compared with open surgery. The advantages of laparoscopic surgery, such as lower PO pain scores and faster recovery times, were also observed in elderly patients.

Laparoscopic versus Open Inguinal Hernia Repair in Aging Patients: A Propensity Score Matching-Based Retrospective Study

OBJECTIVE

Although laparoscopic repair has been widely carried out and promoted due to its minimally invasive advantages, open surgery is still popular compared to elderly patients. This study aims to compare the outcomes of laparoscopic (LIHR) vs open repair of inguinal hernias (OIHR) in elderly patients.

METHODS

A retrospective analysis of the database was performed to identify elderly patients, from January 2021 through December 2022, who underwent surgery for an inguinal hernia. After a 1:1 propensity score matching (PSM) with a caliper of 0.1 was conducted to balance potential bias, binary logistic regressions were used for categorical and continuous outcomes.

RESULTS

After PSM, 78 pairs of elderly patients were enrolled in this study, and there were no significant differences in baseline between LIHR and OIHR groups. Compared to OIHR, univariable and multivariable logistic regression analysis showed that LIHR was independently affected for reducing intraoperative hemorrhage (OR = 0.06, 95% CI: 0.02-0.18, P < 0.001) and shortening postoperative hospitalization time (OR = 0.29, 95% CI: 0.15-0.57, P < 0.001) in elderly patients. Furthermore, LIHR (OR = 0.28, 95% CI: 0.14-0.57, P < 0.001) and age (OR = 0.89, 95% CI: 0.82-0.96, P = 0.002) were independent affecting factors for relieving postoperative pain. Meanwhile, no obvious differences were detected in postoperative complications [LIHR 7.7% (6/78) vs OIHR 14.1% (11/78), P = 0.199].

CONCLUSION

LIHR was closely associated with reducing intraoperative hemorrhage and shortening postoperative hospitalization time. Whilst LIHR and age were independently affecting factors for relieving postoperative pain.

Laparoscopic Techniques in Treatment of Inguinal Hernia in Patients with Peritoneal Dialysis: Experiences from 15 Cases

Objective: This study aimed to investigate the feasibility, efficacy, and safety of laparoscopic transabdominal preperitoneal (TAPP) repair in the treatment of inguinal hernia in patients on peritoneal dialysis, and the optimal timing for initiating postoperative peritoneal dialysis. Methods: We conducted a retrospective analysis of the clinical data pertaining to patients on peritoneal dialysis with inguinal hernias treated with TAPP repair in the First Affiliated Hospital of Shandong First Medical University from July 15, 2020 to December 15, 2022. Follow-up observations of the treatment effect were also analyzed. Results: A total of 15 patients underwent TAPP repair with success. Contralateral occult hernias were found in 3 cases intraoperatively and were treated simultaneously. During the operation, it was found that the peritoneal dialysis tube was completely wrapped in the omentum majus in 1 case and incompletely wrapped in 5 cases and was separated smoothly under laparoscopy. Conclusion: For patients on peritoneal dialysis with inguinal hernia, TAPP repair has the advantages of less trauma, simultaneous treatment of contralateral occult hernias, adjustment and fixation of peritoneal dialysis tubes, lower incision complication rates, and lower recurrence rates, compared with open surgery. With the gradual resumption of peritoneal dialysis 7 days postoperatively, TAPP repair can be performed safely and effectively in this population group; thus it is a procedure worth promoting.

The impact of laparoscopic versus open inguinal hernia repair for inguinal hernia treatment: A retrospective cohort study

OBJECTIVES

Although laparoscopic inguinal hernia repair (LIHR) has been widely accepted for treating inguinal hernia, the procedure remains very technical and challenging. The present study aimed to assess the effect of LIHR in relation to operation time, intraoperative hemorrhage and postoperative hospitalization.

METHODS

A total of 503 patients with inguinal hernia admitted at the Wuxi Rehabilitation Hospital between June 2019 and July 2021 were included in this retrospective cohort study. Binary logistic and linear regressions were used for categorical and continuous outcomes, respectively. The learning curve was drawn by cumulative sum analysis.

RESULTS

Multivariate logistic regression analysis identified LIHR as an independent factor associated with prolonging operation time (odd ratio [OR] = 1.750, 95% confidence interval [CI]: 1.215-2.520, p = 0.003) and decreasing intraoperative hemorrhage levels (OR = 0.079, 95 CI: 0.044-0.142, p < 0.001). Multivariate linear regression identified LIHR (Coefficient = -0.702, 95% CI: [-1.050] to [-0.354], p < 0.001) as an independent factor for shortening postoperative hospitalization time. After learning curve, LIHR (OR = 1.409, 95% CI: 0.948 to 2.094, p = 0.090) no longer resulted as a risk factor prolonging operation time.

CONCLUSIONS

LIHR is an important independent predictive factor for decreasing intraoperative hemorrhage levels and shortening postoperative hospitalization time. Additionally, LIHR does not prolong operation time after the learning curve.