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Singh A, Toh WH, Elzahed N, Khera G, Baig MK, Mihailescu A, Sajid MS. Laparoscopic Versus Robotic Ventral Hernia Repair With Intraperitoneal Mesh: A Systematic Review and Meta-Analysis Comparing the Perioperative Outcomes Randomised Controlled Trials. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2025; 3:13809. [PMID: 39911526 PMCID: PMC11793996 DOI: 10.3389/jaws.2024.13809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2024] [Accepted: 12/17/2024] [Indexed: 02/07/2025]
Abstract
Objective The objective of this meta-analysis is to compare the perioperative surgical outcomes and cost-effectiveness of robotic ventral hernia repair (RVHR) versus laparoscopic ventral hernia repair (LVHR) with intraperitoneal mesh. Methods Randomised control trials (RCTs) reporting perioperative outcomes and costs in patients undergoing RVHR versus LVHR were selected from medical electronic databases and meta-analysis was conducted in accordance with the guidelines of the Cochrane Collaboration using statistical software RevMan version 5. Results Four RCTs on 337 patients reporting perioperative outcomes and cost comparison were included. In the random effect model analysis, the duration of operation was shorter, and cost was lower in the LVHR group but with significant statistical heterogeneity [standardized mean difference (SMD) -48.07, 95%, CI (-78.06, -18.07), Z = 3.14, P = 0.002], [SMD 0.82, 95%, CI (-1.48, -0.16), Z = 2.45, P = 0.01]. However, the variables of hernia recurrence and surgical site complications were statistically similar in both groups without any statistical heterogeneity among the included studies [Risk Ratio (RR) 1.05, 95%, CI (0.22, 4.99), Z = 0.06, P = 0.95], [RR 0.85, 95%, CI (0.48, 1.50), Z = 0.55, P = 0.58]. Conclusion This systematic review demonstrates that RVHR does not offer any superiority among the compared perioperative variables (Duration of operation, hernia recurrence and surgical site complications) and it is not cost-effective when compared to LVHR. Due to the paucity of the RCTs and significant heterogeneity among the compared variables, a major multi-centre RCT is needed to validate these findings.
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Affiliation(s)
- Anurag Singh
- Department of General Surgery, Tameside General Hospital, Ashton-Under-Lyne, United Kingdom
| | - Wei H. Toh
- Department of Gastrointestinal Surgery, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Nada Elzahed
- Department of Gastrointestinal Surgery, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Goldie Khera
- Department of Gastrointestinal Surgery, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Mirza K. Baig
- Department of Colo-Rectal Surgery, Worthing Hospital, Worthing, United Kingdom
| | - Andrei Mihailescu
- Department of General Surgery, Tameside General Hospital, Ashton-Under-Lyne, United Kingdom
| | - Muhammad S. Sajid
- Department of Gastrointestinal Surgery, Royal Sussex County Hospital, Brighton, United Kingdom
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Mainprize M, Spencer Netto FAC, Svendrovski A, Mantke R, Paasch C. Quality of life following Shouldice Repair: a prospective cohort study among inguinal hernia patients. Hernia 2024; 29:28. [PMID: 39580600 DOI: 10.1007/s10029-024-03217-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 11/10/2024] [Indexed: 11/25/2024]
Abstract
PURPOSE The aim of this study was to evaluate quality of life from the preoperative time to six months after surgery of patients who underwent a Shouldice Repair for primary inguinal hernia. METHODS After ethical approval, consent was obtained, and data collected from surveys and chart review. The study population was composed of male and female patients aged 16-90 years of age, who had a Shouldice Repair of a primary unilateral inguinal hernia. The EQ-5D-3L, a questionnaire applied to hernia surgery in Canada, was used to determine quality of life at the preoperative and 1 week, 1- and 6-month postoperative time. Data analysis included descriptive statistics, as well as inferential analysis. RESULTS From January 2023 to February 2024, 532 participants met the criteria, completed and returned the preoperative survey, and underwent primary inguinal hernia repair. The participants were mostly male (94%) with an average age of 62.18 years and BMI of 24.93 kg/m2. The EQ-5D-3L health index scores and EQ-VAS health status at preoperative were 0.83 ± 0.13 and 79.5 ± 12.59. At the 1-month postoperative time, health index scores and health status had significantly increased from preoperative (score:0.91 ± 0.12, p = .001; status 83.56 ± 12.93, p = .001), and continued to significantly increase from baseline at the 6-month postoperative time (score:0.95 ± 0.10, p = .001; status:85.25 ± 12.17, p < .001). CONCLUSION Quality of life, as measured by the ED-5D-3L health index score, significantly improved for patients that underwent a Shouldice Repair for an inguinal hernia.
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Affiliation(s)
- Marguerite Mainprize
- Department of Surgery, Shouldice Hospital, 7750 Bayview Ave. Thornhill, Ontario, ON, L3T 4A3, Canada.
- Department of General Surgery, University Hospital Brandenburg an Der Havel, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany.
| | | | | | - Rene Mantke
- Department of General Surgery, University Hospital Brandenburg an Der Havel, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - Christoph Paasch
- Department of Surgery, Shouldice Hospital, 7750 Bayview Ave. Thornhill, Ontario, ON, L3T 4A3, Canada
- Department of General Surgery, University Hospital Brandenburg an Der Havel, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
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Albendary M, Mohamedahmed AY, Mohamedahmed MY, Ihedioha U, Rout S, Van Der Avoirt A. Evaluation of Mesh Closure of Laparotomy and Extraction Incisions in Open and Laparoscopic Colorectal Surgery: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:6980. [PMID: 39598123 PMCID: PMC11594634 DOI: 10.3390/jcm13226980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2024] [Revised: 11/06/2024] [Accepted: 11/10/2024] [Indexed: 11/29/2024] Open
Abstract
Background and Objectives: Evisceration and incisional hernia (IH) represent a significant morbidity following open or laparoscopic colorectal surgery where midline laparotomy or extraction incision (EI) are performed. We executed a systematic review to evaluate primary mesh closure of laparotomy or EI in colorectal resections of benign or malignant conditions. Methods: A comprehensive literature search was performed using PubMed, Science Direct, Cochrane, and Google Scholar databases for studies comparing prophylactic mesh to traditional suture techniques in closing laparotomy in open approach or EI when minimally invasive surgery was adopted in colorectal procedures, regardless of the diagnosis. Both IH and evisceration were identified as primary outcomes. Secondary outcomes included surgical site infections (SSI), postoperative seroma, and length of hospital stay (LOS). Results: Six studies were included in our analysis with a total population of 1398 patients, of whom 411 patients had prophylactic mesh augmentation when closing laparotomy or EI, and 987 underwent suture closure. The mesh closure group had a significantly lower risk of developing IH compared to the conventional closure group (OR 0.23, p = 0.00001). This result was significantly consistent in subgroup analysis of open laparotomy or EI of laparoscopic surgery subgroups. There was no statistically notable difference in evisceration incidence (OR 0.51, p = 0.25). Secondary endpoints did not significantly differ between both groups in terms of SSI (OR 1.20, p = 0.54), postoperative seroma (OR 1.80, p = 0.13), and LOS (MD -0.54, p = 0.63). Conclusions: primary mesh reinforcement of laparotomy or EI closure in colorectal resections lessens IH occurrence. No safety concerns were identified; however, further high-quality research may provide more solid conclusions.
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Affiliation(s)
- Mohamed Albendary
- General Surgery Department, Northampton General Hospital NHS Trust, Northampton NN1 5BD, UK
- Brighton and Sussex Medical School, University of Brighton, Brighton BN1 9PX, UK;
| | - Ali Yasen Mohamedahmed
- General Surgery Department, University Hospitals of Derby and Burton NHS Trust, Derby DE22 3ND, UK;
| | | | - Ugochukwu Ihedioha
- General Surgery Department, Northampton General Hospital NHS Trust, Northampton NN1 5BD, UK
| | - Shantanu Rout
- General Surgery Department, Sandwell and West Birmingham NHS Trust, West Bromwich B71 4HJ, UK
| | - Anouk Van Der Avoirt
- Brighton and Sussex Medical School, University of Brighton, Brighton BN1 9PX, UK;
- University Hospitals Sussex NHS Trust, Worthing BN2 5BE, UK
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Hayward R, Smith JJ, Kontovounisios C, Qiu S, Warren OJ. Laparoscopic totally extraperitoneal hernia repair in patients with a history of previous abdominopelvic surgery. Updates Surg 2024; 76:2387-2393. [PMID: 38652433 PMCID: PMC11541412 DOI: 10.1007/s13304-024-01810-w] [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: 11/19/2023] [Accepted: 03/04/2024] [Indexed: 04/25/2024]
Abstract
A retrospective cohort study of patients undergoing laparoscopic inguinal hernia repair compared short- and long-term outcomes between individuals with or without history of previous abdominopelvic surgery, aiming to determine the feasibility of totally extraperitoneal (TEP) repair within this population. All patients who underwent elective TEP inguinal hernia repair by one consultant surgeon across three London hospitals from January 2017 to May 2023 were retrospectively analysed to assess perioperative outcomes. Two hundred sixty-two patients were identified, of whom two hundred forty-three (93%) underwent laparoscopic TEP repair. The most frequent complications were haematoma (6.2%) and seroma (4.1%). Recurrence occurred in four cases (1.6% of operations, 1.1% of hernias). One hundred eighty-four patients (76%) underwent day-case surgery. There were no mesh infections or explanations, vascular or visceral injuries, port-site hernias, damage to testicle, or persisting numbness. There were no requirements for blood transfusion, returns to theatre, or readmissions within 30 days. There was one conversion to open and one death within 60 days of surgery. Eighty-three (34%) had a history of previous AP surgery. There was no significant difference in perioperative outcomes between the AP and non-AP arms. This finding carried true for subgroup analysis of 44 patients whose AP surgical history did not include previous inguinal hernia repair and for those undergoing repair of recurrent hernia. In expert hands, laparoscopic TEP repair is associated with excellent outcomes and low rates of long-term complications, and thus should be considered as standard for patients regardless of a history of AP surgery.
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Affiliation(s)
| | - Jacob J Smith
- Imperial College London School of Medicine, London, UK
| | - Christos Kontovounisios
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Shengyang Qiu
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK.
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Oliver J Warren
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
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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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Toi T, Paduraru M, Chotai R, Pandya A, Stolady D, Lillig K, Foster J, Gismondi M, Lewis M. Impact on quality of life following inguinal hernia repair under local anaesthetic in a primary care setting. Hernia 2024; 28:1457-1460. [PMID: 38869812 DOI: 10.1007/s10029-024-03085-x] [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: 01/20/2024] [Accepted: 05/31/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE Inguinal hernia repair remains one of the most common elective general surgical procedures. Previous studies have suggested high rates of chronic pain afterwards. The aim of this study was to evaluate changes in quality of life after local anaesthetic (LA) inguinal hernia surgery performed in a primary care setting. METHODS Quality of life (QoL) was measured in all patients both pre-operatively and at 6-months post-operatively using the European Hernia Society Scoring tool. Data was analysed by tertile grouping according to initial symptom score. RESULTS 497 patients filled out pre-operative QoL forms between June 2020 and May 2022. Post-operative QoL scores were received from 179 patients (164 male (91.6%)). Median pre-operative score was 33 (IQR 20-48). Median post-operative score was 4 (IQR 1-11). Mean improvement in QoL score was 27.8. Nine patients had a worse score at 6-months compared to pre-op (5%). When the data was analysed by pre-op QoL group as expected the low symptom group (score 0-10) had minimal improvement in QoL (0.23) and 5 out of 13 patients (38%) had a worse score. The medium group (score 11-40) had a mean improvement in QoL of 17.25 with 3 out of 92 (3.2%) experiencing a worse score. The high symptom group (score 41-90) had a mean improvement in QoL of 45.4 with only 1 of 76 (1.3%) experiencing a worse score. CONCLUSIONS LA Inguinal hernia repair improves QoL substantially 6-months after surgery. However, in those patients with low pre-operative scores (< 11) the gain is minimal and rates of chronic symptoms following surgery are very high. We recommend avoiding surgery in this group and instead adopting a surveillance approach.
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Affiliation(s)
- T Toi
- West Suffolk Hospital NHS Trust, Hardwick Ln, Bury St Edmunds, Bury Saint Edmunds, IP33 2QZ, UK.
- Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK.
| | - M Paduraru
- Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - R Chotai
- Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - A Pandya
- Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - D Stolady
- St Stephen's Gate Medical Practice, 55 Wessex St, Norwich, NR2 2TJ, UK
| | - K Lillig
- St Stephen's Gate Medical Practice, 55 Wessex St, Norwich, NR2 2TJ, UK
| | - J Foster
- St Stephen's Gate Medical Practice, 55 Wessex St, Norwich, NR2 2TJ, UK
| | - M Gismondi
- Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - Mpn Lewis
- Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK
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Köckerling F, Morales-Conde S, Simons M, Casanova D, East B, de Beaux A, Henriksen N, Roka S, Felice A. Certified Fellowship in Abdominal Wall Surgery-A Collaboration Between the UEMS and the European Hernia Society. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2024; 3:12945. [PMID: 38711962 PMCID: PMC11070935 DOI: 10.3389/jaws.2024.12945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/08/2024] [Indexed: 05/08/2024]
Abstract
Background: Abdominal wall surgery (AWS) is characterised by the increasing caseload and the complexity of the surgical procedures. The introduction of a tailored approach to AWS utilising laparoendoscopic, robotic and/or open techniques requires the surgeon to master several surgical techniques. All of which have an associated learning curve, and the necessary knowledge/experience to know which operation is the right one for the individual patient. However, the reality in general surgery training shows that training in just a limited number of procedures is not enough. By the end of general surgery training, many chief residents do not feel they are yet ready to carry out surgery independently. Therefore, hernia surgery experts and societies have called for the introduction of a Fellowship in Abdominal Wall Surgery. Methods: The UEMS (Union Européenne des Médecins Spécialistes, European Union of Medical Specialists) in collaboration with the European Hernia Society (EHS) introduced a fellowship by examination in 2019. As a prerequisite, candidates must complete further training of at least 2 years with a special focus on abdominal wall surgery after having completed their training in general surgery. To be eligible for the examination, candidates must provide evidence of having performed 300 hernia procedures. In addition, candidates must have accrued sufficient "knowledge points" by attending abdominal wall surgery congresses, courses and clinical visitations, and engaged in scientific activities. On meeting the requirements, a candidate may be admitted to the written and oral examination. Results: To date, three examinations have been held on the occasion of the Annual Congress of the European Hernia Society in Copenhagen (2021), Manchester (2022) and Barcelona (2023). Having met the requirements, 48 surgeons passed the written and oral examination and were awarded the Fellow European Board of Surgery-Abdominal Wall Surgery certificate. During this time period, a further 25 surgeons applied to sit the examination but did not fulfil all the criteria to be eligible for the examination. Fifty experienced abdominal wall surgeons applied to become an Honorary Fellow European Board of Surgery-Abdominal Wall Surgery. Fourty eight were successful in their application. Conclusion: The Fellowship of the European Board of Surgery - Abdominal Wall Surgery by examination has been successfully introduced at European level by the joint work of the UEMS and the EHS. The examination is also open to surgeons who work outside the European area, if they can fulfil the eligibility criteria.
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Affiliation(s)
- Ferdinand Köckerling
- Hernia Center, Vivantes Humboldt Hospital, Academic Teaching Hospital of Charité University Medicine, Berlin, Germany
| | | | | | - Daniel Casanova
- Department of Surgery, University of Cantabria, Santander, Spain
| | - Barbora East
- 3rd Department of Surgery and 1st Medical Faculty, Charles University at Motol University Hospital, Prague, Czechia
| | - Andrew de Beaux
- NHS Lothian and Oxford University Hospitals, University of Edinburgh Sire Murrayfield Hospital, Edinburgh, United Kingdom
| | - Nadia Henriksen
- Department of Hepatic and Gastrointestinal Disease, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Sebastian Roka
- Wiener Gesundheitsverbund, Klinik Donaustadt, Vienna, Austria
| | - Arthur Felice
- Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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Singh A, Subramanian A, Toh WH, Bhaskaran P, Fatima A, Sajid MS. Comprehensive systematic review on the self-gripping mesh vs sutured mesh in inguinal hernia repair. Surg Open Sci 2024; 17:58-64. [PMID: 38293004 PMCID: PMC10826810 DOI: 10.1016/j.sopen.2023.12.010] [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: 10/13/2023] [Revised: 12/17/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024] Open
Abstract
Objective The objective of this systematic review is to analyse the randomised control trials (RCTs) comparing the self-gripping mesh (SGM) with sutured mesh fixation (SMF) in open inguinal hernia repair. Materials and methods RCTs comparing SGM with SMF in open inguinal hernia repair were selected from medical electronic databases and analysis was performed using the principles of meta-analysis with RevMan version 5 statistical software. Results Seventeen RCTs involving 3863 patients were used for the final analysis. In the random effect model analysis, the operative time [mean difference - 7.72, 95 %, CI (-9.08, -6.35), Z = 11.07, P = 0.00001] was shorter for open inguinal hernia repair with SGM. However, there was noteworthy heterogeneity (Tau2 = 4.24; Chi2 = 1795.04, df = 12; (P = 0.00001; I2 = 99 %) among the included studies. The incidence of chronic groin pain [odds ratio 1.17, 95 %, CI (0.88, 1.54), Z = 1.09, P = 0.28], postoperative complications [odds ratio 0.92, 95 %, CI (0.73, 1.16), Z = 0.71, P = 0.48] and recurrence [odds ratio 1.31, 95 %, CI (0.80, 2.12), Z = 1.08, P = 0.28] were statistically similar between both groups, without heterogeneity. Conclusion SGM failed to demonstrate a clinical advantage over SMF in terms of perioperative outcomes although the duration of surgery was shorter in SGM.
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Affiliation(s)
- Anurag Singh
- Department of Gastrointestinal Surgery, Royal Sussex County Hospital Brighton, BN2 5BE, United Kingdom
| | - Atreya Subramanian
- Department of Gastrointestinal Surgery, Royal Sussex County Hospital Brighton, BN2 5BE, United Kingdom
| | - Wei H. Toh
- Department of Gastrointestinal Surgery, Royal Sussex County Hospital Brighton, BN2 5BE, United Kingdom
| | - Premjithlal Bhaskaran
- Department of Gastrointestinal Surgery, Royal Sussex County Hospital Brighton, BN2 5BE, United Kingdom
| | - Anam Fatima
- Department of Gastrointestinal Surgery, Royal Sussex County Hospital Brighton, BN2 5BE, United Kingdom
| | - Muhammad S. Sajid
- Department of Gastrointestinal Surgery, Royal Sussex County Hospital Brighton, BN2 5BE, United Kingdom
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Naraynsingh V, Cawich SO, Hassranah S. Alternative to mesh repair for ventral hernias: Modified rectus muscle repair. World J Surg Proced 2023; 13:14-21. [DOI: 10.5412/wjsp.v13.i3.14] [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: 09/23/2023] [Revised: 11/18/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND Mesh utilization for ventral hernia repair is associated with potential complications such as mesh infections, adhesions, seromas, fistula formation and significant postoperative pain. The modified rectus muscle repair (RMR) is as an option to repair midline ventral hernias without mesh.
AIM To evaluate the short term outcomes when the modified RMR was used to repair ventral hernias.
METHODS This was a 5-year prospective study that examined the outcome of all consecutive patients with ventral abdominal wall hernias > 5 cm in maximal diameter who underwent repair using the modified RMR technique in a single surgeon unit. Patients were reviewed in an outpatient clinic at 3, 6 and 12 mo and evaluated for hernia recurrence on clinical examination. Each patient’s abdominal wall was also assessed with using ultrasonography at 24 mo to detect recurrences. All data were examined with SPSS ver 18.0.
RESULTS Over the 5-year study period, there were 52 patients treated for ventral hernias at this institution. Four patients were excluded and there were 48 in the final study sample, at a mean age of 56 years (range 28-80). The mean maximal diameter of the hernia defect was 7 cm (range 5-12 cm). There were 5 (10.4%) seromas and 1 recurrence (2.1%) at a mean of 36 mo follow-up.
CONCLUSION The authors recommend the modified RMR as an acceptable alternative to mesh repair of ventral hernias. The seroma rate can be further reduced with routine use of drains. The modified RMR also has the benefit of eliminating all mesh-specific complications.
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Affiliation(s)
- Vijay Naraynsingh
- Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | - Shamir O Cawich
- Department of Surgery, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Samara Hassranah
- Department of Surgery, Medical Associate Hospital, St. Joseph, Trinidad and Tobago
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Pizza F, D'Antonio D, Lucido FS, Brusciano L, Mongardini FM, Dell'Isola C, Brillantino A, Docimo L, Gambardella C. IPOM plus versus IPOM standard in incisional hernia repair: results of a prospective multicenter trial. Hernia 2023; 27:695-704. [PMID: 37149818 DOI: 10.1007/s10029-023-02802-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/25/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE Laparoscopic ventral hernia repair is a well-established technique with satisfying outcomes even at long term for the treatment of incisional and ventral hernia. However, the literature debate is still ongoing regarding the preferred surgical technique. Nowadays, two approaches are commonly adopted: the intraperitoneal onlay mesh repair (sIPOM) and the intraperitoneal onlay mesh reinforcement with defect closure before mesh placement (pIPOM). The aim of this prospective analysis is to compare the postoperative outcomes of patients treated for incisional hernia (IH) with sIPOM and pIPOM after 36 months follow-up in terms of recurrence, quality of life and wound events. METHODS Patients receiving pIPOM and sIPOM for IH were actively followed up for 36 months. At the outpatient clinic, hernia recurrence (HR), mesh bulging (MB), quality of life with the Gastrointestinal Quality of Life Index (GIQLI) and wound events were assessed. RESULTS Between January 2015 and January 2019, 98 patients underwent a pIPOM and 89 underwent an sIPOM. At 36 months, nine patients (4 in pIPOM and 5 in sIPOM) experienced an HR, while MB was recorded in four patients in pIPOM and nine in sIPOM. No statistically significant difference could be identified also in terms of final GIQLI score and wound events. CONCLUSIONS LVHR with or without fascial closure, also in our study, provides satisfactory results in terms of safety and efficacy. The discordant results in the literature are probably related to independent variables such as the type of mesh, the type of suture and closure technique. Therefore, was the funeral of sIPOM done too early? STUDY DATASET IS AVAILABLE ON CLINICALTRIALS. GOV ID NCT05712213.
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Affiliation(s)
- F Pizza
- Department of Surgery, Hospital "A. Rizzoli", LaccoAmeno Aslnapoli2nord, Naples, Italy.
| | - D D'Antonio
- Department of Surgery, Hospital "A. Rizzoli", LaccoAmeno Aslnapoli2nord, Naples, Italy
| | - F S Lucido
- Division of General, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - L Brusciano
- Division of General, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - F M Mongardini
- Division of General, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - C Dell'Isola
- AORN "Dei Colli" Monaldi-Cotugno-CTO Department of Infectious Diseases - Hepatologic Address Naples, Naples, Italy
| | - A Brillantino
- AORN "A. Cardarelli" Division of General Surgery Naples, Naples, Italy
| | - L Docimo
- Division of General, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - C Gambardella
- Division of General, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
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Ma Q, Jing W, Liu X, Liu J, Liu M, Chen J. The global, regional, and national burden and its trends of inguinal, femoral, and abdominal hernia from 1990 to 2019: findings from the 2019 Global Burden of Disease Study - a cross-sectional study. Int J Surg 2023; 109:333-342. [PMID: 37093073 PMCID: PMC10389329 DOI: 10.1097/js9.0000000000000217] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 01/05/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Inguinal, femoral, and abdominal hernia repairs are the most common surgical procedure worldwide. However, studies on hernia disease burden are notably limited, in both developed and low-income and middle-income countries (LMICs). We investigated temporal trends in the incidence and prevalence of inguinal, femoral, and abdominal hernias at global, regional, and national levels in 204 countries and territories from 1990 to 2019 using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019). MATERIALS AND METHODS Annual incident cases, prevalent cases, age-standardized incidence rates (ASIRs), and age-standardized prevalence rates (ASPRs) of inguinal, femoral, and abdominal hernias between 1990 and 2019 were extracted from the GBD 2019 study and stratified by sex, age, and location. Percentage changes in incident cases and prevalent cases, and the estimated annual percentage changes of ASIRs and ASPRs were calculated to quantify the trends in the incidence and prevalence of inguinal, femoral, and abdominal hernias. Data analysis for the present study was conducted from 15 June 2022 to 15 July 2022. RESULTS Globally, there were 32.53 million [95% uncertainty interval (UI): 27.71-37.79] prevalent cases and 13.02 million (10.68-15.49) incident cases of inguinal, femoral, and abdominal hernias in 2019, which increased by 36.00% and 63.67%, respectively, compared with 1990. Eighty-six percent of the incident cases were males, the male-to-female ratio was 6 : 1, and most patients were aged 50-69 years. India (2.45 million), China (1.95 million), and Brazil (0.71 million) accounted for more than one-third (39%) of the incident cases worldwide. From 1990 to 2019, the ASIR and ASPR showed a decreasing trend worldwide, except in Central Sub-Saharan Africa, which had an increasing trend in ASIR and ASPR. CONCLUSION The global incident cases and prevalent cases of inguinal, femoral, and abdominal hernias increased substantially from 1990 to 2019, with a heavier burden observed in males, older adults, and in LMICs such as India and China. In addition, the ASIR and ASPR increased substantially in Central Sub-Saharan Africa. More efforts are warranted for hernia management to reduce the burden of inguinal, femoral, and abdominal hernias, such as by providing safe hernia surgical treatment for males, older adults, and LMICs.
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Affiliation(s)
- Qiuyue Ma
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wenzhan Jing
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Xiaoli Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jie Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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12
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Randomised Controlled Clinical Trial of Spinal Anesthesia Versus Paravertrebral Block for Hernia Surgery. Indian J Surg 2023. [DOI: 10.1007/s12262-023-03686-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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13
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Kumar D, Wu D, Tan B, Guilbert M, Muthukumarsamy G. Emergency groin hernia: outcome after mesh and non-mesh repair. ANZ J Surg 2023; 93:120-124. [PMID: 36541911 DOI: 10.1111/ans.18212] [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: 07/11/2022] [Revised: 10/31/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Emergency inguinal and femoral hernia repair can be done by suture or mesh repair, there is still scepticism around using mesh. We aim to evaluate the usage of mesh and the outcome of emergency groin hernia repair after mesh and suture repair. METHODS Retrospective cohort study of adult patients who underwent emergency inguinal and femoral hernia repair from 1st January 2018 to 31st July 2020. Electronic data and case notes were reviewed and outcome data were collected. RESULTS Eighty-nine emergency groin hernia repairs were carried out. Sixty-two were males, 60 inguinal hernia and 29 femoral hernia. Median age was 72 years (range 20-95). 74 (83.1%) were primary hernia and 15 (16.9%) recurrent hernias. 67 (75.3%) mesh and 22 (24.7%) suture repairs were carried out. Eleven cases required bowel resection and of those 10 had suture repair. Inguinal hernia was more likely to have mesh repair as compared to femoral (P-value 0.002). Median length of stay was significantly lower in mesh group 2 days (1-5 IQR) versus 7.5 days (5-11 IQR) in suture repair group (P-value <0.0001). Five cases (6.74%) had wound complications (3 wound infections, 2 haematoma). With median 20 months (range 6-36 months) follow-up, 1 recurrence each in both mesh and suture repair groups, no mesh infection and 2 (2.2%) 30-day mortality recorded. Wound infection, recurrence and reoperation were not statistically different in two groups. CONCLUSION Emergency groin hernia are amenable to mesh repair and in case of bowel resection or gross contamination non- mesh repair is recommended.
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Affiliation(s)
| | - Diana Wu
- General Surgery, Ninewells Hospital, Dundee, UK
| | - Brandon Tan
- General Surgery, Ninewells Hospital, Dundee, UK
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14
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The case for a new post-graduate hernia designation: a review of fellowship council case logs from the past twelve-years. Surg Endosc 2022; 37:3430-3438. [PMID: 36542134 DOI: 10.1007/s00464-022-09800-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The Fellowship Council (FC) is a robust accreditation body with numerous fellowships; however, no specific criteria exist for hernia fellowships. This study analyzed the case log database to evaluate trends in fellowship exposure to hernia repairs. METHODS FC hernia case log records (2007-2019) were coded as inguinal or ventral hernias and with or without mesh repair. Retrospective analysis examined total hernia repairs logged, type of repair, program designation, and robotic adoption. Robotic adoption was categorized by quartiles of program performance according to the final year of analysis (2018-2019); yearly performance was then graphed by quartiles. RESULTS Over this twelve-year period, 93,334 hernia repairs, 5 program designations, 152 unique programs and 1,558 unique fellows were analyzed. The number of fellows grew from 106 (2007-2008) to > 130 (2018-2019). Total hernias repairs per fellow increased from an average of 41.2 in 2007-2008 to 75.7 in 2018-2019 (183.7%). Open and robotic hernia repairs increased by 241.9% and 266.3%, respectively; laparoscopic hernia repairs decreased by 14.8%. Inguinal and ventral hernia repairs comprised 48.1% and 51.9% of total cases, respectively. Advanced GI/MIS and Advanced GI/MIS/Bariatrics programs logged the majority of hernia repairs (86.0-90.2%). 2014 began an exponential rise in robotic adoption, with fellows averaging < 1 robotic repairs before and > 25 repairs in 2019. A significant difference was found between all groups when comparing quartiles of robotic adopters (median robotic repairs per fellow; IQR): first quartile (72.0; 47.9-108.8), second quartile (25.5; 21.0-30.6), third quartile (13.0; 12.0-14.3) and fourth quartile (3.5; 0.5-5.0) (p-value < 0.05). CONCLUSIONS This twelve-year analysis shows a near doubling in the growth of total hernia repairs, with a decrease in laparoscopic repairs as robotic repairs increased. These data show the importance of hernia repairs in FC fellows' training and warrant further granular analysis to determine specific accreditation criteria for hernia fellowship designations.
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15
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Alijla SS, Binti Amran FA. Comparison of the Analgesic Effect of Subcutaneous Bupivacaine Infiltration and Intravenous Diclofenac vs. Intravenous Diclofenac Monotherapy After Inguinal Hernioplasty: A Retrospective Study. Cureus 2022; 14:e28312. [PMID: 36158363 PMCID: PMC9499650 DOI: 10.7759/cureus.28312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 12/04/2022] Open
Abstract
Background Postoperative pain is a significant problem encountered by patients after a surgical intervention, and there is a crucial need for effective postoperative pain control. The studies have shown that multimodal analgesia and wound infiltration are effective ways to reduce this pain and have a substantial role in the reduction of postoperative medications requirement. This study aimed to evaluate the effect of subcutaneous infiltration of bupivacaine hydrochloride and intravenous (IV) diclofenac as postoperative pain relief in adults undergoing inguinal hernia repair. Methods A single-center retrospective study included 104 patients aged 18-65 undergoing unilateral inguinal herniorrhaphy at the selected hospital. The patients were in two groups of 52 each. Group A received a 75 mg dose of IV diclofenac plus a subcutaneous injection of 10 mL of bupivacaine hydrochloride (HCl) 0.5% while Group B only received the IV diclofenac without the bupivacaine injection. The postoperative pain was assessed at one, two, three, six, and 12 hrs after the operation using the visual analog scale (VAS), which exhibited a range of pain from zero (no pain) to 10 (extreme pain). Results Of a total of 104 patients, 92% of patients were male. The patients' mean age was 36 ± 11 years, and the mean body mass index (BMI) was 22 ±3 kg/m2. American Society of Anesthesiologists physical class I was similar in both groups (90.4% versus 84.6%). Patients in Group A had significantly lower VAS pain scores at one, two, three, six, and 12 hrs after the operation and a longer emergence time than Group B (all p-values were < 0.001). Subcutaneous bupivacaine infiltration and IV diclofenac were also found to be an effective analgesic technique in open hernia repair with mesh (p-value < 0.001 for all). Conclusion Subcutaneous injection of bupivacaine combined with IV diclofenac provides superior analgesia to monotherapy intravenous diclofenac after inguinal hernia repair.
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16
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Implementation of robotic hernia surgery using the Versius® system. J Robot Surg 2022; 17:565-569. [PMID: 35951280 PMCID: PMC9366786 DOI: 10.1007/s11701-022-01451-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/29/2022] [Indexed: 10/24/2022]
Abstract
This case series aims to demonstrate that hernia surgery is safe and feasible using the Versius® robotic system from CMR Surgical, and to describe the surgical techniques used. It is the first series published using this novel system. Forty-one consecutive hernia repair cases were completed using Versius®, including inguinal and ventral hernias. Data were collected prospectively on a number of pre-, peri-, and postoperative outcomes. Techniques are described for robotic transabdominal preperitoneal repair of inguinal hernia, and intraperitoneal onlay mesh repair of ventral hernia. Thirty-two inguinal and nine ventral hernia repairs were performed over a 12-month period. The population were 88% male with a mean body mass index of 27.4 ± 3.5. There were no conversions to open surgery. Median length of stay was 0 days. Six patients (15%) experienced urinary retention, and there were 2 further minor complications with no major complications, readmissions or reoperations. Use of the Versius® system for robotic hernia surgery is safe, with comparable results to existing robotic systems. Implementation is possible with minimal changes to established surgical techniques.
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17
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Zhang Z, Li L, Liu B, Wang F, Wang W, Liu X, Ju Y. Effect of Laparoscopic Total Extraperitoneal Umbilical Hernia Repair on Incision Infection, Complication Rate, and Recurrence Rate in Patients with Umbilical Hernia. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7055045. [PMID: 35070242 PMCID: PMC8767355 DOI: 10.1155/2022/7055045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/29/2021] [Accepted: 12/15/2021] [Indexed: 11/25/2022]
Abstract
The aim of this study is to clarify the influence of laparoscopic total extraperitoneal umbilical hernia repair on incision infection, complication rate, and recurrence rate in patients with an umbilical hernia (UH). Sixty-seven UH patients referred to our hospital from June 2017 to June 2019 were selected as the research participants. Thirty-six patients in the research group (RG) were treated with laparoscopic total extraperitoneal umbilical hernia repair, and the other 31 cases in the control group (CG) were treated with traditional umbilical hernia repair. The two cohorts of patients were compared with respect to the curative effect after treatment; intraoperative blood loss, operation time, postoperative pain time, ambulation time, and hospital stay; incidence of complications; pain severity (VAS) before and after operation; sleep quality (PSQI) before and after operation; patient satisfaction after treatment; and recurrence half a year after discharge. The RG presented a higher effective treatment rate (P < 0.05), less intraoperative blood loss, operation time, postoperative pain time, ambulation time, and hospital stay, as well as lower incidence of complications than the CG (P < 0.05). VAS and PSQI scores differed insignificantly between the two cohorts of patients before treatment (P > 0.05) but reduced after treatment, with lower VAS and PSQI scores in the RG than in the CG (P < 0.05). The number of people who were highly satisfied, as investigated by the satisfaction survey, was higher in the RG than in the CG, while the recurrence rate of prognosis was lower than that in the CG (P < 0.05). Laparoscopic total extraperitoneal umbilical hernia repair is effective for UH patients and can validly reduce the incidence of complications and recurrence rate, which has huge clinical application value.
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Affiliation(s)
- Zhao Zhang
- Surgical Gucheng County Hospital of Hebei Province, Hengshui 053000, China
| | - Li Li
- Surgical Gucheng County Hospital of Hebei Province, Hengshui 053000, China
| | - Bo Liu
- Surgical Gucheng County Hospital of Hebei Province, Hengshui 053000, China
| | - Fengen Wang
- Surgical Gucheng County Hospital of Hebei Province, Hengshui 053000, China
| | - Wenli Wang
- Surgical Gucheng County Hospital of Hebei Province, Hengshui 053000, China
| | - Xian Liu
- Surgical Gucheng County Hospital of Hebei Province, Hengshui 053000, China
| | - Yanmei Ju
- Surgical Gucheng County Hospital of Hebei Province, Hengshui 053000, China
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18
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Minimally Invasive Repair of a Posterior Perineal Hernia With Mesh: A Case Report. Female Pelvic Med Reconstr Surg 2021; 27:e691-e695. [PMID: 34690261 DOI: 10.1097/spv.0000000000001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Grove TN, Kontovounisios C, Montgomery A, Heniford BT, Windsor ACJ, Warren OJ. Perioperative optimization in complex abdominal wall hernias: Delphi consensus statement. BJS Open 2021; 5:6375607. [PMID: 34568888 PMCID: PMC8473840 DOI: 10.1093/bjsopen/zrab082] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 08/03/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The incidence of incisional hernia after major abdominal surgery via a midline laparotomy is 20-41 per cent with short-term follow-up, and over 50 per cent in those surviving an abdominal catastrophe. Abdominal wall reconstruction (AWR) requires complex operations, often involving mesh resection, management of scarred skin, fistula takedown, component separation or flap reconstruction. Patients tend to have more complex conditions, with multiple co-morbidities predisposing them to a vicious cycle of complications and, subsequently, hernia recurrence. Currently there appears to be variance in perioperative practice and minimal guidance globally. The aim of this Delphi consensus was to provide a clear benchmark of care for the preoperative assessment and perioperative optimization of patients undergoing AWR. METHODS The Delphi method was used to achieve consensus from invited experts in the field of AWR. Thirty-two hernia surgeons from recognized hernia societies globally took part. The process included two rounds of anonymous web-based voting with response analysis and formal feedback, concluding with a live round of voting followed by discussion at an international conference. Consensus for a strong recommendation was achieved with 80 per cent agreement, and a weak recommendation with 75 per cent agreement. RESULTS Consensus was obtained on 52 statements including surgical assessment, preoperative assessment, perioperative optimization, multidisciplinary team and decision-making, and quality-of-life assessment. Forty-six achieved over 80 per cent agreement; 14 statements achieved over 95 per cent agreement. CONCLUSION Clear consensus recommendations from a global group of experts in the AWR field are presented in this study. These should be used as a baseline for surgeons and centres managing abdominal wall hernias and performing complex AWR.
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Affiliation(s)
- T N Grove
- Department of Surgery, Chelsea and Westminster Hospital, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - C Kontovounisios
- Department of Surgery, Chelsea and Westminster Hospital, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK.,Department of General Surgery, Royal Marsden Hospital, London, UK
| | - A Montgomery
- Department of Surgery, Skåne University Hospital SUS, Malmö, Sweden
| | - B T Heniford
- Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
| | | | - O J Warren
- Department of Surgery, Chelsea and Westminster Hospital, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
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20
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Farquharson BJ, Sivarajah V, Mahdi S, Bergman H, Jeyarajah S. Where is the nerve? Review of operation note documentation practice for inguinal hernia repair. Ann R Coll Surg Engl 2021; 103:651-655. [PMID: 34412537 DOI: 10.1308/rcsann.2021.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Careful identification and management of inguinal nerves during inguinal hernia repair is important to avoid iatrogenic injury. Documentation of this practice may inform postoperative clinical management. We set out to investigate how often surgeons identify inguinal nerves and document findings and management in their operation notes. METHODS We carried out a retrospective review of operation notes at a single district general hospital. We analysed operation notes for documentation of identification and intraoperative management (preservation or sacrifice) of the inguinal nerves (iliohypogastric, ilioinguinal, genital branch of genitofemoral nerve). We collected data on the baseline characteristics of the patients, hernia characteristics and primary operating surgeons for subgroup analysis. RESULTS A total of 100 patients were included in the analysis. Identification of any inguinal nerves (generic 'nerve') was documented in 17% of operation notes. Documentation in the operation notes of named individual nerves was limited. No documentation of intraoperative management of inguinal nerves was found in 83% of operation notes. Preservation of the inguinal nerves (generic 'nerve') was recorded in 8% and sacrifice recorded in 9% of cases. Subgroup analysis revealed similar incidence of documentation of identification and management of inguinal nerves across grades of primary surgeon, with overall incidence low for all grades. CONCLUSION This study reveals a lack of appreciation of the importance of documenting identification and management of inguinal nerves in operation notes. Further consideration of the potential implications of poor documentation would be beneficial to improve standards.
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Affiliation(s)
| | | | - S Mahdi
- East and North Hertfordshire NHS Trust, UK
| | - H Bergman
- East and North Hertfordshire NHS Trust, UK
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21
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Köckerling F, Brunner W, Fortelny R, Mayer F, Adolf D, Niebuhr H, Lorenz R, Reinpold W, Zarras K, Weyhe D. Treatment of small (< 2 cm) umbilical hernias: guidelines and current trends from the Herniamed Registry. Hernia 2020; 25:605-617. [PMID: 33237505 DOI: 10.1007/s10029-020-02345-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 11/13/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Based on meta-analyses and registry data, the European Hernia Society and the Americas Hernia Society have published guidelines for the treatment of umbilical hernias. These recommend that umbilical hernia should generally be treated by placing a non-absorbable (permanent) flat mesh into the preperitoneal space with an overlap of the hernia defect of 3 cm. Suture repair should only be considered for small hernia defects of less than 1 cm. Hence, the use of a mesh in general is subject to controversial debate particularly for small (< 2 cm) umbilical hernias. This analysis of data from the Herniamed Registry now presents data on the treatment of small (< 2 cm) umbilical hernias over the past 10 years. METHODS Herniamed is an Internet-based hernia registry in which hospitals and surgical centers in Germany, Austria and Switzerland can voluntarily enter data on their routine hernia operations. Between 2010 and 2019, data were entered into the Herniamed Registry by 737 hospitals/surgery centers on a total of 111,765 patients with primary elective umbilical hernia repair. The prospective data were analyzed retrospectively for each year and statistically compared. Due to a higher number of cases, the years 2013 and 2019 were compared for the perioperative outcome and the years 2013 and 2018 for 1-year follow-up. Fisher's exact test was applied for unadjusted analyses between the years, using a significance level of alpha = 5%. For post hoc tests of single categories, a Bonferroni adjustment for multiple testing was implemented. RESULTS A mesh technique was used to treat 45.4% of all umbilical hernias. The proportion of small (< 2 cm) umbilical hernias in the total collective of umbilical hernias was 55.6%. Suture repair was used consistently over the 10-year period to treat around 75% of all small (< 2 cm) umbilical hernias. Preperitoneal mesh placement as recommended in the guidelines was used only in 1.8% of cases. Between 2013 and 2019, stable values of 2 and 0.7% were observed for the postoperative complications and complication-related reoperations, respectively, with no relevant effect identified for the surgical technique. At 1-year follow-up, significantly higher rates of pain at rest (2.6 vs. 3.3), pain on exertion (5.7 vs. 6.6), and recurrences (1.3 vs. 1.8) (all p < 0.05) were identified for 2018 compared with 2013. CONCLUSIONS A suture technique is still used to treat 75% of patients with small (< 2 cm) umbilical hernias. The pain and recurrence rates are significantly less favorable for 2018 compared with 2013.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - W Brunner
- Department of Surgery, Kantonspital St. Gallen, Rorschacher Str. 95, CH-9007, St. Gallen, Switzerland
| | - R Fortelny
- Department of General Surgery, Faculty of Medicine, Sigmund Freud University, Freudplatz 3, 1020, Vienna, Austria
| | - F Mayer
- Department of Surgery, Paracelsus Medical University Salzburg, University Hospital of Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria
| | - D Adolf
- StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany
| | - H Niebuhr
- Hansechirurgie, Niebuhr Marleschki & Partner, Alte Holstenstr. 16, 21031, Hamburg, Germany
| | - R Lorenz
- Hernia Center 3+CHIRURGEN, Klosterstrasse 34/35, 13581, Berlin, Germany
| | - W Reinpold
- Wilhelmsburger Hospital Gross-Sand, Gross-Sand 3, 21107, Hamburg, Germany
| | - K Zarras
- Marien Hospital Düsseldorf, Rochusstrasse 2, 40479, Düsseldorf, Germany
| | - D Weyhe
- University Hospital of Visceral Surgery, Pius Hospital Oldenburg, Georgstrasse 12, 26121, Oldenburg, Germany
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22
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Köckerling F, Hoffmann H, Mayer F, Zarras K, Reinpold W, Fortelny R, Weyhe D, Lammers B, Adolf D, Schug-Pass C. What are the trends in incisional hernia repair? Real-world data over 10 years from the Herniamed registry. Hernia 2020; 25:255-265. [PMID: 33074396 DOI: 10.1007/s10029-020-02319-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/07/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION There is an increasingly controversial debate about the best possible incisional hernia repair technique. Despite the good outcomes of laparoscopic IPOM, concerns about the intraperitoneal mesh placement and its potential intraabdominal complications have risen. Against that background, this paper now analyzes changes and trends in incisional hernia repair techniques in the recent decade. METHODS Between 2010 and 2019 a total of 61,627 patients with primary elective incisional hernia repair were enrolled in the Herniamed Registry. The outcome results were assigned to the year of repair and summarized as curves to visualize trends. The explorative Fisher's exact test was used for statistical calculation of significant differences. Since the number of cases entered into the Herniamed Registry for the years 2010-2012 was still relatively small, the years 2013 and 2019 were compared for statistical analysis. RESULTS In the analyzed time period, the proportion of incisional hernias repaired in open suture technique remained unchanged at about 10%. The proportion of laparoscopic IPOM repairs decreased significantly from 33.8% in 2013 to 21.0% (p < 0.001) in 2019. Conversely, the proportion of open sublay repairs increased significantly from 32.1% in 2013 to 41.4% (p < 0.001) in 2019. Starting in 2015, there has also been the introduction and increasing use (4.5% in 2013 vs. 10.0% in 2019; p < 0.001) of new minimally-invasive techniques with placement of a mesh into the sublay/retromuscular/preperitoneal abdominal wall layer (E/MILOS, eTEP, preperitoneal mesh technique). CONCLUSION Analysis of data from the Herniamed Registry shows a significant trend to the disadvantage of the laparoscopic IPOM and to the advantage of the open sublay operation and the new minimally-invasive techniques (E/MILOS, eTEP, preperitoneal mesh technique). Despite all the recommendations in the guidelines, 10% of incisional hernias continue to be treated by means of a suture technique.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - H Hoffmann
- Center for Hernia Surgery and Proctology, ZweiChirurgen GmbH, St. Johanns-Vorstadt 44, 4056, Basel, Switzerland.,University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - F Mayer
- Department of Surgery, Paracelsus Medical University Salzburg, University Hospital of Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria
| | - K Zarras
- Department of Visceral, Minimally Invasive and Oncologic Surgery, Academic Teaching Hospital of University of Düsseldorf, Marien Hospital, Rochusstraße 2, 40479, Düsseldorf, Germany
| | - W Reinpold
- Department of Surgery, Wilhelmsburger Hospital Groß Sand, Academic Teaching Hospital of University Hamburg, Groß Sand 3, 21107, Hamburg, Germany
| | - R Fortelny
- Department of General Surgery, Wilhelminen Hospital, Sigmund Freud University Vienna, Medical Faculty, Freudplatz 3, 1020, Vienna, Austria
| | - D Weyhe
- Department of General and Visceral Surgery, Pius Hospital, University Hospital of Visceral Surgery, Georgstraße 12, 26121, Oldenburg, Germany
| | - B Lammers
- Department of Surgery I, Section Coloproctology and Hernia Surgery, Lukas Hospital, Preussenstr. 84, 41464, Neuss, Germany
| | - D Adolf
- StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany
| | - C Schug-Pass
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany
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Sivarajah V, Farquharson B, Mahdi S, Cathcart P, Jeyarajah S. Chronic groin pain following open inguinal hernia repair: has consenting practice improved? Ann R Coll Surg Engl 2020; 103:5-9. [PMID: 32981334 DOI: 10.1308/rcsann.2020.0184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Chronic groin pain following inguinal hernia surgery is a common and potentially debilitating complication, and yet patients are infrequently informed of this risk. This leaves surgeons open to negligence claims, especially given recent changes to case law, which for the first time highlighted the need for a more patient-centred approach to risk disclosure. We investigated how these changes have influenced our consenting practice with respect to the disclosure of this risk. METHODS We compared how often surgeons discussed the risk of chronic groin pain with adults undergoing elective open unilateral inguinal hernia mesh repairs in 2019 and 2009. The first 50 patients in each of these two years were retrospectively compared. Discussions during the initial consultation and on the day of surgery were assessed by reviewing clinic letters, medical notes and consent forms. FINDINGS The risk of chronic pain was discussed with significantly more patients in 2019 than in 2009 (96% v 54%, p<0.0001). Most of these discussions occurred on the day of surgery (92% v 54%, p<0.0001). Only a few patients had these discussions during their initial consultation (18% v 4%, p<0.025). CONCLUSIONS Discussing the risk of chronic groin pain has improved significantly over the past 10 years. However, these discussions occur mostly on the day of surgery, which gives patients very little time to weigh up the risk. This potentially invalidates the consent they give for surgery. Patients should be given an opportunity to discuss their operative risks in advance of their operation.
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Affiliation(s)
| | | | - S Mahdi
- East and North Hertfordshire NHS Trust, UK
| | - P Cathcart
- East and North Hertfordshire NHS Trust, UK
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Köckerling F, Brunner W, Mayer F, Fortelny R, Adolf D, Niebuhr H, Lorenz R, Reinpold W, Zarras K, Weyhe D. Assessment of potential influencing factors on the outcome in small (< 2 cm) umbilical hernia repair: a registry-based multivariable analysis of 31,965 patients. Hernia 2020; 25:587-603. [PMID: 32951104 DOI: 10.1007/s10029-020-02305-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/09/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION How best to treat a small (< 2 cm) umbilical hernia continues to be the subject of controversial debate. The recently published guidelines for treatment of umbilical hernias from the European Hernia Society and Americas Hernia Society recommend open mesh repair for defects ≥ 1 cm. Since the quality of evidence is limited for hernias with defect sizes smaller than 1 cm, suture repair can be considered. To date, little is known about the potential influencing factors on the outcome in small (< 2 cm) umbilical hernia repair. This multivariable analysis of data from the Herniamed Registry now aims to assess these factors. METHODS The data of patients with primary elective umbilical hernia repair and defect size < 2 cm entered into the Herniamed Registry from September 1, 2009 to December 31, 2018 were analyzed to assess through multivariable analysis all confirmatory pre-defined potential influencing factors on the primary outcome criteria intraoperative and postoperative complications, general complications, complication-related reoperations, recurrence rate and rates of pain at rest, pain on exertion and chronic pain requiring treatment at 1-year follow-up. RESULTS 31,965 patients (60%) met the inclusion criteria. The proportion of suture repairs was 78.6% (n = 25,119), of open mesh repairs 15.2% (n = 4853), and of laparoscopic mesh repairs 6.2% (n = 1993). Compared with open mesh repair, suture repair had a highly significantly unfavorable association with the recurrence rate (OR = 1.956 [1.463; 2.614]; p < 0.001). Female gender also had an unfavorable relation to the recurrence rate (OR = 1.644 [1.385; 1.952]; p < 0.001). Compared with open mesh repair, open suture repair had a highly significantly favorable association with the rate of postoperative complications (OR = 0.583 [0.484; 0.702]; p < 0.001) and complication-related reoperations (OR = 0.567 [0.397; 0.810]; p = 0.002).While laparoscopic IPOM showed a favorable relationship with the postoperative complications and complication-related reoperations, it demonstrated an unfavorable association with the intraoperative complications, general complications, recurrence rate and pain rates. CONCLUSION Suture repair continues to be used for 78% of umbilical hernias with a defect < 2 cm. While suture repair has a favorable influence on the rates of postoperative complications and complication-related reoperations, it has a higher risk of recurrence. Female gender also has an unfavorable influence on the recurrence rate. Laparoscopic IPOM appears to be indicated only in settings of obesity (BMI ≥ 30).
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - W Brunner
- Department of General, Visceral, Endocrine and Transplant Surgery, Rorschacher Kantonsspital St. Gallen, Str. 95, 9007, St. Gallen, Switzerland
| | - F Mayer
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria
| | - R Fortelny
- Department of General Surgery, Hospital Ottakring, Montleartstrasse 37, 1160, Vienna, Austria.,Sigmund Freud University Vienna, Medical Faculty, Schnirchgasse 9a, 1030, Vienna, Austria
| | - D Adolf
- StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany
| | - H Niebuhr
- Hansechirurgie, Niebuhr Marleschki & Partner, Alte Holstenstr. 16, 21031, Hamburg, Germany
| | - R Lorenz
- Hernia Center 3 + CHIRURGEN, Klosterstrasse 34/35, 13581, Berlin, Germany
| | - W Reinpold
- Wilhelmsburger Hospital Gross-Sand, Gross-Sand 3, 21107, Hamburg, Germany
| | - K Zarras
- Marien Hospital Düsseldorf, Rochusstrasse 2, 40479, Düsseldorf, Germany
| | - D Weyhe
- Department of General and Visceral Surgery, Pius Hospital Oldenburg, University Hospital of Visceral Surgery, Georgstraße 12, 26121, Oldenburg, Germany
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Pawlak M, Newman M, de Beaux AC, Tulloh B. The darn technique for small (< 2 cm diameter) midline hernias. Hernia 2020; 25:625-630. [PMID: 32876796 DOI: 10.1007/s10029-020-02283-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/27/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Primary midline hernias arising in the linea alba are common. While mesh repair has been shown to reduce recurrence rates even in small hernias, many surgeons still use a suture repair for defects of less than 2 cm. The recent European and Americas Hernia Societies Guidelines recommended suture repair only for hernias smaller than 1 cm. A suture repair implies edge-to-edge or overlapping fascial margins, which necessarily involves tension on the repair. A darn is a tension-free repair where, in effect, a "mesh" is hand-woven across the defect in situ. METHODS The darn repair is a modification of the darn techniques for inguinal hernia repair. Eligible patients undergoing this repair at the Royal Infirmary of Edinburgh between 1 January 2008 and 31 December 2017 were identified from a prospective computer-based medical record system and their case notes reviewed. Inclusion criteria were adult patients with a primary midline abdominal wall defect smaller than 2 cm in the widest diameter of the hernia defect measured intra-operatively. Patients were followed up by telephone in 2019. Those who reported possible recurrence or other symptoms in the region of their hernia repair were reviewed in the outpatient clinic. RESULTS 47 suture-darn repairs were undertaken over the 10-year period. Fifteen of the darn repair operations (32%) were performed under local anaesthesia. Forty-one patients were followed up with a mean of 80 ± 35 and median of 87 months after surgery. Six patients (13%) were lost to follow-up. Recurrence was found in two cases (5%) and one patient has since been diagnosed with a new epigastric hernia some 5 cm cranial to the previous repair. CONCLUSIONS The darn repair for small primary midline hernias is quick and inexpensive with promising long-term results. It can be performed under local anaesthesia. It can serve as an alternative to mesh repair for defects less than 2 cm in maximum dimension.
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Affiliation(s)
- M Pawlak
- North Devon Comperhensive Hernia Centre, North Devon District Hospital, Barnstaple, UK.
| | - M Newman
- Upper GI Surgery Department, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A C de Beaux
- Upper GI Surgery Department, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - B Tulloh
- Upper GI Surgery Department, Royal Infirmary of Edinburgh, Edinburgh, UK
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The emerging role of sarcopenia as a prognostic indicator in patients undergoing abdominal wall hernia repairs: a systematic review of the literature. Hernia 2020; 24:1361-1370. [PMID: 32300901 PMCID: PMC7701077 DOI: 10.1007/s10029-020-02179-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/24/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is strong evidence suggesting that excessive fat distribution, for example, in the bowel mesentery or a reduction in lean body mass (sarcopenia) can influence short-, mid-, and long-term outcomes from patients undergoing various types of surgery. Body composition (BC) analysis aims to measure and quantify this into a parameter that can be used to assess patients being treated for abdominal wall hernia (AWH). This study aims to review the evidence linking quantification of BC with short- and long-term abdominal wall hernia repair outcomes. METHODS A systematic review was performed according to the PRISMA guidelines. The literature search was performed on all studies that included BC analysis in patients undergoing treatment for AWH using Medline, Google Scholar and Cochrane databases by two independent reviewers. Outcomes of interest included short-term recovery, recurrence outcomes, and long-term data. RESULTS 201 studies were identified, of which 4 met the inclusion criteria. None of the studies were randomized controlled trials and all were cohort studies. There was considerable variability in the landmark axial levels and skeletal muscle(s) chosen for analysis, alongside the methods of measuring the cross-sectional area and the parameters used to define sarcopenia. Only two studies identified an increased risk of postoperative complications associated with the presence of sarcopenia. This included an increased risk of hernia recurrence, postoperative ileus and prolonged hospitalisation. CONCLUSION There is some evidence to suggest that BC techniques could be used to help predict surgical outcomes and allow early optimisation in AWH patients. However, the lack of consistency in chosen methodology, combined with the outdated definitions of sarcopenia, makes drawing any conclusions difficult. Whether body composition modification can be used to improve outcomes remains to be determined.
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