An Analysis of Early Postoperative Returns after Inguinal Hernia Surgery

2018 ◽  
Vol 84 (10) ◽  
pp. 1613-1616 ◽  
Author(s):  
Nikhil Crain ◽  
Talar Tejirian
Keyword(s):  
Inguinal Hernia ◽  
Urinary Retention ◽  
Laparoscopic Group ◽  
Urgent Care ◽  
Hernia Surgery ◽  
Kaiser Permanente ◽  
Inguinal Herniorrhaphy ◽  
Medical Centers ◽  
Inguinal Hernia Surgery ◽  
Risk Patients

Although inguinal herniorrhaphy is low risk, patients still return to the urgent care or ED. We performed a retrospective study on 19,296 inguinal hernia operations across 14 Southern California Kaiser Permanente medical centers over five years. Unplanned returns within the first postoperative week were evaluated focusing on four potentially avoidable diagnoses (AD): pain, constipation, urinary retention, and nausea/vomiting. Overall, 1370 (7%) patients returned to the urgent care/emergency department, of which 537 (39%) had an AD. There was no difference in total returns (7.1 vs 7.4%, P = 0.33) or AD returns [2.8 vs 2.6%, ( P = 0.44)] for males vs females. Of the 537 total AD returns, there were 205 (38%) patients with pain, 191 (36%) with urinary retention, 112 (21%) with constipation, and 29 (5%) with nausea/vomiting. Most AD returns (78%) occurred within the first three postoperative days. Pain was greater in open operations [44 vs 26%, ( P < 0.05)], and urinary retention was greater in the laparoscopic group [27 vs 55%, ( P < 0.05)]. The overall rate of return was higher for laparoscopic compared with open unilateral operations [8 vs 6%, ( P < 0.05)], but similar between approaches for bilateral operations [11 vs 10%, ( P = 0.32)].

scholarly journals Litigation claims following laparoscopic and open inguinal hernia repairs

Hernia ◽  
2020 ◽  
Vol 24 (5) ◽  
pp. 1113-1120
Author(s):  
R. Varley ◽  
C. Lo ◽  
B. Alkhaffaf
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Vascular Injury ◽  
Laparoscopic Hernia Repair ◽  
Laparoscopic Approach ◽  
Laparoscopic Group ◽  
Hernia Surgery ◽  
Visceral Injury ◽  
Inguinal Hernia Surgery ◽  
The Uk

Abstract Purpose Groin hernia repair is the most frequently performed general surgical operation in the UK. Complications from laparoscopic and open repair are well recognised; however, potential differences are yet to be considered in relation to litigation. Methods Administrative data were obtained and analysed from the NHS Litigation Authority for inguinal hernia-related claims from 1995 to 2016. Claims identified as using an open or laparoscopic approach were compared. Results 880 claims were made, 760 had been settled. 88 laparoscopic and 241 open procedures were identified; 65% laparoscopic and 63% open hernia claims were found to be in favour of the claimant. Payouts totalled to 4.1GBP/4.8EUR/5.3USD million and 9.4GBP/11.0EUR/12.1USD million for laparoscopic (mean 82,824GBP/96,579EUR/106,453USD) and open (mean 66,796GBP/77,892EUR/85,852USD) approaches, respectively. The most common reasons for claim initiation were visceral/vascular injury (54%) in the laparoscopic group, and testicular complications or chronic pain (35%) in the open group. Additional procedures were necessary for 48% and 44% of laparoscopic and open claims, respectively. The highest average payouts were associated with visceral injury, (laparoscopic 116,482GBP/135,820EUR/149,715USD; open 199,103GBP/232,246EUR/255,905USD) and vascular injury (laparoscopic 88,624GBP/103,369EUR/113,892USD; open 64,460GBP/75,163EUR/82,870USD). Additional procedures resulted in an average payout of 93,352GBP/108,917EUR/120,008USD (laparoscopic) and 60,408GBP/70,506EUR/77,657USD (open). The most common additional procedures were corrective visceral/vascular repairs, orchidectomy and recurrent hernia repair. Conclusions The rate of litigation for clinical negligence in inguinal hernia surgery in the UK is increasing. Whilst there has been a recent increase in laparoscopic hernia repair claims, the volume and burden of claims related to open procedures remain greater.

scholarly journals Unplanned Returns to Care within Seven Days after Anorectal Surgery: Can they be Avoided?

2019 ◽  
Vol 85 (1) ◽  
pp. 92-97 ◽  
Author(s):  
Nikhil Crain ◽  
Armen Aboulian
Keyword(s):  
Retrospective Analysis ◽  
Urinary Retention ◽  
Return Rate ◽  
Urgent Care ◽  
Care Group ◽  
Anesthesia Care ◽  
Anorectal Surgery ◽  
Monitored Anesthesia Care ◽  
Kaiser Permanente ◽  
Medical Centers

With rates up to 50 per cent, unanticipated returns after anorectal surgery remain a major issue. A retrospective analysis was performed on 5929 anorectal operations from January 2011 to December 2015 across 14 Kaiser Permanente Southern California medical centers. Data were gathered on the cause, frequency and timing of unplanned returns to the ED and urgent care. Of all patients, 246 (4%) returned with a nonavoidable diagnosis and 243 (4%) returned with one of four avoidable diagnoses: pain, constipation, urinary retention, and nausea/vomiting. Seventy four per cent of avoidable diagnoses returns occurred within the first four postoperative days, with 48 per cent between days 2 and 4. In patients older than 50 years of age, males showed higher urinary retention (P = 0.001), whereas females had higher constipation (P < 0.001). Contrarily, pain was higher for both males (P = 0.02) and females (P < 0.001) less than 50 years old. In a separate subanalysis on anesthesia type, both constipation (P = 0.03) and urinary retention (P = 0.01) showed double the return rate in the general versus local/monitored anesthesia care group, whereas pain (P = 0.15) and nausea/vomiting (P = 0.20) showed no differences. Half of returns fall into a category that is potentially avoidable with preemptive interventions.

New Four-fold Technique to Spread the Self-Gripping Mesh in Open Inguinal Hernia Surgery

2021 ◽  
Author(s):  
Arun Kumar Gupta ◽  
Aman Raj ◽  
Devadatta Poddar ◽  
Lalit Kumar Bansal ◽  
Peeyush Kumar ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
The Self ◽  
Hernia Surgery ◽  
Inguinal Hernia Surgery

scholarly journals Postoperative condition of patients as a result of treatment of inguinal hernias by laparoscopic and open methods

2021 ◽  
pp. 30-35
Author(s):  
V.V. Skyba ◽  
◽  
A.V. Ivanko ◽  
N.V. Voytyuk ◽  
V.V. Lysytsia ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Surgical Treatment ◽  
Open Access ◽  
Hospital Stay ◽  
Laparoscopic Approach ◽  
Length Of Hospital Stay ◽  
Lower Percentage ◽  
Hernia Surgery ◽  
Inguinal Hernias ◽  
Inguinal Hernia Surgery

Purpose – to analyze condition of patients after surgical treatment of inguinal hernias by laparoscopic and open methods. Materials and methods. A retrospective review of medical histories and outpatient charts of all patients who underwent inguinal hernia surgery at the Kyiv City Clinical Hospital No. 1 from January 2018 to July 2020 was conducted. Results. During the above period of time in our hospital open hernioplasty was performed in 86 patients, laparoscopic hernioplasty – 138 patients. With open hernioplasty, the average duration of surgical treatment was 40±12 minutes. The laparoscopic technique was 35±12 minutes. The length of hospital stay was significantly longer in the group of patients with the open method (48±12 hours) than in the group of laparoscopic plastic surgery (12±3 hours). From the group of patients who underwent open hernioplasty, 62 patients complained of long-term pain syndrome, from the group of laparoscopy – 12 patients. The cosmetic appearance was dissatisfied with 34 patients in the open access group and only 2 patients in the laparoscopic plastic group. Postoperative complications were observed in 34 patients who underwent surgical treatment through open access, and in 15 patients – by laparoscopy. Conclusions. The laparoscopic approach of inguinal hernia surgery is superior to open access, as it reduces the length of hospital stay, postoperative recovery, improves the aesthetic effect of the operation, reduces the frequency of infection of incisions. According to the results of the study, this technique gives a better result in the early postoperative period, a lower percentage of chronic pain and a higher degree of patient satisfaction compared to open access with the same low recurrence rate. Therefore, in our opinion, laparoscopic access to hernioplasty is the optimal method of treatment and can be recommended as a method of choosing inguinal hernia surgery. Postoperative assessment of the quality of life of patients after treatment of inguinal hernia by laparoscopic and open methods. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: inguinal hernia, laparoscopy, open access surgery, analysis of methods, operation.

scholarly journals P144 SPERMATIC CORD LIPOSARCOMA - A VERY RARE FINDING DURING INGUINAL HERNIA SURGERY

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Christian Gröger ◽  
Lena Kundel ◽  
Hardwig Riediger
Keyword(s):  
Inguinal Hernia ◽  
Spermatic Cord ◽  
Rare Condition ◽  
Minimal Invasive ◽  
Tumor Board ◽  
Fatty Tissue ◽  
Industrialized Countries ◽  
Hernia Surgery ◽  
Rare Finding ◽  
Inguinal Hernia Surgery

Abstract Aim Repair of inguinal hernia is one of the most common operations in general surgery in industrialized countries. Isolated spermatic cord liposarcoma is a very rare soft tissue tumor. Despite standardized diagnostic algorithms for inguinal hernia, it could be difficult to predict such a rare finding. Material and Methods We report a case of inadvertent inguinal liposarcoma excision during hernia surgery in a 72-year-old male patient. Except for polyposis coli there were no further illnesses. Results After a minimal invasive transabdominal preperitoneal (TAPP) repair of a symptomatic inguinal hernia last year a persistent scrotal swelling developed. Computed tomography (CT) showed a protrusion of fatty tissue into the scrotal sac. Diagnosis of scrotal hernia was made. We performed an open Lichtenstein procedure. The final pathologic examination revealed a highly differentiated liposarcoma. Staging was completed and the case was presented to a multidisciplinary sarcoma tumor board at our institution. As recommended, a inguinal reoperation was performed with wide excision. Conclusions Although a very rare condition, spermatic cord liposarcoma should be considered as a possible differential diagnosis for inguinal hernia surgery.

scholarly journals P004 TREATMENT OF RECURRENT INGUINAL HERNIA AFTER TRANSINGUINAL PREPERITONEAL (TIPP) SURGERY

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Lysanne van Silfhout ◽  
Ludo van Hout ◽  
Myrthe Jolles ◽  
Hilco P. Theeuwes ◽  
Willem J.V. Bökkerink ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Surgical Outcomes ◽  
Medical Records ◽  
Surgical Techniques ◽  
Recurrent Inguinal Hernia ◽  
Hernia Surgery ◽  
Exclusion Criteria ◽  
Inguinal Hernia Surgery ◽  
Mean Time

Abstract Aim To report feasibility and surgical outcomes of recurrent inguinal hernia repair after TransInguinal PrePeritoneal (TIPP) repair. Material and Methods Patients who underwent recurrent IHR after TIPP between January 2013 and January 2015 in a single hernia-dedicated teaching hospital were included. Exclusion criteria were femoral hernia, incarcerated hernia and reasons for unreliable follow-up. Electronic medical records were assessed retrospectively to register surgical outcomes and complications. Results Thirty-three patients underwent surgical repair of recurrent inguinal hernia after TIPP. Twenty patients were treated with a “re-TIPP when possible” strategy; resulting in 13 successful re-tipps and 7 conversions to Lichtenstein repair. Eleven patients underwent primarily a Lichtenstein’s repair, the remaining two patients underwent recurrent IHR using other techniques (transrectus sheath Pre-Peritoneal and transabdominal preperitoneal repair). Mean time of surgery was 44.7 minutes (standard deviation 16.7). There was one patient (3.0%) with a re-recurrent inguinal hernia during follow-up. Other minor complications included urinary tract infection. There were no significant differences in post-operative results between the different surgical techniques used for recurrent IHR. Conclusions These results indicate that after TIPP it is feasible and safe to perform re-surgery for recurrence with an anterior approach again. For these recurrences, a Lichtenstein can be performed, or a ‘re-TIPP if possible’ strategy can be applied by experienced TIPP surgeons. Whether a re-TIPP has the same advantages over Lichtenstein as is for primary inguinal hernia surgery, needs to be evaluated in a prospective manner.

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