scholarly journals Ambulatory Hernia Repair: A Study of 1294 Patients in a Single Institution

2021 ◽  
Author(s):  
Mohamed Hajri ◽  
Dhafer Haddad ◽  
Mouna Cherif ◽  
Alia Zouaghi ◽  
Nizar Khedhiri ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Mortality Rate ◽  
Hernia Repair ◽  
Failure Rate ◽  
Groin Hernia ◽  
Study Data ◽  
Morbidity Rate ◽  
Unplanned Admission ◽  
Single Institution ◽  
Hernia Surgery

Abstract Background: Ambulatory surgery is defined as surgery without an overnight hospital stay, which allows the patient to return home on the same day of admission after the surgical procedure. It is increasing countinuously in the world because of its several advantages. This study aimed to describe the experience of our department in outpatient hernia surgery, evaluate its feasibility and safety, and determine the predictive factors for failure of this surgery. Results: We collected 1294 patients. One thousand twenty patients underwent groin hernia repair (GHR). The failure rate of ambulatory management of GHR was 3.7%: 31 patients (3%) had an unplanned admission (UA) and 7 patients (0.7%) had an unplanned rehospitalisation (UR). Morbidity rate was 2.4% (24 patients) and mortality rate was zero. In multivariate analysis, we did not identify any variable predicting discharge failure in the GHR group. Two hundred and seventy-four patients underwent ventral hernia repair (VHR). The failure rate of ambulatory management of VHR was 5.5%: 11 patients (4%) had a UA and 4 patients (1.5%) had an UR. Morbidity rate was 3.6% (10 patients) and the mortality rate was zero. In multivariate analysis, we did not identify any variable predicting discharge failure in the VHR group. Conclusions: Our study data suggest that ambulatory hernia surgery is feasible and safe in well-selected patients. The development of this practice would allow for better management of eligible patients and would offer many economic and organisational advantages to healthcare structures.

Natural course of long-term postherniorrhaphy pain in a population-based cohort

2010 ◽  
Vol 1 (1) ◽  
pp. 55-59 ◽  
Author(s):  
Gabriel Sandblom ◽  
Maija-Liisa Kalliomäki ◽  
Ulf Gunnarsson ◽  
Torsten Gordh
Keyword(s):  
Multivariate Analysis ◽  
Postoperative Pain ◽  
Hernia Repair ◽  
Groin Hernia ◽  
Population Based ◽  
Persistent Pain ◽  
Natural Course ◽  
Hernia Surgery ◽  
Persistent Postoperative Pain ◽  
Postherniorrhaphy Pain

AbstractBackgroundPersistent pain after hernia repair is widely recognised as a considerable problem, although the natural course of postoperative pain is not fully understood. The aim of the present study was to explore the natural course of persistent pain after hernia repair in a population-based cohort and identify risk factors for prolonged pain duration.MethodsThe study cohort was assembled from the Swedish Hernia Register (SHR), which has compiled detailed information on more than 140 000 groin hernia repairs since 1992. All patients operated on for groin hernia in the County of Uppsala, Sweden, 1998–2004 were identified in the SHR. Those who were still alive in 2005 received the Inguinal Pain Questionnaire, a validated questionnaire with 18 items developed with the aim of assessing postherniorrhaphy pain, by mail. Reminders were sent to non-responders 5 months after the first mail. The halving time was estimated from a linear regression of the logarithmic transformation of the prevalence of pain each year after surgery. A multivariate analysis with pain persisting more than 1 month with a retrospective question regarding time to pain cessation as dependent variable was performed.ResultsAltogether 2834 repairs in 2583 patients were recorded, 162 of who had died until 2005. Of the remaining patients, 1763 (68%) responded to the questionnaire. In 6.7 years the prevalence of persistent pain had decreased by half for the item “pain right now” and in 6.8 years for the item “worst pain last week”. The corresponding figures if laparoscopic repair was excluded were 6.4 years for “pain right now” and 6.4 years for “worst pain past week”. In a multivariate analysis, low age, postoperative complication and open method of repair were found to predict an increased risk for pain persistence exceeding 1 month.ConclusionPersistent postoperative pain is a common problem following hernia surgery, although it often recedes with time. It is more protracted in young patients, following open repair and after repairs with postoperative complications. Whereas efforts to treat persistent postoperative pain, in particular neuropathic pain, are often fruitless, this group can at least rely on the hope that the pain, for some of the patients, gradually decreases with time. On the other hand, 14% still reported a pain problem 7 years after hernia surgery. We do not know the course after that.Although no mathematical model can provide a full understanding of such a complex process as the natural course of postoperative pain, assuming an exponential course may help to analyse the course the first years after surgery, enable comparisons with other studies and give a base for exploring factors that influence the duration of the postoperative pain. Halving times close to those found in our study could also be extrapolated from other studies, assuming an exponential course.

Open and laparoscopic surgeries are associated with comparable 90 day morbidities and mortalities following ERAS protocols- A retrospective Study. (Preprint)

2020 ◽  
Author(s):  
BHAVIN VASAVADA ◽  
Hardik Patel
Keyword(s):  
Multivariate Analysis ◽  
Retrospective Study ◽  
Mortality Rate ◽  
Operative Time ◽  
Univariate Analysis ◽  
Morbidity And Mortality ◽  
Morbidity Rate ◽  
Blood Products ◽  
Asa Score

UNSTRUCTURED All the gastrointestinal surgeries performed between April 2016 to march 2019 in our institution have been analysed for morbidity and mortality after ERAS protocols and data was collected prospectively. We performed 245 gastrointestinal and hepato-biliary surgeries between April 2016 to march 2019. Mean age of patients was 50.96 years. 135 were open surgeries and 110 were laparoscopic surgeries. Mean ASA score was 2.40, mean operative time was 111 minutes, mean CDC grade of surgery was 2.56. 40 were emergency surgeries and 205 were elective surgeries. Overall 90 days mortality rate was 8.5% and over all morbidity rate was around 9.79% . On univariate analysis morbidity was associated significantly with higher CDC grade of surgeries, higher ASA grade, more operative time, more blood products use, more hospitalstay, open surgeries,HPB surgeries and luminal surgeries(non hpb gastrointestinal surgeries) were associated with higher 90 days morbidity. On multivariate analysis no factors independently predicted morbidity. On univariate analysis 90 days mortality was predicted by grade of surgeries, higher ASA grade, more operative time, more blood products use, open surgeries and emergency surgeries. However on multivariate analysis only more blood products used was independently associated with mortality There is no difference between 90 day mortality and moribidity rates between open and laparoscopic surgeries.

EP.TH.747Audit of antibiotic prophylaxis in groin hernia repair

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Maitreyi Patel ◽  
Aleem O'Balogun ◽  
Naveed Kirmani
Keyword(s):  
Hernia Repair ◽  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Groin Hernia ◽  
Open Repair ◽  
Risk Category ◽  
Site Infection ◽  
Groin Hernia Repair ◽  
Hernia Surgery ◽  
International Guidelines

Abstract Aims To review practice of antibiotic prophylaxis in patients undergoing groin hernia repair against the International guidelines for groin hernia management 2018, in order to improve compliance with International Guidelines. We also assessed the risk category of patients. Methods Retrospective data of all patients undergoing groin hernia repair from November 2019 to March 2020 was collected using hospital software. Data collected included patient demographics, details of hernia repair including; primary/recurrent hernia, emergency/elective, laparoscopic/open repair and use of mesh. The details of antibiotic prophylaxis were recorded. Descriptive statistics was used. Data was analyzed using Microsoft Excel. Results 67 patients were included, of which 38(57%) were high risk. 62 (92.5%) primary repairs were done, of which 48(72%) were open. 62(92.5%) were operated electively. 46(69%) patients underwent open repair with mesh, 6(9%) had open repair without mesh, while 15(22%) had laparoscopic repair with mesh. A total of 45 (67%) patient received antibiotic prophylaxis. Adherence to International guidelines for groin hernia in open hernia surgery was 82.67%, while that for laparoscopic surgery was 60%. Overall adherence to the Guidelines was 56.67%. Conclusions The audit reflects the need for improved understanding and adherence to the International Guidelines. Data collection of surgical site infection can help inform and influence practice to minimize the risk for surgical site infection and assist in better communication with patients regarding risk. Risk assessment for surgical site infection of patients prior to procedure helps to identify those with indication of antibiotic prophylaxis.

scholarly journals Audit of Referral Patterns for Hernia Repair – Are General Practitioners Aware of the Changing Face of Herniorrhaphy?

2008 ◽  
Vol 90 (2) ◽  
pp. 140-141 ◽  
Author(s):  
JE Coulston ◽  
GL Williams ◽  
BM Stephenson
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
General Practitioners ◽  
Groin Hernia ◽  
Postal Questionnaire ◽  
Further Education ◽  
General Surgeon ◽  
Hernia Surgery ◽  
Referral Patterns ◽  
Inguinal Hernia Surgery

INTRODUCTION The objective of this study was to examine referral patterns from general practitioners for groin hernia surgery and to assess their knowledge of services available to their patients. PATIENTS AND METHODS An anonymous postal questionnaire was sent to 120 general practitioners (GPs) in the South East Wales region who routinely refer patients for inguinal hernia surgery to the Royal Gwent Healthcare NHS Trust. RESULTS A total of 86 questionnaire replies were returned. There was variation in referral patterns between the GPs with the majority (84%) referring their patients for groin hernia repair to either a general surgeon or as an open referral. Only 14% referred directly to a hernia specialist and none regularly referred to a laparoscopic surgeon. CONCLUSIONS Referral patterns for inguinal hernia surgery do not reflect services provided in secondary care. Further education is required so that a patient's care can be optimised.

scholarly journals Trends in Emergent Groin Hernia Repair—An Analysis From the Herniamed Registry

2021 ◽  
Vol 8 ◽  
Author(s):  
Ferdinand Köckerling ◽  
Till Heine ◽  
Daniela Adolf ◽  
Konstaninos Zarras ◽  
Dirk Weyhe ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Hernia Repair ◽  
Groin Hernia ◽  
Bowel Resection ◽  
Emergency Admission ◽  
Female Gender ◽  
Developed Countries ◽  
Perioperative Outcomes ◽  
Groin Hernia Repair ◽  
Gender And Age

Introduction: While the proportion of emergency groin hernia repairs in developed countries is 2.5–7.7%, the percentage in developing countries can be as high as 76.9%. The mortality rate for emergency groin hernia repair in developed countries is 1.7–7.0% and can rise to 6–25% if bowel resection is needed. In this present analysis of data from the Herniamed Registry, patients with emergency admission and operation within 24 h are analyzed.Methods: Between 2010 and 2019 a total of 13,028 patients with emergency admission and groin hernia repairs within 24 h were enrolled in the Herniamed Registry. The outcome results were assigned to the year of repair and summarized as curves. The total patient collective is broken down into the subgroups with pre-operative manual reduction (taxis) of the hernia content, operative reduction of the hernia content without bowel resection and with bowel resection. The explorative Fisher's exact test was used for statistical assessment of significant differences with Bonferroni adjustment for multiple testing.Results: The proportion of emergency admissions with groin hernia repair within 24 h was 2.7%. The percentage of women across the years was consistently 33%. The part of femoral hernias was 16%. The proportion of patients with pre-operative reduction (taxis) remained unchanged at around 21% and the share needing bowel resection was around 10%. The proportion of TAPP repairs rose from 21.9% in 2013 to 38.0% in 2019 (p < 0.001). Between the three groups with pre-operative taxis, without bowel resection and with bowel resection, highly significant differences were identified between the patients with regard to the rates of post-operative complications (4% vs. 6.5% vs. 22.7%; p < 0.0001), complication-related reoperations (1.9% vs. 3.8% vs. 17.7%; p < 0.0001), and mortality rate (0.3% vs. 0.9% vs. 7.5%; p < 0.001). In addition to emergency groin hernia repair subgroups female gender and age ≥66 years are unfavorable influencing factors for perioperative outcomes.Conclusion: For patients with emergency groin hernia repair the need for surgical reduction or bowel resection, female gender and age ≥66 years have a highly significantly unfavorable influence on the perioperative outcomes.

scholarly journals Recommendations on postoperative strain and physical labor after abdominal and hernia surgery: an expert survey of attendants of the 41st EHS Annual International Congress of the European Hernia Society

Hernia ◽  
2021 ◽  
Author(s):  
S. Schaaf ◽  
A. Willms ◽  
R. Schwab ◽  
C. Güsgen
Keyword(s):  
Incisional Hernia ◽  
Hernia Repair ◽  
Groin Hernia ◽  
Incisional Hernia Repair ◽  
International Congress ◽  
Hernia Surgery ◽  
Physical Strain ◽  
Laparoscopic Operation ◽  
Heavy Work ◽  
International Experts

Abstract Background There are no valid recommendations or reliable guidelines available to guide patients how long they should refrain from lifting weights or returning to heavy physical labor after abdominal or hernia surgery. Recent studies found that surgeons’ recommendations not to be evidence-based and might be too restrictive considering data on fascial healing and incisional hernia development. It is likely that this impairs the patient’s quality of life and leads to remarkable socio-economic costs. Hence, we conducted this survey to gather international expert’s opinions on this topic. Materials and methods At the 41st Annual International Congress of the EHS, attending international experts were asked to complete a questionnaire concerning recommendations on given proposals for postoperative refrain from heavy work or lifting after abdominal surgery and also after hernia repairs. Results In total, 127 experts took part in the survey. 83.9% were consultants with a mean experience since specialization of more than 11 years. Two weeks of no heavy physical strain after laparoscopic surgery were considered sufficient by more than 50% of the participants. For laparotomy, more than 50% rated 4 weeks appropriate. For mesh-augmented sublay and IPOM repair of ventral or incisional hernias, more than 50% rated 4 weeks of rest appropriate. For complex hernia repair, 37% rated 4 weeks reasonable. Two weeks after, groin hernia surgery was considered sufficient by more than 50% of the participants. Conclusion Following groin hernia repair (Lichtenstein/endoscopic technique) and laparoscopic operation, the majority agreed on the proposal of 2 weeks refraining from physical strain. Four weeks of no physical strain were considered appropriate by a majority after laparotomy and open incisional hernia repair. However, the results showed substantial variation in the ratings, which indicates uncertainty even in this selected cohort of hernia surgery experts and emphasizes the need for further scientific evaluation. This is particularly remarkable, because a lack of evidence that early postoperative strain leads to higher incisional hernia rates. Trial registration Number DRKS00023887.

A new criterion to predict recurrence after laparoscopic ventral hernia repair: mesh/defect area ratio

2021 ◽  
Vol 93 (6) ◽  
pp. 40-46
Author(s):  
Ramazan Kozan ◽  
Ahmet Ziya Anadol ◽  
Mustafa Sare
Keyword(s):  
Multivariate Analysis ◽  
Hernia Repair ◽  
Ventral Hernia ◽  
Ventral Hernia Repair ◽  
Area Ratio ◽  
Laparoscopic Ventral Hernia Repair ◽  
Hernia Surgery ◽  
Significant Difference ◽  
Defect Area ◽  
New Criterion

<b>Introduction:</b>Minimizing recurrence in hernia surgery is one of the major aims. Defining surgeon-dependent risk factors for recurrence is therefore of great importance in laparoscopic ventral hernia repair (LVHR). This study aims to analyze the predictive value of the mesh area/defect area ratio (M/D ratio) in terms of recurrence as a new criterion in LVHR.</br> </br> <b>Methods:</b> A total of 124 patients were enrolled in the study. Age, gender, hernia type, body mass index, defect size, size of the mesh, mesh overlapping, area of the defect, area of the mesh, M/D ratio, postoperative complications, follow-up time, recurrences and timing of recurrence were also recorded. The potential variables that may affect recurrence were examined by univariate and multivariate analysis.</br> </br> <b>Results:</b> There were 12 (9.7%) recurrences in our series. A statistically significant difference was found if either the mesh/defect ratio was ≤6 or >6 (p = 0.012). Multivariate analysis confirmed that M/D ratio was the only independent parameter for recurrence. </br></br><b>Conclusion:</b> Understanding M/D ratio concept and using it in surgical clinical practice may help reduce recurrence rates after LVHR.</br>

scholarly journals Groin Hernia Surgery in Uganda: Caseloads and Practices at Hospitals Operating Within the Publicly Funded Healthcare Sector

2020 ◽  
Vol 44 (10) ◽  
pp. 3277-3283
Author(s):  
Alphonsus Matovu ◽  
Pär Nordin ◽  
Andreas Wladis ◽  
Mary Margaret Ajiko ◽  
Jenny Löfgren
Keyword(s):  
Hernia Repair ◽  
Groin Hernia ◽  
Public Health Problem ◽  
Sub Saharan Africa ◽  
Healthcare Sector ◽  
Major Public Health Problem ◽  
Publicly Funded ◽  
Hernia Surgery ◽  
First Choice ◽  
Groin Hernia Surgery

Abstract Background Groin hernia is a major public health problem with over 200 million people affected. The unmet need for surgery is greatest in Sub-Saharan Africa where specialist surgeons are few. This study was carried out in Uganda to investigate caseloads and practices of groin hernia surgery at publicly funded hospitals. Methods The study employed mixed methods covering 29 hospitals: the National Referral Hospital (NRH), 14 Regional Referral Hospitals (RRH) and 14 General Hospitals (GH). In part one of the study, surgeons and medical doctors performing hernia repair were interviewed about their practices and experiences of groin hernia surgery. In part two, operating theater records from 2013 to 2014 from the participating hospitals were reviewed and information about groin hernia operations collected. Results All respondents reported that sutured repair was the first-choice method. A total of 5518 groin hernia repairs were performed at the participating hospitals, i.e., an annual hernia repair rate of 7/100 000 population. Of the patients operated, almost 16% were women and 24% were children. Local anesthesia (LA) was used in 40% of the cases, and non-surgeon physicians performed 70.3% of the groin hernia repairs. Conclusion Groin hernia repair outputs need to increase along with the training of surgical providers in modern hernia repair methods. Methods and outcomes for hernia repair in women and children should be investigated to improve the quality of care.

scholarly journals P116 “KIGNSNORTH MODIFIED SCORE” FOR OPEN INGUINAL HERNIA REPAIR COMPLICATIONS PREDICTION. POINTHER STUDY

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Alejandro Bravo-Salva ◽  
Alba Gonzalez-Martin ◽  
Margarita Salva-Puigserver ◽  
Clara Tellez-Marques ◽  
Joan Sancho-Insenser ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Postoperative Complications ◽  
Hernia Repair ◽  
Abdominal Wall ◽  
Inguinal Hernia Repair ◽  
Groin Hernia ◽  
University Hospital ◽  
Wound Complications ◽  
Hernia Surgery ◽  
Inguinal Hernia Surgery

Abstract Aim Aim of our study is to analysis of postoperative outcomes (30 days) after elective unilateral open anterior inguinal hernia repair and prove correlation to modified Kingsnorth (MK) score classification system. Material and Methods Prospective registered (NTC 04806828) study of all consecutive unilateral open anterior groin hernia repair performed at a University Hospital General Surgery Department from January 2019 to December 2020. Data was stored at National Spanish Groin Hernia Registry (EVEREG). All patients were preoperatively classified using MK score. Statistical analysis of postoperative complications and their relation to preoperative modified Kingsnorth scale was performed. Results 403 patients were included. 61% were performed as ambulatory surgery. 15.7% had more than 5-8 MK punctuation. A total of 62 patients had postoperative complications, 81% of all complications were classified as Clavien I. Higher Surgery duration was directly related to higher MK (Pearson's correlation 0.291; P &lt; 0.0001score.) Statistically significant relationship with the presence of higher rate of complications were a KN score of 5-8 (OR 2.7; 95% CI 1.07-4.82; P = 0.03) whereas performance of surgery by an abdominal wall surgery specialist had less complications (OR 0.28; 95% CI 0.08-0.92; P = 0.03) Conclusions MK classification predicts surgical wound complications on patients who undergo a primary unilateral inguinal hernia surgery. A KN score of 5-8 had a higher probability of wound complications. When surgery was performed by a specialist in abdominal wall surgery, less postoperative complications were observed.

scholarly journals Open and laparoscopic transabdominal preperitoneal approach for inguinal hernia: our single institution experience

2020 ◽  
Vol 7 (4) ◽  
pp. 1179
Author(s):  
Bhushankumar A. Thakur ◽  
Vivek Mukhamale ◽  
Snehal Deotale
Keyword(s):  
Inguinal Hernia ◽  
Retrospective Study ◽  
Hernia Repair ◽  
Rural Areas ◽  
Laparoscopic Hernia Repair ◽  
Single Institution ◽  
Revolutionary Change ◽  
Hernia Surgery ◽  
Open Procedure ◽  
Preperitoneal Approach

Background: Trans abdominal preperitoneal (TAPP) a novel approach for inguinal hernia was introduced by Arregui (1991) and Dion in early 1990’s has brought the revolutionary change in the era of hernia surgery over open preperitoneal inguinal hernia repair procedure introduce by Stoppa. Based on this we have done single institution retrospective study of TAPP and open preperitoneal procedure for inguinal hernia.Methods: This study was single institution retrospective study, where we have analyzed the data of 93 male and 7 female patients out of which 50 underwent standard TAPP procedure and 50 patients who underwent open preperitoneal procedure for inguinal hernia, with median 1 year of follow up. Their data analyzed for demographics, surgical site occurrence and short terms recurrence.Results: 100 patients with mean age of 55 years, median ASA of 1, ratio of left: right: bilateral for open 18:30:2 and for laparoscopic 26:20:4. Mean time for surgery was 102.3 min for open and 142.4 mins for TAPP. There was surgical site infection in 3 patients operated by open procedure and 2 patients in TAPP procedure. 4 patients from open procedure group and no one with TAPP group developed seroma which were managed conservatively and resolved at 6 weeks and 8 weeks. One recurrence in TAPP group patient at the 1 week follow.Conclusions: Open preperitoneal repair is hence a technique as effective as laparoscopic hernia repair with a minimal learning curve, ability to be performed under regional anaesthesia and cost effective. It can hence be used to carry out inguinal hernia repairs effectively in rural areas. 

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