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1.
Saïd C. Azoury Andrew P. Dhanasopon Xuan Hui Carla De La Cruz Sami H. Tuffaha Justin M. Sacks Kenzo Hirose Thomas H. Magnuson Caiyun Liao Monica Lovins Michael A. Schweitzer Hien T. Nguyen 《Surgical endoscopy》2014,28(12):3349-3358
Background
The authors analyzed surgical factors and outcomes data in the largest single institutional study comparing endoscopic (ECS) and open component separation (OCS) in ventral hernia repairs (VHR).Methods
A prospectively maintained database was reviewed, identifying 76 patients who underwent component separation for VHR with mesh from 2010 to 2013: 34 OCS and 42 ECS. Comparisons were made for demographics, surgical risk factors, and peri-operative outcomes. Wound complications and hernia occurrence post-operatively were reviewed. Risk analyses were performed to determine the association of pre-operative risk factors with surgical site occurrences.Results
Twenty-five ECS patients underwent subsequent laparoscopic hernia repair, and 17 underwent open repair. Operative time for ECS was longer than OCS (334 vs. 239 min; P < 0.001); however, there was no difference in length of stay (4 days in both groups, P = 0.64) and estimated blood loss (ECS: 97 vs. OCS: 93 cc, P = 0.847). In a sub-analysis of ECS patients, those who underwent laparoscopic hernia repair had a 96 min shorter operative time (P < 0.001) and lower EBL (63 vs. 147 cc, P < 0.001) than open repair. Wound complications were 24 % in the ECS (n = 10) and 32 % in OCS group (n = 11). There was one midline hernia recurrence in the ECS group (mean follow-up of 8 months, range 0.5–34.5 months) and no hernia recurrences in the OCS group (mean follow-up 10 months, range 0.5–30 months). Three of the patients in the ECS group developed new lateral abdominal wall hernias post-operatively.Conclusions
The ECS group had a significantly longer operative time than the OCS group. Post-operative wound complications were similar between ECS and OCS groups. Patients in the ECS group who underwent subsequent laparoscopic VHR had a shorter operative time and blood loss than open repair. 相似文献2.
Ali Darehzereshki Melanie Goldfarb Joerg Zehetner Ashkan Moazzez John C. Lipham Rodney J. Mason Namir Katkhouda 《World journal of surgery》2014,38(1):40-50
Background
The current standard of treatment for most ventral hernias is a mesh-based repair. Little is known about the safety and efficacy of biologic versus nonbiologic grafts. A meta-analysis was performed to examine two primary outcomes: recurrence and wound complication rates.Methods
Electronic databases and reference lists of relevant articles were systematically searched for all clinical trials and cohort studies published between January 1990 and January 2012. A total of eight retrospective studies, with 1,229 patients, were included in the final analysis.Results
Biologic grafts had significantly fewer infectious wound complications (p < 0.00001). However, the recurrence rates of biologic and nonbiologic mesh were not different. In subgroup analysis, there was no difference in recurrence rates and wound complications between human-derived and porcine-derived biologic grafts.Conclusions
Use of biologic mesh for ventral hernia repair results in less infectious wound complications but similar recurrence rates compared to nonbiologic mesh. This supports the application of biologic mesh for ventral hernia repair in high-risk patients or patients with a previous history of wound infection only when the significant additional cost of these materials can be justified and synthetic mesh is considered inappropriate. 相似文献3.
S. C. Azoury A. P. Dhanasopon X. Hui S. H. Tuffaha C. De La Cruz C. Liao M. Lovins H. T. Nguyen 《Hernia》2014,18(5):637-645
Purpose
To our knowledge, there are limited small case series reports on endoscopic component separation (ECS) and no single institutional study comparing the difference in outcomes between laparoscopic and open ventral hernia repairs following endoscopic component separation.Methods
A single institutional retrospective review was performed, identifying 42 patients who underwent endoscopic component separation at a single institution by a single surgeon for ventral hernia repair with prosthesis from 2010 to 2013. Seventeen patients underwent subsequent open ventral hernia repair (OHR) and 25 underwent laparoscopic ventral hernia repair (LHR). Demographics, surgical factors, wound complications and hernia occurrence post-operatively were reviewed.Results
Surgical factors/demographics were similar between groups. All patients achieved primary fascial and skin closure. Operative time for the laparoscopic group was significantly shorter than the open group (278 vs. 378 min; P = 0.0001), and there was a trend towards a shorter hospital stay in the laparoscopic group (laparoscopic, 4 days; open, 5 days; P = 0.063). Estimated blood loss per case with ECS and subsequent laparoscopy was significantly lower than in the open cases (63 vs. 147 cc; P = 0.0017). In both groups, wound complications occurred in five patients (laparoscopic, 20 %; open, 29 %; P = 0.71). There was one midline hernia recurrence and two lateral abdominal wall hernia occurrences post-operatively in the laparoscopic group, whereas there were no midline and one lateral wall hernia occurrence in the open group.Conclusions
Patients undergoing endoscopic component separation with subsequent laparoscopic fascial reapproximation had a significantly shorter operative time and estimated blood loss when compared with open fascial reapproximation. Wound complications were similar in both groups although there were a greater number of hernia occurrences post-operatively in the laparoscopic group, though of no statistical significance. 相似文献4.
Background
Stomal site incisional hernia is a common complication following ileostomy closure. The effectiveness of prophylactic mesh placement at the time of stomal closure is unknown because of fear of mesh infection and subsequent wound complications. The present study investigated whether prophylactic mesh placement reduces the rate of incisional hernia after ileostomy closure without increasing wound complications. The study was based on retrospective review of consecutive ileostomy closures undertaken at a tertiary referral center between January 2007 and December 2011. Hernias were identified through clinical examination and computed tomography.Results
Eighty-three cases of ileostomy closure were reviewed; 47 patients received mesh reinforcement, and 36 underwent non-mesh closure (controls). In total, 16 (19.3 %) patients developed incisional hernia, 13 (36.1 %) of which occurred in the control group; 3 (6.4 %), in the mesh group [odds ratio (OR): 8.29; 95 % confidence interval (CI) 2.14–32.08; p = 0.001]. Incisional hernia repair was performed in 3 (23 %) patients in the control group; no hernias in the mesh group required surgery. There was no significant difference in wound infection rates between mesh (2 patients, 4.3 %) and control (1 patient, 2.8 %) groups. No mesh infection was found. Multivariate analysis demonstrated that malignancy (OR: 21.93, 95 % CI 1.58–303.95; p = 0.021) and diabetes (OR: 20.98, 95 % CI 3.23–136.31; p = 0.001) independently predicted incisional herniation, while mesh reinforcement prevented hernia development (OR: 0.06, 95 % CI 0.01–0.36; p = 0.002).Conclusions
Mesh placement significantly reduced the incidence of incisional hernia following ileostomy closure, but without increasing complication rates. This technique should be strongly considered in patients at high risk of hernia development. 相似文献5.
Brett L. Ecker Lindsay E. Y. Kuo Kristina D. Simmons John P. Fischer Jon B. Morris Rachel R. Kelz 《Surgical endoscopy》2016,30(3):906-915
Background
There is still considerable debate regarding the best operative approach to ventral hernia repair. Using two large statewide databases, this study sought to evaluate the longitudinal outcomes and associated costs of laparoscopic and open ventral hernia repair.Methods
All patients undergoing elective ventral hernia repair from 2007–2011 were identified from inpatient discharge data from California and New York. In-hospital morbidity, in-hospital mortality, incidence of readmission, and incidence of revisional ventral hernia repair were evaluated as a function of surgical technique. The associated costs of medical care for laparoscopic versus open ventral hernia repair were evaluate for both the index procedure and all subsequent admissions and procedures within the study period.Results
A total of 13,567 patients underwent elective ventral hernia repair with mesh; 9228 (69 %) underwent OVHR and 4339 (31 %) underwent LVHR. At time of the index procedure, LVHR was associated with a lower incidence of reoperation (OR 0.29, CI 0.12–0.58, p = 0.001), wound disruption (OR 0.35, CI 0.16–0.78, p = 0.01), wound infection (OR 0.50, CI 0.25–0.70, p < 0.001), blood transfusion (OR 0.47, CI 0.36–0.61, p < 0.001), ARDS (OR 0.74, CI 0.54–0.99, p < 0.05), and total index visit complications (OR 0.72, CI 0.64–0.80, p < 0.001). LVHR was associated with significantly fewer readmissions (OR 0.81, CI 0.75–0.88, p < 0.001) and a lower risk for revisional VHR (OR 0.75, CI 0.64–0.88, p < 0.001).Conclusions
Open ventral hernia repair was associated with a higher incidence of perioperative complications, postoperative readmissions and need for revisional hernia repair when compared to laparoscopic ventral hernia repair, even when controlling for patient sociodemographics. In congruence, open ventral hernia repair was associated with higher costs for both the index hernia repair and tallied over the length of follow-up for readmissions and revisional hernia repair.6.
Purpose
Treatment guidelines for abdominal wound dehiscence (WD) are lacking. The primary aim of the study was to compare suture to mesh repair in WD patients concerning incisional hernia incidence. Secondary aims were to compare recurrent WD, morbidity, mortality and long-term abdominal wall complaints.Methods
A retrospective chart review of 46 consecutive patients operated for WD between January 2010 and August 2012 was conducted. Physical examination and a questionnaire enquiry were performed in January 2013.Results
Six patients were treated by vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) before definitive closure. Three patients died early resulting in 23 patients closed by suture and 20 by mesh repair. Five sutured, but no mesh repair patients had recurrent WD (p = 0.051) with a mortality of 60 %. Finally, 18 sutured and 21 mesh repair patients were eligible for follow-up. The incidence of incisional hernia was higher for the sutured patients (53 vs. 5 %, p = 0.002), while mesh repair patients had a higher short-term morbidity rate (76 vs. 28 %, p = 0.004). Abdominal wall complaints were rare in both groups.Conclusions
Suture of WD was afflicted with a high incidence of recurrent WD and incisional hernia formation. Mesh repair overcomes these problems at the cost of more wound complications. VAWCM seems to be an alternative for treating contaminated patients until definitive closure is possible. Long-term abdominal wall complaints are uncommon after WD treatment. 相似文献7.
8.
Background
The optimal technique to cure strangulated inguinal hernia remains controversial. The use of mesh in cases of strangulated hernia is still debated due to the potential risk of infection.Objective
This systematic review aimed to determine whether or not the mesh repair technique is associated with a higher risk of surgical site infection than non-mesh techniques for strangulated inguinal hernias in adults.Methods
An electronic search of the relevant literature was performed on 15 December 2012 using the following databases: MEDLINE, the Cochrane Library, Scopus, Embase, and the Web of Science. Articles reporting a comparison between the mesh repair technique and a non-mesh technique to treat strangulated inguinal hernias in adults, and published in the English or French language in a peer-reviewed journal, were considered for analysis. The quality of randomized controlled trials (RCTs) was assessed using the Jadad scoring system. To assess the quality of non-randomized trials, we used the Methodological Index for Non-Randomized Studies (MINORS).Results
A total of 232 papers was found in the initial search; nine were included in the meta-analysis. The wound infection rate in the mesh repair technique group was lower than in the control group, with a trend towards significance (odds ratio [OR] 0.46, 95 % confidence interval [CI] 0.20–1.07; p = 0.07). The hernia recurrence rate was lower in the mesh repair group (OR 0.2, 95 % CI 0.05–0.78; p = 0.02).Conclusion
The mesh repair technique is a good option for the treatment of strangulated inguinal hernias in adults, giving an acceptable wound infection rate and fewer recurrences than non-mesh repair. Our study does not allow us to recommend the use of mesh in cases of bowel resection. We emphasize that, except the two RCTs, the results are predicated on patient selection bias by careful surgeons. Further RCTs are required to obtain more powerful evidence-based data. 相似文献9.
Andreas Heller Saskia E. Westphal Peter Bartsch Michael Haase Peter R. Mertens 《International urology and nephrology》2014,46(6):1175-1181
Background and objectives
Incisional hernias are among the most frequent complications following abdominal surgery with impact on morbidity and mortality rates. Elevated uremia toxins may inhibit granulation tissue formation and impair wound healing, thereby promoting incisional hernia development. Here, we quantified the hazard ratio for incisional hernia prevalence in patients at risk undergoing abdominal reoperations with interrelationship to kidney function. In the same cohort, incidence rates for de novo wound healing disturbances within a 4-month follow-up period were determined.Design, setting, participants and measurements
Upon hospitalization for elective abdominal surgery in a university hospital (tertiary medical center), past medical histories were recorded in 251 patients and incisional hernia prevalence rates were calculated. Known modifiers for hernia formation as well as laboratory values for estimated glomerular filtration rate (eGFR) were recorded. The status of wound healing was assessed by a blinded investigator 4 months postoperatively. Chronic kidney disease (CKD) was defined as eGFR < 60 ml/min/1.73 m2. To identify independent risk factors for incisional hernia or postoperative wound healing disorder, multivariate regression analyses were performed.Results
The incisional hernia prevalence was 24.3 % in the overall cohort. Patients with CKD (32/251; 12.8 %) were more likely to suffer from incisional hernias with an odds ratio (OR) of 2.8 ([95 % CI 1.2–6.1]; p = 0.014) than patients with eGFR > 60 ml/min (219/251; 88.2 %). In multivariate analyses, CKD proved to be an independent risk factor for incisional hernia development with an OR similar to obesity (BMI > 25; OR 2.6 [95 % CI 1.3–5.1]; p = 0.007). In the prospective analysis, disturbed wound healing occurred in 32 of 251 (12.8 %) patients undergoing abdominal operations. Frequency of wound healing was increased when CKD was present (8/32; 25 %; OR 2.3 [95 % CI 1.1–6.7]; p = 0.026) compared to patients with eGFR > 60 ml/min (24/219; 11 %).Conclusions
Chronic kidney disease is associated with impaired wound healing and constitutes an independent risk factor for incisional hernia development. 相似文献10.
Dincer Ozgor Abuzer Dirican Mustafa Ates Mehmet Yilmaz Burak Isik Sezai Yilmaz 《World journal of surgery》2014,38(8):2122-2125
Background
After receiving a living donor liver transplant (LDLT), an incisional hernia is a potentially serious complication that can affect the patient’s quality of life. In the present study we evaluated surgical hernia repair after LDLT.Materials and methods
Medical records of patients who underwent surgery to repair an incisional hernia after LDLT in Turgut Ozal Medical Center between October 2006 and January 2010 were evaluated in this retrospective study. A reverse-T incision was made for liver transplantation. The hernias were repaired with onlay polypropylene mesh. Age, gender, post-transplant relaparatomy, the type, the result of surgery for the incisional hernia, and risk factors for developing incisional hernia were evaluated.Results
An incisional hernia developed in 44 of 173 (25.4 %) patients after LDLT. Incisional hernia repair was performed in 14 of 173 patients (8.1 %) who underwent LDLT from October 2006 to January 2010. Relaparatomy was associated with incisional hernia (p = 0.0002). The mean age at the time of the incisional hernia repair was 51 years, and 79 % of the patients were men. The median follow-up period was 19.2 (13–36) months after the hernia repair. Three patients with intestinal incarceration underwent emergency surgery to repair the hernia. Partial small bowel resection was required in one patient. Postoperative complications included seroma formation in one patient and wound infection in another. There was no recurrence of hernia during the follow-up period.Conclusions
The incidence of incisional hernia after LDLT was 25.4 % in this study. Relaparatomy increases the probability of developing incisional hernia in recipients of LDLT. According to the results of the study, repair of an incisional hernia with onlay mesh is a suitable option. 相似文献11.
Purpose
Obturator hernia is a rare disease and preoperative diagnosis is always difficult. There are increasing reports employing laparoscopic approach in the recent literature. Our aim was to review and compare the open and laparoscopic approach in repairing obturator hernia.Methods
All patients with obturator hernia from 1997 to 2011 were recruited. Patient’s demographics, presentation, operative details, morbidity, and mortality were retrospectively collected and reviewed.Results
There were 36 patients during the 15-year period. All of them were elderly ladies (median 83). Nineteen underwent open surgery while 16 received laparoscopic surgery. Both age and ASA were comparable. The median operative time was 68 and 65 min for laparoscopic and open group, respectively (p = 0.690). The median hospital stay was significantly longer in the open group (19 vs 5 days, p = 0.007). There were less major complications (p = 0.004) and mortality (p = 0.049) in the laparoscopic group. Two recurrences were reported in the laparoscopic group, although statistically not significant (p = 0.202).Conclusions
Laparoscopic repair can achieve a shorter hospital stay and has lesser major complications and mortality in selected patients. 相似文献12.
Background
Groin hernia repair may be associated with long-term complications such as chronic pain, believed to result from damage to regional nerves by tissue penetrating mesh fixation. Studies have shown that mesh fixation with fibrin sealant reduces the risk of these long-term complications, but data on recurrence and reoperation rates after the use of fibrin sealant compared with tacks are not available. This study aimed to determine whether fibrin sealant is a safe and feasible alternative to tacks with regard to reoperation rates after laparoscopic groin hernia repair.Methods
The current study compared reoperation rates after laparoscopic groin hernia repair between fibrin sealant and tacks used for mesh fixation. The study used data collected prospectively from The National Danish Hernia Database and analyzed 8,314 laparoscopic groin hernia repairs for reoperation rates. Mesh fixation was performed with fibrin sealant (n = 784) or tacks (n = 7,530).Results
The findings showed a significantly lower reoperation rate for the fibrin sealant than for the tacks (0.89 vs 2.94 %, p = 0.031). The median follow-up period was 17 months (range, 0–44 months) for the fibrin sealant group and 21 months (range, 0–44 months) for the tacks group.Conclusions
Fibrin sealant was superior to tacks for mesh fixation in laparoscopic groin hernia repair with regard to reoperation rates. The study could not differentiate between different hernia defect sizes, and future studies should therefore explore whether the superior effect of fibrin sealant applies for all hernia types and sizes. 相似文献13.
Purpose
To evaluate the efficacy of negative pressure therapy for superficial and deep mesh infections after ventral and incisional hernia repair by a prospective monocentric observational study.Methods
During a 6-year period, 724 consecutive open ventral and incisional hernia repairs were performed. Pre- and intraoperative data as well as postoperative complications were prospectively recorded. In case of wound infection, negative pressure therapy (NPT) was our primary treatment.Results
Sixty-three patients (8.7 %) were treated using negative pressure therapy after primary ventral and incisional hernia repair. Infectious complications needing NPT occurred in 54 patients in the retromuscular group (54/523; 10.3 %), none when laparoscopically treated and in 9 patients (9/143; 6.3 %) treated by an open intraperitoneal mesh technique. Considering outcome, all meshes were completely salvaged in the retromuscular mesh group after a median of 5 dressing changes (range, 2–9), while in the intraperitoneal mesh, group 3 meshes needed complete (n = 2) or partial (n = 1) excision. Mean duration to complete wound closure was 44 days (range, 26–63 days).Conclusion
NPT is a useful adjunct for salvage of deep infected meshes, particularly when large pore monofilament mesh is used. 相似文献14.
Yuki Hayashi Kanji Miyata Norihiro Yuasa Eiji Takeuchi Yasutomo Goto Hideo Miyake Hidemasa Nagai Yoichiro Kobayashi 《Surgery today》2014,44(12):2255-2262
Purpose
Tension-free mesh repair of adult inguinal hernias has become a standard procedure, but there have been few comparisons of the postoperative outcome after hernia repair using the Prolene Hernia System (PHS) vs. the Mesh Plug (MP) method in a large number of patients from a single institution.Methods
We reviewed the medical records of patients to investigate the short- and long-term outcomes of the different types of hernia repair. Late symptoms were evaluated by questionnaire. A total of 1,141 repairs performed from 1999 to 2008 (PHS in 957 and MP in 184 repairs) were evaluated.Results
There were 93 early postoperative complications (8.2 %). A subcutaneous hematoma was found more frequently after MP repair compared with after PHS repair (3.8 vs. 1.3 %, P = 0.013). Seven hundred and ten patients (62.2 %) could be followed up for more than 2 years. Recurrence was detected in 14 patients with PHS repair and two patients with MP repair (1.5 vs. 1.1 %, P = 0.956). Wound infections occurred in three patients (0.3 %) with PHS repair vs. none with MP repair (P > 0.999). Patients with PHS and MP repair showed no significant differences in the long-term wound pain.Conclusions
The recurrence and wound infection rates were similar after hernia repair using the PHS and MP methods. Patients undergoing PHS repair developed fewer subcutaneous hematomas. An older age (≥65 years) was a significant independent risk factor for recurrence. 相似文献15.
Chi-Wen Lo Stephen Shei-Dei Yang Yao-Chou Tsai Cheng-Hsing Hsieh Shang-Jen Chang 《Hernia》2016,20(1):21-32
Purpose
We systemically reviewed published literatures and performed meta-analysis to compare the surgical outcomes between laparoendoscopic single-site over the multiple-port total extraperitoneal approach in hernia repair.Methods
We did a systemic search of PubMed® and Cochrane review for all randomized controlled trials and comparative trials that compared the efficacy and safety between LESS-TEP and MP-TEP. The evaluated outcomes included perioperative parameters (operative time, conversion rate), hospital stay and complications (seroma, delayed return of bladder function, postoperative pain and recurrence). The Cochrane Collaboration Review Manager software (RevMan®, version 5.2.6) was used for statistical analysis.Results
There were 10 trials met the inclusion criteria and included for meta-analysis. Totally, there were 595 and 514 patients underwent LESS-TEP and MP-TEP, respectively. The LESS-TEP took significantly longer-operative time than the MP-TEP in unilateral hernia repair (weighted mean difference (WMD) 4.11 min, 95 % CI 0.76–7.46, p = 0.02) while not in bilateral hernia repair (WMD 3.87 min, 95 % of CI ?2.59–10.33, z = 1.17, p = 0.24). There were no significant differences in surgical outcomes with regard to postoperative pain scale, conversion rate, hospital stay, recurrence rate and complication rate between two groups. The length of the sub-umbilical wound was the same in both groups. The result of cosmesis was not compared because of the limited data.Conclusion
In experienced hands, LESS-TEP is a feasible alternative to MP-TEP with comparable surgical efficacy and morbidity, but with longer operation time in unilateral hernia repair. Potential advantages of LESS-TEP including better cosmesis, less postoperative pain and less trocar-associated complications were not clearly shown.16.
Background
The objective of this study is to report the 30-day outcomes following inguinal hernia repair in octogenarians (80–89 years of age) and nonagenarians (≥90 years) using a large, prospective, multi-institutional database and to identify the individual risk factors associated with increased morbidity and mortality.Study design
Patients aged 80 and above undergoing inguinal hernia repair were identified from the American College of Surgeons’ National Surgical Quality Improvement Program (2007–2008). Univariate analysis was performed using chi square, Fisher’s exact test and t test. Multivariate logistic regression analysis was carried out to assess factors associated with increased postoperative complications and mortality.Results
Of 2,377 patients above 80 years of age, 226 (9.5 %) were nonagenarians. Men accounted for 81.4 % (1,936) of patients. There were significantly more female patients in the nonagenarian group (29.2 vs. 17.4 %, p < 0.0001). Laparoscopic repair was performed in 210 (9.9 %) patients. Emergency repair was more frequent in nonagenarians than octogenarians (12 vs. 4.4 %, p < 0.0001). The 30-day overall complication rate was significantly increased in nonagenarians compared to octogenarians (6.1 vs. 3.2 %, p = 0.03). Mortality is increased tenfold in elective inguinal hernia repair in nonagenarians compared to octogenarians (3 vs. 0.3 %, p < 0.0005). On multivariate analysis, preoperative variables found to be significantly associated with morbidity included totally dependent functional status, congestive heart failure and emergent nature of procedure, while higher age, emergency repair and open wound are associated with increased mortality.Conclusions
Elective inguinal hernia repair can be safely performed in octogenarians with low morbidity and mortality but is increased in nonagenarians. More vigilant postoperative care is required after emergent hernia repairs due to the increased risk of morbidity and mortality, and effort should be made to electively repair inguinal hernias early in this elderly population. 相似文献17.
Purpose
The management of the contralateral inguinal canal in children with clinical unilateral inguinal hernia is controversial. Our objective was to systematically review the literature regarding management of the contralateral inguinal canal.Methods
We searched MEDLINE, EMBASE, and Cochrane databases (1940–2011) using ‘hernia’ and ‘inguinal’ and either ‘pediatric,’ ‘infant,’ or ‘child,’ to identify studies of pediatric (age ≤21 years) patients with inguinal hernia. Among clinical unilateral hernia patients, we assessed the number of cases with contralateral patent processus (CPP) and incidence of subsequent clinical metachronous contralateral hernia (MCH). We evaluated three strategies for contralateral management: expectant management, laparoscopic evaluation or pre-operative ultrasound. Pooled estimates of MCH or CPP were generated with random effects by study when heterogeneity was found (I 2 > 50 %, or Cochrane’s Q p ≥ 0.10).Results
We identified 2,477 non-duplicated studies, 129 of which met our inclusion criteria and had sufficient information for quantitative analysis. The pooled incidence of MCH after open unilateral repair was 7.3 % (95 % CI 6.5–8.1 %). Laparoscopic examination identified CPP in 30 % (95 % CI 26–34 %). Lower age was associated with higher incidence of CPP (p < 0.01). The incidence of MCH after a negative laparoscopic evaluation was 0.9 % (95 % CI 0.5–1.3 %). Significant heterogeneity was found in studies and pooled estimates should be interpreted with caution.Conclusions
The literature suggests that laparoscopically identified CPP is a poor indicator of future contralateral hernia. Almost a third of patients will have a CPP, while less than one in 10 will develop MCH when managed expectantly. Performing contralateral hernia repair in patients with CPP results in overtreatment in roughly 2 out of 3 patients. 相似文献18.
Purpose
Female gender is a risk factor for early pain after several specific surgical procedures but has not been studied in detail after laparoscopic groin hernia repair. The aim of this study was to compare early postoperative pain, discomfort, fatigue, and nausea and vomiting between genders undergoing laparoscopic groin hernia repair.Methods
Prospective consecutive enrollment of women and age-matched (±1 year) and uni-/bilateral hernia-matched male patients undergoing elective transabdominal preperitoneal hernia repair (TAPP). Patients in the two groups received a similar anesthetic, surgical, and analgesic treatment protocol.Results
Between August 2009 and August 2010, 25 women and 25 men undergoing elective TAPP were prospectively included in the analysis (n = 50) with no significant difference between groups in psychological status regarding anxiety, depression, and catastrophizing. On day 0, women had significantly more pain during rest (p = 0.015) and coughing (p = 0.012), discomfort (p = 0.001), and fatigue (0.020) compared with men. Additionally, cumulative overall postoperative pain during coughing, discomfort, and fatigue on day 0–3 was significantly higher in women compared with men (all p values < 0.05). Women required significantly more opioids (p = 0.015) and had a significantly higher incidence of vomiting on days 0 and 1 (p = 0.002).Conclusions
Women experienced more pain, discomfort, and fatigue compared with men after laparoscopic groin hernia repair.Trial registration
Registration number NCT00962338 (www.clinicaltrials.gov). 相似文献19.
Objective
To systematically compare the tacker mesh fixation (TMF) with the suture mesh fixation (SMF) in laparoscopic incisional and ventral hernia (LIVH) repair.Methods
Trials evaluating the TMF with the SMF in LIVH repair were analysed using the statistical tool RevMan®. Combined dichotomous and continuous data were expressed as odds ratio (OR) and mean difference (MD), respectively.Results
Four trials (2 randomised and 2 non-randomised) encompassing 207 patients undergoing LIVH repair with TMF versus SMF were retrieved from the standard electronic databases and analysed systematically. Ninety-nine patients underwent TMF and 108 patients underwent SMF in LIVH repair. There was no statistically significant heterogeneity (p = 0.27)] among trials. In the fixed-effects model, LIVH repair with TMF was associated with shorter operation time (MD, ?23.65; 95 % CI, ?31.06, ?16.25; z = 6.26; p < 0.00001). Four- to six-week postoperative pain score was significantly lower (MD, ?0.69; 95 % CI, ?1.16, ?0.23; z = 2.92; p < 0.004) following TMF. Peri-operative complications (p = 0.65), length of hospital stay (p = 1) and risk of hernia recurrence (OR, 1.54; 95 % CI, 0.38, 6.27; z = 0.61; p = 0.54) following TMF and SMF were statistically not different.Conclusion
TMF in LIVH repair is associated with shorter operative time and lesser postoperative pain. TMF is comparable with SMF in terms of peri-operative complications, length of hospital stay and hernia recurrence. Therefore, TMF may be used in LIVH repair. However, further randomised trials recruiting higher number of patients are required to validate these findings. 相似文献20.