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1.
Kaul A Hutfless S Le H Hamed SA Tymitz K Nguyen H Marohn MR 《Surgical endoscopy》2012,26(5):1269-1278
Background
Fixation of mesh is typically performed to minimize risk of recurrence in laparoscopic inguinal hernia repair. Mesh fixation with staples has been implicated as a cause of chronic inguinal pain. Our study aim is to compare mesh fixation using a fibrin sealant versus staple fixation in laparoscopic inguinal hernia and compare outcomes for hernia recurrence and chronic inguinal pain.Methods and procedures
PubMed was searched through December 2010 by use of specific search terms. Inclusion criteria were laparoscopic total extraperitoneal repair inguinal hernia repair, and comparison of both mesh fibrin glue fixation and mesh staple fixation. Primary outcomes were inguinal hernia recurrence and chronic inguinal pain. Secondary outcomes were operative time, seroma formation, hospital stay, and time to return to normal activity. Pooled odds ratios (OR) were calculated assuming random-effects models.Results
Four studies were included in the review. A total of 662 repairs were included, of which 394 were mesh fixed by staples or tacks, versus 268 with mesh fixed by fibrin glue. There was no difference in inguinal hernia recurrence with fixation of mesh by staples/tacks versus fibrin glue [OR 2.13; 95% confidence interval (CI) 0.60–7.63]. Chronic inguinal pain (at 3 months) incidence was significantly higher with staple/tack fixation (OR 3.25; 95% CI 1.62–6.49). There was no significant difference in operative time, seroma formation, hospital stay, or time to return to normal activities.Conclusions
The meta-analysis does not show an advantage of staple fixation of mesh over fibrin glue fixation in laparoscopic total extraperitoneal inguinal hernia repair. Because fibrin glue mesh fixation with laparoscopic inguinal hernia repair achieves similar hernia recurrence rates compared with staple/tack fixation, but decreased incidence of chronic inguinal pain, it may be the preferred technique.2.
Neil Mier Melissa Helm Andrew S. Kastenmeier Jon C. Gould Matthew I. Goldblatt 《Surgery》2018,163(3):578-581
Background
Patients presenting for inguinal hernia repair report a wide range of pain. We hypothesized that patients presenting with less preoperative pain would experience a greater improvement in long-term quality of life after an inguinal hernia repair.Methods
A total of 54 patients underwent either laparoscopic or open inguinal hernia repair and completed the Short Form 12 (SF-12) survey both preoperatively and 6 to 12 months after their repair. The physical and mental component scores (PCS and MCS) were calculated from the SF-12. Patients also completed an analog surgical pain scale. t Tests and analyses of covariance were used. A preoperative surgical pain scale score of >12 was representative of moderate to severe pain.Results
Regardless of preoperative pain, there was improvement in long-term PCS quality of life (45.4?±?11.3 vs 50.1?±?9.1; P?<?.0001) that was not noted when assessing MCS quality of life (55.0?±?8.3 vs 54.7?±?9.4; P?=?.76). Patients who reported no or a low amount of preoperative pain experienced improved PCS quality of life compared with patients who reported moderate to severe preoperative pain (P?=?.048). This relationship was not noted with MCS (P?=?.16).Conclusion
This study suggests that patients presenting for inguinal hernia repair with no or low pain are more likely to experience improved physical function quality of life as a result of the herniorrhaphy. 相似文献3.
M. Matikainen E. Aro J. Vironen J. Kössi T. Hulmi S. Silvasti I. Ilves M. Hertsi K. Mustonen H. Paajanen 《Hernia》2018,22(5):813-818
Background
Chronic pain after inguinal hernioplasty is the foremost side-effect up to 10–30% of patients. Mesh fixation may influence on the incidence of chronic pain after open anterior mesh repairs.Methods
Some 625 patients who underwent open anterior mesh repairs were randomized to receive one of the three meshes and fixations: cyanoacrylate glue with low-weight polypropylene mesh (n?=?216), non-absorbable sutures with partially absorbable mesh (n?=?207) or self-gripping polyesther mesh (n?=?202). Factors related to chronic pain (visual analogue scores; VAS?≥?30, range 0–100) at 1 year postoperatively were analyzed using logistic regression method. A second analysis using telephone interview and patient records was performed 2 years after the index surgery.Results
At index operation, all patient characteristics were similar in the three study groups. After 1 year, chronic inguinal pain was found in 52 patients and after 2 years in only 16 patients with no difference between the study groups. During 2 years’ follow-up, three (0.48%) patients with recurrences and five (0.8%) patients with chronic pain were re-operated. Multivariate regression analysis indicated that only new recurrent hernias and high pain scores at day 7 were predictive factors for longstanding groin pain (p?=?0.001). Type of mesh or fixation, gender, pre-operative VAS, age, body mass index or duration of operation did not predict chronic pain.Conclusion
Only the presence of recurrent hernia and early severe pain after index operation seemed to predict longstanding inguinal pain.4.
Jeremy A. Warren Lucas R. Beffa Alfredo M. Carbonell Jennifer Cull Brent Sinopoli Joseph A. Ewing Cedrek McFadden Jay Crockett William S. Cobb 《Surgery》2018,163(4):839-846
Background
Reversal of an enterostomy results in a high rate of incisional hernia at the ostomy site. Prophylactic mesh reinforcement of the fascial defect is typically not considered due to the contaminated nature of the case. We present the outcomes of a series of prophylactic mesh reinforcements with retromuscular, large-pore polypropylene at the time of enterostomy reversal.Methods
Retrospective review of all ostomy reversals was performed. All cases with placement of synthetic mesh reinforcement were identified from a prospectively maintained, hernia database. Primary end points were surgical site occurrence, surgical site infection, and hernia occurrence.Results
Ostomy reversal was performed in 359 patients; 91 were reinforced with mesh and 268 without mesh. Colostomy reversal was performed in 56.5% and ileostomy in 43.5%. The mesh group had a greater body mass index and a greater incidence of chronic obstructive pulmonary disease, but groups were otherwise similar. A midline incisional hernia was present in 45% of the mesh group vs 4.5% in the controls. Incidence of surgical site occurrence and surgical site infection were similar for mesh and control groups (21 vs 22.8%; P?=?.82 and 20 vs 19.8%; P?=?1.000, respectively). Superficial surgical site infection was less with mesh (8 vs 16.4%; P?=?.039). Incidence of a hernia developing at the stoma site was decreased markedly with mesh (1% vs 17.2%; P?<?.001), as was the occurrence of a midline hernia (6% vs 19%; P?=?.004). Mesh was placed across the midline prophylactically in 29.7% of cases, which decreased midline hernia formation from 24.1% to 4% (P?=?.019).Conclusion
Retromuscular placement of permanent synthetic mesh at the time of enterostomy reversal is effective in preventing development of incisional hernia without increased risk of surgical site occurrence or surgical site infection. 相似文献5.
Purpose
As more mesh is implanted for hernia repairs, mesh-related complications may increase, with some requiring mesh removal. We describe our experience as to indications and perioperative factors that surround hernia mesh removal.Methods
All patients who underwent hernia mesh removal from the abdomen (ventral, flank) and pelvis (inguinal, femoral, obturator, perineal) were captured from a single hernia center database.Results
Over 4.5 years, we removed 105 mesh. Most were in males (58%), average age 53 years, with average pain score 5/10. Males most commonly had mesh removed from the pelvis (65%), and females from the abdomen (63%, P?=?0.009). Pain score was significantly higher prior to removal of hernia mesh from the pelvis (5.7 vs 4.5, P?=?0.047). Type of mesh implanted and positioning of mesh showed no difference in pain (P?>?0.05). Indications for hernia mesh removal significantly varied between the abdomen (infection, 43%) and the pelvis (pain, 91%, P?<?0.0001). Mesh reaction became a more frequent indication for mesh removal in the pelvis, reaching 1/3 of patients by 2017. Most required general anesthesia (87%), with inpatient stay (53%, mode 1 day). Open technique decreased with time (82–17%), laparoscopic decreased (20–10%), and robotic increased (0–70%).Conclusions
This is the largest and most comprehensive study detailing why we remove mesh. We provide awareness of indications and operative options to help guide physicians as they encounter patients who may require hernia mesh removal.6.
Objective
We report a prospective study of repairs using the Rives technique of the more difficult primary inguinal hernias, focusing on the immediate post-operative period, clinical recurrence, testicular atrophy, and chronic pain. A mesh placed in the preperitoneal space can reduce recurrences and chronic pain.Methods
For the larger primary inguinal hernias (Types 3, 4, 6, and some 7), we favour preperitoneal placement of a mesh, covering the myopectineal orifice by means of a transinguinal (Rives technique) approach. The Rives technique was performed on 943 patients (1000 repairs), preferably under local anaesthesia plus sedation in ambulatory surgery.Results
The mean operative time was 31.8 min. Pain assessment after 24 h with an Andersen scale and a categorical scale gave two patients with intense pain on the Andersen scale, and four patients who thought their state was bad. Surgical wound complications were below 1%, and urinary retention was 1.2% mostly associated with spinal anaesthesia and, in one case, bladder perforation. There was spermatic cord and testicular oedema with some degree of orchitis in 17 patients. The clinical follow-up of 849 repairs (86.4%), mean (range) 30.0 (12–192) months, gave five recurrences (0.6%), three cases (0.4%) of testicular atrophy, and 37 (4.3%) of post-operative chronic pain (8 patients with visual analogue scale of 3–10).Conclusions
The Rives technique requires a sound knowledge of inguinal preperitoneal space anatomy, but it is an excellent technique for the larger and difficult primary inguinal hernias, giving a low rate of recurrences and chronic pain.7.
Background
The issue of mesh fixation in endoscopic inguinal hernia repair is frequently debated and still no conclusive data exist on differences between methods regarding long-term outcome and postoperative complications. The quantity of trials and the simultaneous lack of high-quality evidence raise the question how future trials should be planned.Methods
PubMed, EMBASE and the Cochrane Library were searched, using the filters “randomised clinical trials” and “humans”. Trials that compared one method of mesh fixation with another fixation method or with non-fixation in endoscopic inguinal hernia repair were eligible. To be included, the trial was required to have assessed at least one of the following primary outcome parameters: recurrence; surgical site infection; chronic pain; or quality-of-life.Results
Fourteen trials assessing 2161 patients and 2562 hernia repairs were included. Only two trials were rated as low risk for bias. Eight trials evaluated recurrence or surgical site infection; none of these could show significant differences between methods of fixation. Two of 11 trials assessing chronic pain described significant differences between methods of fixation. One of two trials evaluating quality-of-life showed significant differences between fixation methods in certain functions.Conclusion
High-quality evidence for differences between the assessed mesh fixation techniques is still lacking. From a socioeconomic and ethical point of view, it is necessary that future trials will be properly designed. As small- and medium-sized single-centre trials have proven unable to find answers, register studies or multi-centre studies with an evident focus on methodology and study design are needed in order to answer questions about mesh fixation in inguinal hernia repair.8.
Purpose
Establishing the existence of inguinal neuritis, and defining patterns of nerve involvement in primary inguinal hernia repair.Methods
A retrospective chart review of 100 consecutive primary inguinal hernia repairs by Lichtenstein technique with frequent ilioinguinal nerve removal was performed. Nerves suspected of containing neuritis had been sent for histological examination. Objective clinical parameters and nerve pathology reports were reviewed. An independent biostatistician reviewed the data.Results
There were 34 cases of inguinal neuritis in these primary inguinal hernia repairs. The nerve most affected in primary repairs was the ilioinguinal nerve, accounting for 88% of the neuritis cases. Inguinal neuritis occurred mainly at the external oblique neuroperforatum—where the nerve pierces the external oblique fascia, accounting for 83% in primary repair. The only clinical parameter with statistical significance was hernia laterality (P = 0.04), 46% of the patients who had a hernia on the left also had inguinal neuritis.Conclusion
The overall incidence of inguinal neuritis was 34% in primary inguinal hernia repairs. The ilioinguinal nerve was most commonly affected in these primary inguinal hernia repairs, and inguinal neuritis was most likely to occur at the external oblique neuroperforatum.9.
Purpose
Total extraperitoneal preperitoneal (TEP) repair is widely used for inguinal, femoral, or obturator hernia treatment. However, mesh repair is not often used for strangulated hernia treatment if intestinal resection is required because of the risk of postoperative mesh infection. Complete mesh repair is required for hernia treatment to prevent postoperative recurrence, particularly in patients with femoral or obturator hernia.Cases
We treated four patients with inguinocrural and obturator hernias (a 72-year-old male with a right indirect inguinal hernia; an 83-year-old female with a right obturator hernia; and 86- and 82-year-old females with femoral hernias) via a two-stage laparoscopic surgery. All patients were diagnosed with intestinal obstruction due to strangulated hernia. First, the incarcerated small intestine was released and then laparoscopically resected. Further, 8–24 days after the first surgery, bilateral TEP repairs were performed in all patients; the postoperative course was uneventful in all patients, and they were discharged 5–10 days after TEP repair. At present, no hernia recurrence has been reported in any patient.Conclusion
The two-stage laparoscopic treatment is safe for treatment of strangulated inguinal, femoral, and obturator hernias, and complete mesh repair via the TEP method can be performed in elderly patients to minimize the occurrence of mesh infection.10.
Background
Chronic groin pain appears in athletes with a diverse etiology. In a select few, it can be defined as a sportsman’s hernia, that may be related, among other pathologies, to weakness of the posterior inguinal wall and may successfully respond to surgery.Hypothesis
Surgical repair of the sportsman’s hernia is associated with good functional outcomes, if the diagnosis is based on meticulous examination and follows a simple selection flowchart.Study design
Prospective case cohort study.Methods
The study assessed patients recruited from 2006 until the present assessed by a dedicated team with clinical and radiographic features of a sportsman’s hernia who had failed a specified period of conservative therapies. Surgery was performed using a tension-free mesh open inguinal hernia repair.Results
Of 246 male patients with chronic groin pain, 51 underwent surgery (mean age 20.7 years, range 14–36 years) with 58 inguinal procedures performed. Of the operated group, seven underwent bilateral surgery with a direct hernia found in 9/58 operated sides (15.5 %), an indirect hernial sac in 8/58 (14 %) and a direct and indirect hernia being found in 3/58 (5 %) of operated sides. There was no post-operative morbidity (median follow-up 36.1 months; range 1–74 months), with two failures (3.45 % of operated sides). All other patients were asymptomatic, returned to full sports activity within 4.3 weeks (range 3–8 weeks) after surgery, and required no analgesics or further treatment.Conclusion
Selective surgical hernia repair, based on meticulous anamnesis and physical examination is effective in the management of chronic groin pain in athletes.11.
Purpose
Chronic pain and discomfort are common after inguinal hernia repair (IHR). In this study, results from a 3-year follow-up from a randomized controlled study comparing three different mesh repairs for postoperative pain, discomfort, Quality of Life (QoL) and patient satisfaction are reported.Methods
Between November 1, 2006 and January 31, 2009, 309 men, who underwent day surgery for primary unilateral inguinal hernia under local anesthesia, were randomized to three different mesh repairs; UltraPro Hernia System (U), Prolene Hernia System (P) and Lichtenstein procedure (L).Results
Preoperatively, there were no differences between groups regarding demographics, symptoms, inguinal pain or QoL (SF-36 and a hernia-specific questionnaire). Operating time, postoperative pain, complications and time to full recovery were similar. At 36 months, 21 patients indicated pain [L, n = 6, P, n = 6 and U, n = 9; VAS (median (IQR)): L 0.4 (0.2–1.7), P 0.2 (0.1–2.3) and U 1.6 (0.7–4.6), p = ns]. Physical QoL was reduced in all groups before surgery and was similarly increased to normal levels after 3 months without further changes throughout the study. Although 92 % of participants were satisfied, sixteen percent reported any discomfort from the groin (ns between groups). Five recurrences were reported (L, n = 2, P, n = 1 and U, n = 2, p = ns).Conclusions
After 3 years of follow-up, all three procedures provided equally good results regarding, pain, discomfort and QoL and could therefore be recommended for primary IHR in LA.12.
Suolin Li Xuelai Liu Kenneth K.Y. Wong Lin Liu Yingchao Li 《Journal of pediatric surgery》2018,53(12):2507-2510
Background
Laparoscopic percutaneous extraperitoneal closure (LPEC) with variable devices seems to be one of the most simple and reliable methods. We described our modifications of single-port laparoscopic herniorrhaphy using an inner two-hooked cannula device with preperitoneal hydrodissection.Patients and methods
1568 children with 2114 inguinal hernias were treated by single-port LPEC. Under laparoscopic visualization, the two-hooked cannula device carrying a silk suture was inserted at the point of the internal ring and could be readily kept in an identical path. The hernia orifice was completely lassoed extraperitoneally by the suture with the assistance of hydrodissection. Any huge hernias of more than 1.5?cm were repaired with the incorporation of medial umbilical fold flap as reinforcement.Results
All hernia repairs were successfully performed by LPEC. 1022 patients had unilateral inguinal hernia repair, and 546 patients underwent bilateral inguinal hernia repair. Of these, additional medial umbilical flap reinforcement was necessary in 68 cases, and an assisted grasping instrument was used in 19 cases owing to omental adhesion or sliding hernia. Mean operating times for unilateral and bilateral inguinal hernia repairs were 9.8?±?2.1?min and 13.6?±?2.2?min, respectively. There were no operative complications. Two recurrences and three hydroceles were observed during 6 to 30?months of follow-up.Conclusions
One-puncture LPEC using the two-hooked cannula device with preperitoneal hydrodissection has proved to be a safe and effective procedure with excellent cosmetic results.Level of evidence
IV 相似文献13.
Purpose
Different techniques and mesh materials are used in parastomal hernia repair with recently reported recurrence rates ranging from 10 to 28%. The aim of this cohort study was to examine the risk of recurrence and chronic pain after Sugarbaker or keyhole parastomal hernia repair with intraperitoneal placement of a polyester monofilament macroporous composite mesh.Methods
Data on all patients undergoing parastomal hernia repair with Parietex? Composite Parastomal Mesh at our institution during a 4-year period were examined. Patients with urostomy were excluded. A team of three experienced surgeons performed all repairs. Follow-up including physical examination was done after 10 days, 6 and 12 months, and hereafter as annual structured telephone interviews. Patients suspected of hernia recurrence were offered computed tomography scan. Chronic pain was defined as pain requiring out-patient visit(s) and/or regular use of analgesics.Results
79 patients (Sugarbaker, n = 69; keyhole, n = 10) were included. Of those, 72 procedures were performed laparoscopically and seven by open technique. Two patients were reoperated within 30 days with removal of the mesh. In total, seven (9%) patients had parastomal hernia recurrence (reoperation, n = 3; conservative management, n = 4) during follow-up of median 12 months (range 0–49 months). In univariable logistic analyses, type of stoma was associated with recurrence (ileostomy 28% vs colostomy 3%, p = 0.007). Three patients (4%) reported chronic pain.Conclusion
In this study, we found low rates of recurrence and chronic pain following parastomal hernia repair using intraperitoneal reinforcement with a polyester monofilament composite mesh.14.
Background Context
Studies have shown that pain acceptance strategies related to psychological flexibility are important in the presence of chronic musculoskeletal pain. However, the predictors of these strategies have not been studied extensively in patients with whiplash-associated disorders (WAD).Purpose
The purpose of this study was to predict chronic pain acceptance and engagement in activities at 1-year follow-up with pain intensity, fear of movement, perceived responses from significant others, outcome expectancies, and demographic variables in patients with WAD before and after multimodal rehabilitation (MMR).Study design
The design of this investigation was a cohort study with 1-year postrehabilitation follow-up.Study setting
The subjects participated in MMR at a Swedish rehabilitation clinic during 2009–2015.Patient sample
The patients had experienced a whiplash trauma (WAD grade I–II) and were suffering from pain and reduced functionality. A total of 386 participants were included: 297 fulfilled the postrehabilitation measures, and 177 were followed up at 1 year after MMR.Outcome measures
Demographic variables, pain intensity, fear of movement, perceived responses from significant others, and outcome expectations were measured at the start and after MMR. Chronic pain acceptance and engagement in activities were measured at follow-up.Methods
The data were obtained from a Swedish Quality Registry for Pain Rehabilitation (SQRPR).Results
Outcome expectancies of recovery, supporting and distracting responses of significant others, and fear of (re)injury and movement before MMR were significant predictors of engagement in activities at follow-up. Pain intensity and fear of (re)injury and movement after MMR significantly predicted engagement in activities at follow-up. Supporting responses of significant others and fear of (re)injury and movement before MMR were significant predictors of pain acceptance at the 1-year follow-up. Solicitous responses of significant others and fear of (re)injury and movement at postrehabilitation significantly predicted pain acceptance at follow-up.Conclusion
For engagement in activities and pain acceptance, the fear of movement appears to emerge as the strongest predictor, but patients' perceived reactions from their spouses need to be considered in planning the management of WAD. 相似文献15.
Robby De Pauw Iris Coppieters Tanneke Palmans Lieven Danneels Mira Meeus Barbara Cagnie 《The spine journal》2018,18(8):1406-1416
Background Context
Motor impairment is a key sign in patients with traumatic (whiplash-associated disorder [WAD]) and non-traumatic (idiopathic neck pain [INP]) neck pain.Purpose
This study aimed to analyze differences in motor impairment between two patient groups and to assess the association between motor performance and self-reported symptoms.Study Design
This is a case-control study.Patient Sample
A total of 38 patients with chronic INP, 35 patients with chronic WAD, and 30 healthy pain-free controls were included in the study.Outcome Measures
Outcome measures used in this study were mobility (°), strength (N), repositioning accuracy (°), endurance (seconds), sway velocity (cm/s), sway area (cm2), and neuromuscular control.Methods
Group differences of motor impairment, together with questionnaires to evaluate pain intensity, fear avoidance, pain catastrophizing, symptoms of central sensitization, and disability, were analyzed with analysis of covariance, including age as a covariate.Results
Motor impairment was observed in both patient groups with a higher degree in patients with chronic WAD. These impairments were moderately linked to self-reported disability and were in most cases associated with pain, fear avoidance, and symptoms of central sensitization (|ρ| ranging from 0.28 to 0.59).Conclusions
Motor impairment should be addressed when treating both groups of patients, keeping in mind the association with self-reported pain and disability, fear-avoidance, and central sensitization. 相似文献16.
Background
Today, ventral hernia repair is predominantly performed with meshes. There is no meta-analysis of high quality evidence that compares the results of suture to mesh repair. The objective of this systematic review with meta-analysis is to compare patient centred outcomes of suture versus mesh repair.Methods
A systematic literature search was performed in EMBASE, MEDLINE and CENTRAL (inception to 06/2014). Furthermore a hand search was performed. RCTs comparing suture versus mesh repair in primary and incisional ventral hernia repair were included. Data on patient characteristics, interventions and results were extracted in standardized tables. Risk of bias was assessed with the cochrane risk of bias tool. Results of studies were pooled with a meta-analysis. All steps were performed by two reviewers. Discrepancies were discussed until a consensus.Results
The search in the databases resulted in 1560 hits. After screening, 10 randomized controlled trials including 1215 patients satisfied all inclusion criteria. Risk of bias was moderate to high. The relative risk for recurrence was 0.36 [95% CI (0.27, 0.49); I 2 = 0; heterogeneity p = 0.70]. Other complications did not differ significantly. Results for chronic pain were heterogeneous across studies.Conclusion
Mesh repair reduces the number of recurrences significantly. In patients without recurrence mesh repairs seem to be associated with a risk of chronic pain especially if the mesh is fixed sublay.17.
Purpose
To evaluate the management and outcomes of modified Marcy repair for inguinal hernia in a large series of children.Methods
We analyzed the case records of 6826 pediatric patients who underwent surgery for inguinal hernia between January, 1991 and January, 2015 at Split University Hospital in Croatia. The following parameters were examined: sex, age, location of the hernia, intraoperative or postoperative complications, recurrence, and surgical method.Results
The 6826 patients included 4751 boys and 2075 girls operated on for inguinal hernia. The mean age was 3.5 years, and mean followup was 14 years. Right-side predominance was noted with 59.50 % right hernia repairs, 33.72 % left hernia repairs, and 6.78 % bilateral hernia repairs. There were 6410 (93.90 %) elective procedures and 416 (6.10 %) emergency procedures for incarceration. The mean duration of surgery was 26 min (14–90 min), and the mean hospital stay was 1 day. Marcy repair was the most commonly performed operation (95.76 %), whereas Ferguson’s technique was performed in only 3.98 % of the children. The overall recurrence rate was 0.43 %, with a recurrence rate of 0.36 % for Marcy repair and 1.83 % for Ferguson repair (p = 0.0003).Conclusion
Modified Marcy hernia repair is a safe and effective procedure for inguinal hernia in children with excellent outcomes and a low incidence of recurrence.18.
Jeffrey G. Jarvik Laura S. Gold Katherine Tan Janna L. Friedly Srdjan S. Nedeljkovic Bryan A. Comstock Richard A. Deyo Judith A. Turner Brian W. Bresnahan Sean D. Rundell Kathryn T. James David R. Nerenz Andrew L. Avins Zoya Bauer Larry Kessler Patrick J. Heagerty 《The spine journal》2018,18(9):1540-1551
Background Context
Although back pain is common among older adults, there is relatively little research on the course of back pain in this age group.Purpose
Our primary goals were to report 2-year outcomes of older adults initiating primary care for back pain and to examine the relative importance of patient factors versus medical interventions in predicting 2-year disability and pain.Study Design/Setting
This study used a predictive model using data from a prospective, observational cohort from a primary care setting.Patient Sample
The study included patients aged ≥65 years at the time of new primary care visits for back pain.Outcome Measures
Self-reported 2-year disability (Roland-Morris Disability Questionnaire [RDQ]) and back pain (0–10 numerical rating scale [NRS]).Methods
We developed our models using a machine learning least absolute shrinkage and selection operator approach. We evaluated the predictive value of baseline characteristics and the incremental value of interventions that occurred between 0 and 90 days, and the change in patient disability and pain from 0 to 90 days. Limitations included confounding by indication and unmeasured confounding.Results
Of 4,665 patients (89%) with follow-up, both RDQ (from mean 9.6 [95% confidence interval {CI} 9.4–9.7] to mean 8.3 [95% CI 8.0–8.5]) and back pain NRS (from mean 5.0 [95% CI 4.9–5.1] to mean 3.5 [95% CI 3.4–3.6]) scores improved slightly. Only 16% (15%-18%) reported no back pain-related disability or back pain at 2 years after initial visits. Regression model parameters explained 40% of the variation (R2) in 2-year RDQ scores, and the addition of 0- to 3-month change in RDQ score and pain improved prediction (R2=51%). The most consistent predictors of 2-year RDQ scores and back pain NRS scores were 0- to 90-day change in each respective outcome and patient confidence in improvement. Patients experienced 50% and 43% improvement in back pain and disability, respectively, 2 years after their initial visit. However, fewer than 20% of patients had complete resolution of their back pain and disability at that time.Conclusions
Baseline patient factors were more important than early interventions in explaining disability and pain after 2 years. 相似文献19.
Purpose
Chronic post-operative groin pain is a substantial complication following open mesh inguinal hernia repair. The exact cause of this pain is still unclear, but entrapment or trauma of the ilioinguinal nerve may have a role to play. Elective division of this nerve during hernia repair has been proposed in an attempt to reduce the incidence of chronic groin pain.Methods
We performed a meta-analysis of nine randomized controlled trials comparing preservation versus elective division of the ilioinguinal nerve during this operation.Results
A substantial proportion of patients having open mesh inguinal hernia repair experience chronic groin pain when the ilioinguinal nerve is preserved (estimated rate of 9.4% at 6 months and 4.8% at 1 year). Elective division of the nerve resulted in a significant reduction of groin pain at 6-months post-surgery (RR 0.47, p = 0.02), including moderate/severe pain (RR 0.57, p = 0.01). However, division of the nerve also resulted in an increase of subjective groin numbness at this time point (RR 1.55, p = 0.06). At 12-month post-surgery, the beneficial effect of nerve division on chronic pain was reduced, with no significant difference in the rates of overall groin pain (RR 0.69, p = 0.38), or of moderate-to-severe groin pain (RR 0.99, p = 0.98) between the two groups. The prevalence of groin numbness was also similar between the two groups at 12-month post-surgery (RR 0.79, p = 0.48).Conclusions
Routine elective division of the ilioinguinal nerve during open mesh inguinal hernia repair does not significantly reduce chronic groin pain beyond 6 months, and may result in increased rates of groin numbness, especially in the first 6-months post-surgery.20.
Andrew J. Hahne Jon J. Ford Rana S. Hinman Matthew C. Richards Luke D. Surkitt Alexander Y.P. Chan Sarah L. Slater Nicholas F. Taylor 《The spine journal》2017,17(3):346-359