Is laparoscopic treatment of adhesions a valid approach for postoperative abdominal pain?

The role of post-operative adhesions in chronic abdominal pain remains controversial. The aim of this study was to assess the value of laparoscopic treatment of adhesions for chronic post-operative abdominal pain in 32 patients. Over a period of 8 years, 32 patients (25 women and 7 men) with a mean age of 41.5 years (18-69) were hospitalized for chronic abdominal pain of more than 6 months duration, without an obvious underlying neoplasm or psychiatric disorder. They had all undergone at least one previous abdominal operation (mean, 1.9; range, 1-5), with a mean follow-up of 28 months (6-82). The mean duration of the pain was 18 months (6-65) and in 24 of the 32 cases it was mainly hypogastric. Other than the presence of a scar, the clinical examination was completely normal. Prior to hospitalization, 163 different laboratory tests, 162 radiological investigations, including 13 CT scans and 3 MRIs, and 25 endoscopies had been performed. A pneumoperitoneum was made by "open laparoscopy" in 23 cases and with Verres needle in 9 cases. Eight patients (25%) did not have any adhesions, but 6 of them were found to have a gynecological problem (endometriosis). In this group, the laparoscopy lasted 34 minutes (15-45) and the mean hospital stay was 48 hours. In 24 cases, adhesions were found and selected. This was thought to be complete in 22 cases (91.6%). There was a strict correlation between the adhesions and the scar in 85% of cases. In 5 cases, the adhesions were associated with another intervention. There were no conversions. The mean duration of surgery and hospitalization was respectively 56 minutes (32-120) and 3.2 days. There was no mortality and the morbidity rate was 4.1% (1 monopolar injury). The average follow-up was 26.7 months: 22 of the 24 patients who had freeing of adhesions were evaluated after at least 6 months of follow-up. In 10 cases, the pain had completely resolved (45%), in 6 it had decreased (27%) and in 6 cases it was unchanged or had even worsened (1 case of endometriosis). Laparoscopic exploration for chronic post-operative abdominal pain, after an extensive work-up performed after a suitably long delay post-surgery, can be used to detect and treat adhesions in 3/4 cases. In the absence of another lesion, the pain is lessened in 72% cases. However, if there is another lesion, laparoscopic treatment of adhesions is less effective with respect to the pain, but it nevertheless can identify an.     

Chronic pain and quality of life (QoL) after transinguinal preperitoneal (TIPP) inguinal hernia repair using a totally extraperitoneal, parietalized, Polysoft ® memory ring patch

Introduction

Little is known about both incidence of chronic pain and quality of life (QoL) after the transinguinal preperitoneal (TIPP) technique using a totally extraperitoneal, parietalized, memory ring patch.

Materials and methods

Among 622 (428 unilateral and 194 bilateral) hernia repairs (HR) in 525 patients, 92 % had a postoperative clinical control. Thereafter, two sets of postal self-assessed questionnaires were sent.

Results

A total of 531 HR were studied with a mean follow-up of 17 ± 8 months. Only one recurrence was detected. In 151 (28.4 %) HR the patients alleged various symptoms, but in only 10 (1.9 %) HR they considered their discomfort more bothersome than the hernia they had before, and in just 2 (0.4 %) HR they judged their result as bad (one patch removal for sepsis and one for hematoma). Only mild pain (including no painful discomfort such as a foreign body sensation) or moderate pain was frequent. Pain was self-graded as severe in four cases. None of them reported any regular consumption of antalgics. None of them judged their result as bad. Dysesthesia (numbness 19, paresthesia 20) mentioned in 39 HR (7 %), associated with pain in 16 HR, was said to be more bothersome than the hernia treated in just 3 HR (0.6 %). The results of the entire series were self-assessed as good or excellent in 97 % of the HR.

Conclusion

In our TIPP series, both the incidence of recurrences (0.2 %) and that of severe chronic pain (≤0.7 %) were very low, as well as patients’ QoL was excellent. In our experience, the postoperative course was as painless as that of laparoscopic TEP we had been performing previously, but TIPP appeared more suited to day-case surgery.     

Laparoscopic ventral hernia repair using a novel intraperitoneal lightweight mesh coated with hyaluronic acid: 1-year follow-up from a case–control study using the Hernia-Club registry

Purpose

A case–control study was performed to compare laparoscopic ventral hernia repair (LVHR) using the Ventralight ST? lightweight surgical mesh with LVHR using other types of mesh.

Methods

Adult patients undergoing intraperitoneal implantation of Ventralight ST? during LVHR (Ventralight ST? group; VG) over a 2-year period (2011–2013) were identified from the prospective French Hernia-Club registry. Patients undergoing elective LVHR using other types of intraperitoneal mesh in the first semester of 2013 formed the control group (CG). Patient, hernia and surgical characteristics, and postoperative outcomes after 8 days, 1 month, and 1 year were compared between the two groups.

Results

The VG comprised 90 LVHRs in 85 patients, and the CG 86 LVHRs in 81 patients. Patient, hernia and surgical characteristics were similar between the two groups, apart from the method of mesh fixation and the number of procedures involving fascial closure. A low rate of minor complications was observed in both groups at 1 month [4.4 % (VG) and 2.3 % (CG)], and the level of postoperative pain was similar in the two groups at Day 8 and 1 month. After 1 year, no complications, recurrences or cases of chronic pain had occurred in either group, and Quality-of-Life outcomes were similar. Patients rated their procedure as excellent or good in 96 % (VG) and 92 % (CG) of cases.

Conclusions

Ventralight ST? mesh is effective and well tolerated in LVHR, producing very low complication and recurrence rates in the short and medium term. The results are comparable to those achieved with other types of mesh.

     

Longitudinal cohort study on preoperative pain as a risk factor for chronic postoperative inguinal pain after groin hernia repair at 2-year follow-up

Hernia - To assess the rate of late chronic postoperative inguinal pain (CPIP) after groin hernia repair in patients with different categories of preoperative VRS (Verbal Rating Scale) pain and to...     

Risk factors for surgical site infection after groin hernia repair: does the mesh or technique matter?

Hernia - Surgical site infections (SSIs) following groin hernia repair (GHR) are getting rarer in high income countries despite a wider use of meshes. Among the risk factors for SSIs, those related...     

Is crude postoperative mortality rate a relevant criterion of the efficiency of a surgical team? Prospective study of 11,756 patients' postoperative course

AIM: Evaluation of the crude postoperative mortality rate as a relevant criterion of the efficiency of a surgical team. MATERIAL [corrected] AND METHODS: We studied prospectively the postoperative course of 11,756 consecutive patients who underwent a general surgery procedure between January 1(st) 1987 and December 31 2002. RESULTS: Seventy-three of patients died (0.60 percent). The median age at the time of death was 77 years old. None of the 5046 patients under 40 years old died. The operations were emergent in 3,265 patients (28 percent). The mortality rate of the 3,952 digestive surgery patients was 1.00 percent (40/3,952 patients). Among them, the mortality rate increased to 3.56 percent (17/478 patients) in case of an emergency procedure excluding procedures for non-suppurative appendicitis. Although only 8 percent of the patients were operated for a cancer (968/11,756 patients), they accounted for 49 percent of the postoperative deaths. In this cohort, the crude mortality rate varied by twice as much as were taken in account (73 deaths) or not (34 deaths) the palliative procedures in terminal phase patients, and the last-chance procedures in patients in imminent-death condition. Six hundred and twenty patients (5.3 percent) experienced at least one postoperative complication, surgical in 166 patients, and parietal in 258 patients. CONCLUSION: This study shows that a long-term rigorous self-assessment is feasible. It confirms that the crude mortality rate is not a relevant criterion to evaluate the efficiency of a surgical team, suggests that an "avoided death" concept is more representative of medical team work and more rewarding for them and allows us to propose an index taking in account the rate of postoperative complications not followed by death.     

Identification of risk factors for 30-day postoperative complications in patients undergoing primary ventral hernia repair: a prospective cohort study of 2,374 patients

Background

Primary ventral hernia is a common condition. Surgical repair is associated with complications, but no clear predictive risk factors have been identified. The European Hernia Society classification offers a structured framework to describe hernias and to analyze postoperative complications. Given this structured nature, the European Hernia Society classification might prove useful for preoperative patient or treatment classification. The objective of this study was to investigate the European Hernia Society classification as a predictor for complications within 30 days after primary ventral hernia surgery.

Le risque opératoire est-il majoré chez les médecins ou leurs proches ?: Étude cas-témoin à partir du suivi prospectif des suites opératoires de 11 756 patients

Aim and methodsAre physicians and their relatives at risk of postoperative complications when they are scheduled for surgery? With the aim to answer this question, a case control study was performed from a cohort of 11,756 patients scheduled for surgery from 01/01/1987 to 12/31/2002. Fourty seven patients were physicians and 122 were a close relative to a physician. The percentage of physicians in the current series is comparable to that in the general urban population in France. Each of these patients was matched with 5 patients as controls regarding sex, age, diagnosis, procedure, and date of surgery.ResultsNo statistically significant difference was observed between the 47 physicians and their 235 controls in the occurence of postoperative complications: 6% vs 6 % (Odds ratio (OR) = 1,07; CI^(95%) : 0,28-3,74), unplanned return to the operative room: 2% vs 2 % (OR = 1,00; CI: 0,11-8,8), and postoperative mortality: 0% vs 0,5 % (p = 0,07).No stastistically significant difference was observed between the 122 close relatives to a physician and their 610 controls in the occurence of postoperative complications: 6% vs 6 % (OR = 1,00; CI: 0,43-2,3), unplanned return to the operative room: 2% vs 3 % (OR = 0,55; CI: 0,18-3,4), and postoperative mortality: 1% vs 0,5 % (OR = 1,67; CI: 0,13-12,12).Conclusionthis study does not confirm the widespread opinion that postoperative course would be worse in physicians as patients and in their close relatives. Their recovery is not different from that to other patients if they are treated as well as other patients.