Non-mesh Repair Research Articles

Minimally invasive approach to incisional hernia in elective and emergency surgery: a SICE (Italian Society of Endoscopic Surgery and new technologies) and ISHAWS (Italian Society of Hernia and Abdominal Wall Surgery) online survey.

Minimally invasive abdominal wall surgery is growing worldwide, with a constant and fast improvement of surgical techniques and surgeons' confidence in treating both primary and incisional hernias (IH). The Italian Society of Endoscopic Surgery and new technologies (SICE) and the ISHAWS (Italian Society of Hernia and Abdominal Wall Surgery) worked together to investigate state of the art in IH treatment in elective and emergency settings in Italy. An online open survey was designed, and Italian surgeons interested in abdominal wall surgery were invited to fill out a 20-point questionnaire on IH surgical procedures performed in their departments. Surgeons were asked to express their points of view on specific questions about technical and clinical variables in IH treatment. Preferred approach in elective IH surgery was minimally invasive (59.7%). Open surgery was the preferred approach in 40.3% of the responses. In emergency settings, open surgery was the preferred approach (65.4%); however, 34.5% of the involved surgeons declare to prefer the laparoscopic/endoscopic approach. Most respondents opted for conversion to open surgery in case of relevant surgical field contamination, with a non-mesh repair of abdominal wall defects. Among those that used the laparoscopic approach in the emergent setting, the majority (74%) used the size of the defect of 5cm as a decisional cut-off. The spread of minimally invasive approaches to IH repair in emergency surgery in Italy is gaining relevance. Code-sharing through scientific societies can improve clinical practice in different departments and promote a tailored approach to IH surgery.

COMPARISON OF DESARDA METHOD VERSUS LICHTENSTEIN METHOD FOR THE MANAGEMENT OF INGUINAL HERNIA: A SHORT-TERM OUTCOME ANALYSIS

Objective: Lichtenstein method is a gold standard surgery modality for the management of inguinal hernia but it is associated with post-operative complications such as groin pain, abdominal wall thickness, and surgical site infections. Desarda method is a physiologic non-mesh repair with no anticipated mesh related complications. The present prospective randomized study was conducted to compare short term outcomes of Desarda with Lichtenstein technique for the management of inguinal hernia. Methods: This was a prospective randomized study conducted on 60 patients undergoing surgery for inguinal hernia. The patients were allocated into two groups as follows, Group A (n=30) patients undergoing Desarda’s repair for inguinal hernia and Group B (n=30) patients undergoing Lichtenstein’s repair. The following outcome was measured, post-operative pain (Day 1, Day 3, Day 5) – visual analog scale, duration of hospital stay and complications. p value <0.05 was considered significant. Results: The demographics characteristic were similar in both the groups and not significant. The hospital stay duration was lower in Desarda group as compared to Lichtenstein groups and was significant (4.07±0.83 vs. 6.87±1.87 days). The post-operative VAS score at day 1, 3, and 5 were significantly lower in Desarda group as compared to Lichtenstein group. The incidence of complications were lesser in Desarda group as compared to Lichtenstein group but not significant. Conclusion: The Desarda technique was superior when compared to Lichtenstein method in terms of early recovery, post-operative pain, and complications for the management of inguinal hernia.

Nonmesh laparoscopic repair of incarcerated obturator hernia

Obturator hernia (OH) is uncommon. With its low incidence, diagnosis can be difficult with physical exams and laboratory data only. Imaging study with computer tomography significantly improved diagnosis accuracy and lower bowel resection and mortality rate. We present a rare case of a 70-year-old female with OH and managed by laparoscopic nonmesh repair method.

A Modification of the Rectus Muscle Repair for Repair Ventral Hernias: Case Report

Background: In an attempt to avoid mesh-related complications, many authorities have described non-mesh repair of midline ventral hernias. We described rectus muscle repair (RMR) for ventral hernias in 1993, but we noticed that a limitation was the inability to repair large hernia defects. We now describe a modification of this technique that allows it to be used for larger defects. Methods: We report a case in which the modified RMR was used to repair a large ventral hernia. In the original RMR, sutures were placed through each rectus abdominis to approximate the muscles, thereby obliterating the linea alba and repairing the hernia. In this modification of the RMR, the hernia sac and the linea alba were imbricated and a vertical relaxing incision was made in each anterior rectus sheath, keeping the underlying muscle and posterior sheath intact. Results: This relaxing incision is a useful modification of the original RMR, especially where there is significant tension on the suture line. This patient had an uneventful recovery with no recurrence on clinical examination at his last clinical review 5 years post-operation. Conclusion: The modified RMR repair for ventral hernias is an acceptable alternative to mesh repair. It brings a low complication profile and avoids the burden of mesh-related complications.

Clinical outcomes of patients undergoing Desarda versus Lichtenstein mesh for inguinal hernia repair: our experience in Qazi Hussain Ahmed Medical Complex, Nowshera Pakistan

Background: The objective of this study was to compare the outcome of Desarda versus Lichtenstein mesh for surgical repair of inguinal hernia.Methods: This randomized controlled trial was done at Qazi Hussain Ahmed Medical Complex, Nowshera from 01 February 2019 to 30 December 2020 with total duration 1 year and 10 months. Study included patients admitted in hospital for inguinal hernia repair. Patients were divided into 2 groups. Group 1 consisted of patients in whom Lichtenstein mesh repair was done while group 2 with patients having Desarda non-mesh repair done. Total time of surgery was noted. Patients were assessed for pain using a visual analog scale (VAS) after 72 hours and for seroma and infection within seven days. Recurrence and resumption of normal gait was assessed after 6 months. Data was analyzed with statistical package for the social sciences (SPSS) 21.Results: Total of 100 male patients were included in the study. About 45 patients were included in group 1 and 55 in group 2. Mean age of the patients was 53±10.55 years in Lichtenstein group and 50±08.11 years in Desarda group. The mean duration of surgery was 47.57±4.95 min with Lichtenstein while 37.96±4.76 min with Desarda. The mean pain score was 2.5±1.0 after 72 hours with Lichtenstein while 1.72±0.20 with Desarda (p<0.05). Seroma was developed in 4 (8.8%) patients, infection in 5 (11.11%) patients and recurrence occurred in 1 (2.2%) patient in group 1 (Lichtenstein) while no patient developed infection in group 2 (Desarda). The rate of normal gait observed in 6 months post operative was in 25 (55.5%) patients with Lichtenstein repair while in group 2, 30 (54.54%) patents resumed normal gate respectively (p>0.05).Conclusions: Both methods for repair are acceptable but the Desarda has less complications and operative time as compared to Lichtenstein repair.

OV08 TREATMENT OF THE INGUINAL HERNIA USING THE SHOULDICE REPAIR

Abstract Aim The Shouldice procedure is a layered reconstruction of the posterior wall in inguinal hernia repair and currently the preferred method if the layers of the abdominal wall are of good quality, the wish of the patient for a non-mesh repair and if a mesh method is not possible or available. The correct performance of the reconstruction of the posterior wall is essential part of the operation. Material and Methods A life educational video was made with the four-layer reconstruction in detail. The first layer of the reconstruction starts at the medial corner and the conjoint tendon is sutured to the caudal flap of the transversalis fascia using a continuous non resorbable suture. The second layer of the reconstruction is made by approximating the cranial flap of the transversalis fascia and the posterior part of the inguinal ligament. The third layer starts at the level of the deep internal inguinal ring and approximates the lower border of the internal oblique muscle with the inguinal ligament. The fourth and final layer approximates the internal oblique muscle again with the inguinal ligament. Results The four-layer reconstruction after splitting the transversalis fascia is shown in detail since treatment of the hernia sac is like the other techniques. Conclusions The instructional video can be used for the resident training as a start in a hernia course followed by the execution on a model before the actual execution on a patient.

Comparison of postoperative infection after emergency inguinal hernia surgery with enterectomy between mesh repair and non-mesh repair: a national database analysis.

Synthetic non-absorbable mesh is used for elective inguinal hernia repair but is not commonly used for incarcerated or strangulated inguinal hernia requiring enterectomy to reduce the risk of surgical-site infection. This study aimed to evaluate the safety of synthetic non-absorbable mesh repair in patients with incarcerated or strangulated inguinal hernia requiring enterectomy versus non-mesh repair. We analyzed patients with incarcerated or strangulated inguinal hernia with enterectomy from April 2012 to March 2017 using a nationwide inpatient database in Japan. We conducted overlap propensity score-weighted analyses to compare surgical-site infection (SSI), duration of anesthesia, antibiotic use at > 3days after surgery, postoperative hospital stay, and 30day readmission. Two sensitivity analyses were performed. First, we compared the proportions of patients requiring wound culture at ≥ 3days after surgery. Second, we performed overlap propensity score-weighted logistic regression analyses for surgical-site infection. We identified 668 eligible patients, comprising 223 patients with mesh repair and 445 with non-mesh repair. Overlap propensity score-weighted analyses showed no significant differences between the mesh repair and non-mesh repair groups for SSI (2.5 vs. 2.8%, P = 0.79). Secondary outcomes did not differ significantly between the groups. Proportion of wound culture at ≥ 3days after surgery was similar in the two groups (11.1 vs. 14.6%, P = 0.18). Logistic regression analysis showed no significant association between mesh repair and SSI (odds ratio, 0.93; 95% confidence interval, 0.34-2.57). Synthetic non-absorbable mesh use may be safe for incarcerated or strangulated inguinal hernia requiring enterectomy.

Surgeon Volume and Risk of Reoperation after Laparoscopic Primary Ventral Hernia Repair: A Nationwide Register-Based Study

Repairs of primary ventral hernias are common procedures but are associated with high recurrence rates. Therefore, it is important to investigate risk factors for recurrence to optimize current treatments. The aim of this study was to assess the impact of annual surgeon volume on the risk of reoperation for recurrence after primary ventral hernia repair. We conducted a nationwide register-based study with data from the Danish Ventral Hernia Database and the Danish Patient Safety Authority's Online Register linked via surgeons' authorization identification. We included patients 18 years and older, undergoing umbilical or epigastric hernia repair between 2011 and 2020. Annual surgeon volume was categorized into ≤ 9, 10 to 19, 20 to 29, and ≥ 30 cases. Patients were followed until reoperation, death, emigration, or end of the study period. We included 7,868 patients who underwent laparoscopic (n= 1,529 [19%]), open mesh (n= 4,138 [53%]), or open nonmesh (n= 2,201 [28%]) repair. There was an increased risk of reoperation after laparoscopic umbilical or epigastric hernia repair for surgeons with ≤ 9 (hazard ratio 6.57; p= 0.008), 10 to 19 (hazard ratio 6.58; p= 0.011), and 20 to 29 (hazard ratio 13.59; p= 0.001) compared with ≥ 30 cases/y. There were no differences in risk of reoperation after open mesh and open nonmesh repair in relation to annual surgeon volume. There was a significantly higher risk of reoperation after laparoscopic primary ventral hernia repair performed by lower-volume surgeons compared with high-volume surgeons. Additional research investigating how sufficient surgical training and supervision are ensured is indicated to reduce risk of reoperation after primary ventral hernia repair.

COMPARATIVE CLINICAL STUDY OF NON-MESH VERSUS MESH REPAIR IN PRIMARY INGUINAL HERNIA

Background: The inguinal regions are one of the natural weak areas in the abdominal wall and are the most common site of herniation. Inguinal hernia repair is one of the most frequently performed operations. Amis: The aim of this study is to compare open mesh and non-mesh suture repair of primary inguinal hernias with respect to clinical outcome which include postoperative pain, complications, time of return to work and recurrence. Matierial and methods: This prospective study of 102 cases of primary inguinal hernia repair was carried out at M.G.M. Medical College & L.S.K. Hospital, Kishanganj with the aim of comparing open mesh and non-mesh suture repair with respect to clinical outcome which included postoperative pain, complications time of return to work and recurrence. Result: In our study there were no specific criteria for allocation of the method of repair and of 102 patients 52 patients randomly underwent non-mesh repair and 50 patients underwent mesh repair. Conclusion: The use of prosthetic mesh allows tension-free repair of inguinal hernia and in theory better results. Our study proves the superiority of this method over non-mesh repair in the long term with regard to hernia recurrence; in addition, there were less complications and postoperative pain.

Obturator hernias: a systematic review of the literature.

Obturator hernias (OH) are extremely rare hernias, accounting for 0.07-1% of all hernias. This is the first systematic review investigating their presentation, imaging, treatment outcomes, and recurrence rate. After a detailed search in electronic search engines, 74 studies matched our criteria. A review of these reports was conducted and the full texts were examined. A total of 146 patients with a mean age of 78.8years were included in our analysis, with 40.1%, 29.9%, and 25.2% of patients suffering from either a right, a left or bilateral OH, respectively. OH were associated with non-specific symptoms and signs; bowel obstruction being the most common. Howship-Romberg sign was present in 56.2% of patients. Computed tomography (CT) scan was the most frequently used diagnostic modality, inversely associated with perioperative mortality. Mesh repair demonstrated a significantly improved perioperative morbidity rate, compared with non-mesh repair. Approximately 30% of patients underwent a laparoscopic operation, which was associated with significantly decreased morbidity and mortality rate as well as length of hospital stay, compared with the open repair. OHs are not associated with specific symptoms and signs; thus, they constitute a diagnostic challenge, requiring a high level of clinical suspicion. Undoubtedly, CT scan of the abdomen is the gold standard diagnostic tool. Their operative repair is mandatory, with the laparoscopic approach demonstrating significant advantages over the open repair.

Robotic iliopubic tract (r-IPT) repair: technique and preliminary outcomes of a minimally invasive tissue repair for inguinal hernia.

The iliopubic tract repair was first introduced by Nyhus in 1959, as an open non-mesh posterior preperitoneal repair for inguinal hernia. We have adapted this repair using a robotic approach to offer a minimally invasive (MIS) non-mesh inguinal hernia repair, termed the robotic iliopubic tract (r-IPT) repair. The aim of this pilot study is to evaluate the safety and effectiveness of this new technique. Starting in 2015, patients were enrolled in a Phase I trial of r-IPT repair. Inclusion criteria included low-risk patients with small inguinal hernias. Using a robotic TAPP approach, the direct and/or indirect defects were repaired by approximating the transversalis arch to the iliopubic tract. This trial was then expanded in Phase II to include a wider range of patients. Outcomes were collected prospectively. Twenty-four inguinal hernias were repaired in 13 patients via r-IPT as outpatients. Patients were followed for a mean of 24.9months (range 2.7-55.3, median 24). There were no surgical site occurrences and no recurrences. One (7.7%) patient had acute post-operative genital branch neuralgia, which self-resolved. One (7.7%) patient has chronic pain. The Nyhus-inspired robotic iliopubic tract (r-IPT) repair is an MIS approach to provide a non-mesh repair in inguinal hernia. The repair is safe with acceptable preliminary outcomes in low-risk patients. We propose the r-IPT repair to be a MIS option for non-mesh inguinal hernia repair in low-risk patients.

Chronic pain after groin hernia repair: pain characteristics and impact on quality of life

BackgroundChronic postsurgical pain (CPSP) after hernia repair research has mainly relied on unconfirmed self-reporting. We aimed to describe confirmed CPSP incidence, management, and quality of life (QoL) in a 2-year prospective study.MethodsMulticenter study (GENDOLCAT) of 3890 patients undergoing 4 common surgical procedures in 23 hospitals to develop a risk model for CPSP; 2352 men underwent open hernia repair. Patients with pain were identified by telephone at 1 and 3 months and referred to the hospital 4 months after surgery for a physical examination to confirm CPSP. Three validated tools were used: the Brief Pain Inventory (BPI) for severity, analgesic use, and interference with activities; the SF-12 questionnaire for QoL (validated Spanish version), and the Douleur Neuropathique 4 (DN4). Patients with CPSP were called again at 1 and 2 years.ResultsIn 1761 patients who underwent hernia repair and were eligible for physical examination for CPSP, the incidence of confirmed pain at 4 months was 13.6% (patient-reported pain, 6.2% at 1 year and 4.0% at 2 years). Neuropathic pain was diagnosed in 38.5% of the CPSP patients at 4 months. The incidences of neuropathic CPSP in patients with mesh or non-mesh repairs were similar (38.6 and 33.3%, respectively). SF-12 physical component scores changed little in all patients, whether or not they developed CPSP. The SF-12 mental component decreased significantly in all patients, but the decrease was clinically significant only in CPSP patients. CPSP interfered with activities (18%), work (15.6%), walking (15%) and mood (10.2%). At 2 years 52.1% of CPSP patients had moderate/intense pain and 28.2% took analgesics.ConclusionCPSP affects QoL-related activities, and although it diminishes over the course of 2 years after surgery, many patients continue to have moderate/intense pain and take analgesics. CPSP and neuropathic pain rates seem to be similar after mesh and non-mesh repair. BPI and SF-12 mental component scores detect effects on QoL.Trial registrationClinicalTrials.gov NCT01510496.

Laparoscopic parastomal hernia repair delays recurrence relative to open repair.

Mesh repair of parastomal hernia is widely accepted as superior to non-mesh repair, yet the most favorable surgical approach is a subject of continued debate. The aim of this study was to compare the clinical outcomes of open versus laparoscopic parastomal hernia repair. An IRB-approved retrospective review was conducted comparing laparoscopic (LPHR) or open (OPHR) parastomal hernia repair performed between 2009 and 2017 at our facilities. Patient demographics, preoperative characteristics, operative details, and clinical outcomes were compared by surgical approach. Subgroup analysis was performed by location of mesh placement. Repair longevity was measured using Kaplan-Meier method and Cox proportional hazards regression. Intention to treat analysis was used for this study based on initial approach to the repair. Sixty-two patients (average age of 61years) underwent repair (31 LPHR, 31 OPHR). Patient age, gender, BMI, ASA Class, and comorbidity status were similar between OPHR and LPHR. Stoma relocation was more common in OPHR (32% vs 7%, p = .022). Open sublay subgroup was similar to LPHR in terms of wound class and relocation. Open "Other" and Sublay subgroups resulted in more wound complications compared to LPHR (70% and 48% vs 27%, p = .036). Operative duration and hospital length of stay were less with LPHR (p < .001). After adjustment for prior hernia repair, risk of recurrence was higher for OPHR (p = .022) and Open Sublay and Other subgroups compared to LPHR (p = .005 and p = .027, respectively). Laparoscopic repair of parastomal hernias is associated with shorter operative duration, decreased length of stay, fewer short-term wound complications, and increased longevity of repair compared to open repairs. Direct comparison of repair longevity between LPHR and OPHR with mesh using Kaplan-Meier estimate is unique to this study. Further study is warranted to better understand methods of parastomal hernia repair associated with fewer complications and increased durability.

Modified keyhole technique for the treatment of parastomal hernia: A case series

IntroductionParastomal hernia is one of the common complications of permanent stoma, and its incidence was nearly 50%. Surgical management is challenging and associated with relatively high recurrence rate. Mesh repair was demonstrated to reduce recurrence compared to non-mesh repair, and modified Surgerbaker and keyhole technique are the most cited intraperitoneal mesh repairs. In the keyhole technique, recurrence often occurs by herniation through the central hole. We present four parastomal hernia cases successfully repaired by modified keyhole technique, in which a cylinder-shaped synthetic mesh was attached to the keyhole mesh to cover the angle between the keyhole and the bowel. Presentation of casesThere were 1 male and 3 females with mean BMI of 25.7 kg/m2. Mean operative time was 114 min. There were two end-colostomies, one loop-ileostomy and one ileal conduit cases. Postoperative complication was observed in two cases, which was cerebral infarction and paralytic ileus. There were neither infectious complications nor seroma formation, and mean postoperative hospital stay was 18 days. With mean follow-up time of 36 months (range 10–66), we experienced no recurrence. ConclusionsHaving lower recurrence rate, the modified Sugerbaker technique is considered preferable over the keyhole technique, but the bowel going to the stoma needs to be lateralized enough to be covered by relatively large mesh, which is not always accomplished. In such instances, our modified keyhole technique would be a feasible alternative.

Giant hiatus hernia: closure of the difficult hiatus

Repair of the large hiatus hernia has been troubled by diaphragmatic hiatal repair failure and recurrence. Use of mesh repair may reduce recurrence at a cost of increased reoperative complications and mesh fistulation. Methods of hiatal closure facilitation are described. Techniques and accompanying intra-surgery pictures are discussed here based on personal experience from within a service performing variable 100 giant hernia repairs annually. Techniques for closure of a large hiatus without mesh repair are described with illustration, the purpose to expose various techniques utilized in a service performing more than 100 giant hernia repairs annually. Techniques adopted and described in this article may facilitate both mesh and non-mesh repair of crural hiatal defects associated with giant hiatus hernia.

Laparoscopic transabdominal preperitoneal hernioplasty for recurrent obturator hernia: A case report

Reports of recurrence after obturator hernia repair are few. We describe the case of an 89-year-old woman who presented to us with a thrice recurrent obturator hernia. She had undergone open non-mesh repair twice and then laparoscopic non-mesh repair. She was readmitted to our hospital 6 months after the laparoscopic repair. Manual reduction was successful, paving the way for elective transabdominal preperitoneal repair. During the endoscopic repair, surgical mesh was placed extraperitoneally over the hernia defect and then fixed to Cooper's ligament with absorbable tacks. The patient was discharged on postoperative day 2 without complications. In the 2 months that have passed since the surgery there has been no sign of recurrence, but the patient will be carefully followed up. Repair of a recurrent obturator hernia is technically challenging; however, the transabdominal preperitoneal approach seems to be reliable and safe.

The most recent recommendations for the surgical treatment of inguinal hernia

The publication of new guidelines in recent years shows that surgical treatment of inguinal hernia remains topical. The main goal is to improve patient outcomes, specifically to decrease recurrence rates and reduce chronic pain. The main purpose of this article is to summarize the latest recommendations in surgical treatment of the groin hernias, especially in the case of strangulation. The authors made literature review of all the guidelines published by the hernia societies, including related articles, in the last ten years. The use of the EHS classification system is suggested. In elective operations, mesh repair is recommended. The Lichtenstein technique is the standard in open inguinal hernia repair. Transabdominal preperitoneal and totally extraperitoneal approach have comparable outcomes. Their clear advantages include minimal invasiveness. Mesh repair is recommended also in the case of strangulation, but only in clean and clean-contami-nated operations. Alaparoscopic approach should be considered as well. Inter alia, it allows an assessment of bowel viability during the whole procedure. The need of bowel resection is hence lower compared to open surgery. If it is not possible to use the mesh, the Shouldice method is regarded as the best non-mesh repair technique. If there is concern about bowel viability, visualization, either by formal laparoscopy, hernia sac laparoscopy or laparotomy, is recommended. Hernioscopy is asimple and safe procedure that uses the hernia sac for insertion of aport following insufflation and diagnostic examination. It requires less advanced laparoscopic skills than does emergency laparoscopic hernia repair. It can be performed even by surgeons who lack sufficient experience with laparoscopy. In elective procedures, the mesh repair is recommended. It is recommended also in the case of strangulation, but not in acontaminated-dirty surgical field. If there is concern about bowel viability, visualization, either by formal laparoscopy, hernia sac laparoscopy or laparotomy, is needed.

Laparoscopy Versus Open Incarcerated Inguinal Hernia Repair in Octogenarians: Single-Center Experience With World Review.

The clinical study is aiming to discuss the therapeutic benefit of laparoscopic hernia (LH) repair with comparing conventional open hernia (OH) repair in incarcerated hernia in octogenarians. The clinical data of 29 octogenarian incarcerated hernia patients who underwent hernia repair from November 2013 to March 2017 were retrospectively analyzed. The variables analyzed include baseline, operation characteristics, and clinical outcomes. The patients were divided into LH and OH according to the surgical approach and their clinical parameters were compared. Descriptive statistics were calculated, and outcomes were compared using the Fisher exact test and the student t test, a P≤0.05 was considered significant. Of reported 18 octogenarian patients, 7 patients underwent LH, whereas the remaining 11 patients underwent OH. The median age of the patients was 86 (81 to 97). All patients in LH group and 3 patients in OH group underwent nonmesh repair. In total, 8 patients in OH group underwent mesh repair. Simultaneous intestinal resection was needed in 4 patients (2 in LH, 2 in OH) due to the necrotic bowel. No mortality was observed in all subjects. The results showed significantly shorter operation time (50±5 vs. 110±3 min; P=0.000), hospital stay (6±1 vs. 12±3 d; P=0.04). There were no noteworthy postoperative complications and during the follow-up period, no patient experienced recurrent hernia in both groups. LH nonmesh repair has not increased the morbidity and mortality but showed shorter hospital stay and fast recovery and no recurrence in octogenarian incarcerated hernia patients. Therefore, LH in octogenarian incarcerated hernia patients might be preferred approach in sophisticated hands with acceptable outcomes.

Risk factors of postoperative complications after emergency repair of incarcerated groin hernia for adult patients: a retrospective cohort study

PurposeThis study aimed to explore risk factors of postoperative complications for adult patients with incarcerated groin hernia (IGH).MethodsFrom January 2010 to December 2017, consecutive patients undergoing emergency hernia repair for IGH in our center were retrospectively reviewed. Postoperative complications, such as surgical site infection, seroma, hernia recurrence and mortality, were investigated, with risk factors for such complications analyzed using univariate and multivariate regressions.ResultsSixty-four patients were included, with 51 males and 13 females (mean age 65.1, range 25–98 years). Ten patients (15.6%) underwent resection of necrotic bowel and anastomosis. 43 patients (67.2%) received open tension-free herniorrhaphy with polypropylene mesh, whereas the rest (32.8%) received herniorrhaphy without mesh. The overall postoperative complication rate was 40.6% (26/64), with an incisional complication rate of 31.2% (20/64) and an infection rate of 6.2% (4/64). At a median follow-up of 32 months, hernia recurrence and mortality were recorded in five cases each (7.8%). Mesh repair was associated with decreased recurrence rate compared with non-mesh repair (2.3% vs. 19.0%, p = 0.019). Diabetes mellitus (OR 8.611, 95%CI 1.292–57.405; p = 0.026) was an independent risk factor of postoperative complications, together with chronic obstructive pulmonary disease (COPD; OR 14.365, 95%CI 1.652–127.767, p = 0.016), intestinal necrosis (OR 14.260, 95%CI 1.079–188.460, p = 0.044), and general anesthesia (OR 14.543, 95%CI 1.682–125.711, p = 0.015) as risk for incisional complications after surgery.ConclusionsDiabetes mellitus was an independent risk factor of postoperative complications for IGH, along with COPD, intestinal necrosis and general anesthesia associated with incisional complications. The use of polypropylene mesh did not increase infection or recurrence rate in this cohort.

Mesh versus non-mesh for inguinal and femoral hernia repair.

Mesh versus non-mesh for inguinal and femoral hernia repair.