Prevalence Of Hernia Research Articles

An estimate of hernia prevalence in Nepal from a countrywide community survey

Background: Herniorrhaphy is one of the most frequently performed general surgical operations worldwide. However, most low- and middle-income countries (LMICs) are unable to provide this essential surgery to the general public, resulting in considerable morbidity and mortality. This study aimed to estimate the prevalence, barriers to care and disability of untreated hernias in Nepal. Methods: Nepal is a low-income country in South Asia with rugged terrain, infrastructure deficiencies and a severely under-resourced healthcare system resulting in substantial unmet surgical need. A cluster randomized, cross-sectional household survey was performed using the validated Surgeons OverSeas Assessment of Surgical (SOSAS) tool. Fifteen randomized clusters consisting of 30 households with two randomly selected respondents each were sampled to estimate surgical need. The prevalence of and disability from groin hernias and barriers to herniorrhaphy were assessed. Results: The survey sampled 1350 households, totaling 2695 individuals (97% response rate). There were 1434 males (53%) with 1.5% having a mass or swelling in the groin at time of survey (95% CI 1.8–4.0). The age-standardized rate for inguinal hernias in men ranged from 1144 per 100,000 persons between age 5 and 49 years and 2941 per 100,000 persons age ≥50 years. Extrapolating nationally, there are nearly 310,000 individuals with groin masses and 66,000 males with soft/reducible groin masses in need of evaluation in Nepal. Twenty-nine respondents were not able to have surgery due to lack of surgical services (31%), fear or mistrust of the surgical system (31%) and inability to afford care (21%). Twenty percent were unable to work as previous or perform self-care due to their hernia. Conclusions: Despite the lower than expected prevalence of inguinal hernias, hundreds of thousands of people in Nepal are currently in need of surgical evaluation. Given that essential surgery is a necessary component in health systems, the prevalence of inguinal hernias and the cost-effectiveness of herniorrhaphy, this disease is an important target for LMICs planning surgical capacity improvements.

Internal mimics hernias and their mimics: How would radiologists help?

PurposeTrying to define the most valuable radiological sign(s) for the diagnosis of internal hernias and their mimics; mainly cocoon syndrome and adhesions. ReviewNowadays with the increasing number of bariatric surgeries, the number of diagnosed internal hernias has increased significantly. Adhesions and cocoon syndrome are among the differential diagnosis. Although many signs were suggested for the diagnosis of such conditions, yet no single sign is enough to diagnose each of the above. Method and subjectsThis is a retrospective study. In a period of 32 consecutive months, from June 2010 to February 2013 a total of 240 patients were admitted with abdominal pain with signs of remittent or persistent intestinal obstruction. All cases are subjected to multislice CT examination. Several criteria are used to diagnose internal hernia. Informed consents were taken from all patients and organizational ethics committee were informed. ResultsThe age of the patients varies between 22 and 63years with average age of 36±2.3years. Most of the patients were females with ratio of 2:1. Commonest presentation was abdominal pain present in all cases. The study diagnosed 13 cases/internal hernias, 14/adhesions, two cases/cocoon syndrome, two cases/intussusceptions and one case/malrotation. The most important signs used are Swirl’s sign, localized bowel gathering and segmental bowel dilatation. ConclusionA single sign is not enough for the diagnosis of internal hernia, rather the use of more than one sign is essential to narrow the differential diagnosis. Clinical relevance/applicationThe prevalence of internal hernia is increasing due to increased rate of operative abdominal intervention. Prompt radiological diagnosis is crucial to avoid unwanted surgery in a non-virgin abdomen.

Association between thoracic aortic disease and inguinal hernia.

BackgroundThe study hypothesis was that thoracic aortic disease (TAD) is associated with a higher‐than‐expected prevalence of inguinal hernia. Such an association has been reported for abdominal aortic aneurysm (AAA) and hernia. Unlike AAA, TAD is not necessarily detectable with clinical examination or ultrasound, and there are no population‐based screening programs for TAD. Therefore, conditions associated with TAD, such as inguinal hernia, are of particular clinical relevance.Methods and ResultsThe prevalence of inguinal hernia in subjects with TAD was determined from nation‐wide register data and compared to a non‐TAD group (patients with isolated aortic stenosis). Groups were balanced using propensity score matching. Multivariable statistical analysis (logistic regression) was performed to identify variables independently associated with hernia. Hernia prevalence was 110 of 750 (15%) in subjects with TAD versus 29 of 301 (9.6%) in non‐TAD, P=0.03. This statistically significant difference remained after propensity score matching: 21 of 159 (13%) in TAD versus 14 of 159 (8.9%) in non‐TAD, P<0.001. Variables independently associated with hernia in multivariable analysis were male sex (odds ratio [OR] with 95% confidence interval [95% CI]) 3.4 (2.1 to 5.4), P<0.001; increased age, OR 1.02/year (1.004 to 1.04), P=0.014; and TAD, OR 1.8 (1.1 to 2.8), P=0.015.ConclusionsThe prevalence of inguinal hernia (15%) in TAD is higher than expected in a general population and higher in TAD, compared to non‐TAD. TAD is independently associated with hernia in multivariable analysis. Presence or history of hernia may be of importance in detecting TAD, and the association warrants further study.

Impact of pelvic osteotomy on the incidence of inguinal hernias in classic bladder exstrophy

Background/purposeThe high prevalence of inguinal hernias in the bladder exstrophy population is well documented. The authors' aim is to determine whether pelvic osteotomy reduces the incidence of primary and recurrent inguinal hernias in patients with classic bladder exstrophy. MethodsUsing an institutionally-approved database, patients who underwent immediate or delayed primary bladder closure between 1974 and 2012 were identified and stratified by the use of pelvic osteotomy at the time of closure. Data were analyzed using Fisher's exact test and multivariate logistic regression analysis. ResultsOne hundred thirty-six patients were identified with a median follow up of 8years. The incidence of inguinal hernias following closure was 25% in the osteotomy group versus 46% in the non-osteotomy group (p=0.017). Osteotomy was associated with a significant decrease in recurrence of inguinal hernias amongst patients who underwent previous repair (17% versus 47%, osteotomy versus non-osteotomy, p=0.027) and the development of primary inguinal hernias in whom initial groin exploration was negative (20% versus 39%, p=0.029). Osteotomy and female sex were associated with a decreased rate of inguinal hernia development after bladder closure while age at closure was not. ConclusionsPelvic osteotomy at the time of exstrophy closure decreases the likelihood of primary or recurrent inguinal hernia development.

The Importance of Surgeon-reviewed Computed Tomography for Incisional Hernia Detection: A Prospective Study

Patients with incisional hernias or abdominal pain are frequently referred with abdominal computed tomography (CT) scans. The purpose of this study was to determine the sensitivity and specificity of a CT radiology report for the detection of incisional hernias. General surgery patients with a history of an abdominal operation and a recent viewable abdominal CT scan were enrolled prospectively. Patients with a stoma, fistula, or soft tissue infection were excluded. The results of the radiology reports were compared with blinded, surgeon-interpreted CT for each patient. Testing characteristics including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. One hundred eighty-one patients were enrolled with a mean age of 54 years. Sixty-eight per cent were women. Hernia prevalence was 55 per cent, and mean hernia width was 5.2 cm. The radiology report had a sensitivity and specificity of 79 per cent and 94 per cent, respectively, for hernia diagnosis. The PPV and NPV were 94 and 79 per cent, respectively. Reliance on the CT report alone underestimates the presence of incisional hernia. Referring physicians should not use CT as a screening modality for detection of hernias. Referral to a surgeon for evaluation before imaging may provide more accurate diagnosis and potentially decrease the cost of caring for this population.

Prevalence of Surgical Affections of Cattle in Aarong Dairy Area of Pabna

AARONG dairy area of Pabna comprises a major part to meet the demand of milk and meat production in Bangladesh. Various diseases including surgical affections reduce the fitness, efficiency and productivity of cattle in this area. There is a need to investigate the occurrence of surgical diseases to take proper preventive measures. Therefore, the prevalence of surgical affections of cattle was studied in four Upazilas of Pabna from December 2012 to May 2013. A total of 2390 cattle from different households were included and surgical affections were recorded. The overall prevalence was 44.3% in stall feeding system, among which surgical affections were more prevalent in Sujanagar Upazilas (13.3%), and the highest prevalent surgical affection was foot diseases (8.2%) followed by navel ill (6.3%), myiasis (4.6%), arthritis, hernia and wounds (3.6%). Overall prevalence of surgical affections was slightly higher in female cattle in comparison to males The prevalence of navel ill (11.3%), foot disease (11.1%), hernia (6.1%) and horn affections (4.9%) were found to be higher in male. Whereas, myiasis (5.9%), upward patellar fixation (2.8%) were found to be higher in females. There is significant (P&lt;0.01) difference in the prevalence of hernia, upward patellar fixation, horn affection, foot diseases and myiasis between male and female. It was also observed that cattle of 0-1 year was affected more frequently with surgical affections (18.7%) among which prevalence of navel ill (15.5%), hernia (8.3%), myiasis (5.4%) and foot diseases (5.3%) were higher. In addition, foot disease was more prevalent surgical affection in cattle of more than one year. Moreover, significant variation (P&lt;0.01) was existed in the prevalence of upward patellar fixation, foot diseases, arthritis and wounds among three age groups. However, results of the present study indicate that there is a strong relation among the prevalence of surgical affections, sex and age of animals. Moreover, foot disease is a common occurrence in stall feeding cattle in Pabna.DOI: http://dx.doi.org/10.3329/pa.v24i1-2.19104 Progress. Agric. 24(1&amp;2): 85 - 92, 2013

The Prevalence of Abdominal Hernias in Patients with Symptomatic Femoroacetabular Impingement

The purpose of this study was to evaluate the prevalence of abdominal hernias (femoral and inguinal) in patients with symptomatic femoroacetabular impingement (FAI). A consecutive case series of 79 patients (87 hips) with radiologic evidence and clinical symptoms of FAI seen by two of the authors (ML and FDN) where sent for an abdominal ultrasound evaluation to assess for the presence of inguinal or femoral hernia. Patients also underwent diagnostic injection of their hip joints. Basic demographics were collected and radiologic measurements for FAI were performed. The mean age of patients in this series was 29.5 years (range, 12-64 years). Of the 87 hips evaluated (79 patients, 8 with bilateral pathology), 34 (39%) were found to have evidence of femoral (10), inguinal (24) hernias, or both concurrently (3). Twenty-three (23) of these (68%) were male. Six (6) of the patients with hernias, either had no or minimal improvement with intra-articular injection. Two (2) of those were found to insertional tendinosis at the os pubis and four (4) underwent surgical repair of their hernia. There were no statistically significant differences with regards to age, center-edge angle, acetabular index, acetabular version, femoral neck-shaft angle. However, we found a statistically significant lower alpha angle (51.8) in patients with hernias compared to without hernias (57.9, p<0.05). Symptomatic and radiologic significant FAI can occur concurrently with abdominal hernias. In patients who do not respond to intra-articular injection, abdominal ultrasound may be an important diagnostic tool to identify abdominal hernias as source of groin pain similar to FAI symptoms. These patients may require referral to a general surgeon for further treatment. Future studies are aimed at assessing the feasibility of integrating abdominal ultrasound evaluation into the diagnostic workup of FAI and at exploring the difference in alpha angles.

Prevalence of treated and untreated groin hernia in eastern Uganda

Hernia repair is the most commonly performed general surgical procedure worldwide. The prevalence is poorly described in many areas, and access to surgery may not be met in low- and middle-income countries. The objectives of this study were to investigate the prevalence of groin hernia and the surgical repair rate in a defined sub-Saharan region of Africa. A two-part study on hernia prevalence was carried out in eastern Uganda. The first was a population-based prevalence study with 900 randomly selected men in a Health and Demographic Surveillance Site. The second was a prospective facility-based study of all surgical procedures performed in the two hospitals providing surgical care in the region. The overall prevalence of groin hernia (current hernia or scar after groin hernia surgery) in men was 9.4 per cent. Less than one-third of men with a hernia had been operated on. More than half had no pain symptoms. The youngest age group had an overall prevalence of 2.4 per cent, which increased to 7.9 per cent in the age range 35-54 years, and to 37 per cent among those aged 55 years and above. The groin hernia surgery rate at the hospitals investigated was 17 per 100,000 population per year, which corresponds to a surgical correction rate of less than 1 per cent per year. Based on hospital records, a considerable number of patients having surgery for groin hernia were women (20 of 84 patients, 24 per cent). Groin hernia is a common condition in men in this east Ugandan cohort and the annual surgical correction rate is low. Investment is needed to increase surgical capacity in this healthcare system.

(827) - Prevalence of Forgut Dysfunction in Pulmonary Fibrosis and COPD Patients Undergoing LTx Evaluation

Pulmonary fibrosis (PF) & COPD are progressive and fatal lung diseases that lead to lung transplantation (LTx). However, the respiratory physiology, intrathoracic pressure variation, and chest wall compliance are markedly different. Gastroesophageal reflux (GER) is a significant risk factor for development and/or progression of end-stage lung disease pre-LTx and chronic rejection post-LTx. This study attempts to define the prevalence of forgut dysfunction based on comprehensive GI testing in patients with end-stage PF and COPD undergoing transplant evaluation. From February 2009-March 2012 126 people underwent bilateral lung transplantation. These patients underwent comprehensive pre-transplant GER work-up including EGD, manometry, esophagram pH testing and nuclear medicine gastric emptying studies. Except gastric emptying readings, all foregut function studies were performed by the same transplant surgeons. Tests were analyzed for comparison between groups according to disease states. The association for group by outcome variables were tested using contingency tables and a chi-square test statistics. Complete data was collected in 82 patients with a mean age of 56.5 years +/- 14.4 years. 41(50%) classified as COPD, 41(50%) PF. No significant differences in prevalence of hiatal hernia (HH) (46% vs. 64%), barrett’s (3% vs. 0%) or delayed gastric emptying (17% vs. 13%) between COPD vs. PF respectively. Similarly, no difference noted in manometer LES basal tone and wave amp @ 7cm. Mean DeMeester pH scores significantly higher in PF (40.1) vs. COPD (15.5), p=0.003. Proportion of time with pH < 4 was significantly higher in PF vs. COPD (1.5% vs. 0.5%, p=0.015). The prevalence of forgut dysfunction based on comprehensive GI testing in patients with end-stage lung disease is significant. pH probe assessment demonstrated a significantly higher proportion of time spent at pH< 4 and elevated DeMeester scores in PF compared to COPD. However, no significant difference were noted in the presence of HH or barrett’s, delayed gastric emptying, or manometer assessments between cohorts.

Laparoscopic incisional hernia repair in an ambulatory surgery–extended recovery centre: a review of 259 consecutive cases

The high prevalence of incisional hernias and an average stay of 3-10 days for open procedures have made this pathology both a health problem and an economic issue. A protocol was developed for performing this procedure in an Ambulatory Surgery Center (ASC) with extended recovery. From January 2000 to December 2011, data about all laparoscopic incisional hernia repairs were gathered prospectively. The patients' clinical features, hernia type, intraoperative and postoperative complications and reasons for hospital admission are studied. A total of 259 patients have been operated for incisional hernia (185) or recurrent hernioplasty (74) in our ASC. Laparoscopic repair was successful in 254 patients (98.07 %). Conversion to open surgery was necessary in five patients (1.93 %). A total of 50 patients (19.69 %) in whom surgery was completed laparoscopically were discharged the same day of surgery, 179 (70.47 %) at 24 h and 25 (9.84 %) required a stay of over 24 h. Postoperative pain was severe in 10 % of patients, moderate in 40 %, and mild in 50 %. Complications, mostly minor and self-limiting, were observed in 25 patients (9.84 %) during hospital stay. Five major complications that occured were: bile peritonitis, an acute peritonitis, due to an inadvertent intestinal perforation, and one intestinal obstruction by partial detachment of the mesh, an intra-abdominal hematoma and a colo-cutaneous fistula. There were no deaths in the series. The mean follow-up of patients was 29.35 months (range 12-129 months). The recurrence rate was 7.03 % (n = 18). Four trocar-site hernias were detected. It is essential to create a protocol with selection criteria that take into account the patient, his entourage, the anesthetic-surgical procedure, and a team dedicated to surgical laparoscopic surgery in an ASC with extended recovery to achieve good results in terms of morbidity and patient safety.

Comparing of two surgical techniques in large incisional hernias

Objectives: Incisional hernias occur from incisions of previous abdominal operations. It is an often complication of abdominal interventions. Prevalence of incisional hernias is approximately 2.9% and 3.6% in vertical midline incisions and transverse incisions, respectively. Incisional hernias cause morbidity and loss of manpower. The only treatment option is surgery. We aimed to compare surgical methods of incisional hernias and discuss the postoperative data in this retrospective report. Methods: We retrospectively analyzed the data of 54 patients with large incisional hernias operated between 2007 and 2011. Results: We compared age, chronic diseases (e.g. Chronic obstructive pulmonary disease, diabetes mellitus),which may cause postoperative recurrence, gender, personal factors, such as patients undergoing incisional hernia repair mesh over solid fascia less or over than 5 cm with the placement of decolation; recurrence, the development of postoperative seroma, receiving postoperative drainage and postoperative length of hospital stay were compared. While the recurrence rate of less than 5 cm above the decolation; seroma development, no significant difference in length of hospital stay and drain times to get. Conclusion: In conclusion, we think that recurrence rate should be reduced by dissection of 5 cm intact fascia and grafting in incisional hernias of anterior abdominal wall.

Prospective Evaluation of Surgeon Physical Examination for Detection of Incisional Hernias

Surgeon physical examination is often used to monitor for hernia recurrence in clinical and research settings, despite a lack of information on its effectiveness. This study aims to compare surgeon-reviewed CT with surgeon physical examination for the detection of incisional hernia. General surgery patients with an earlier abdominal operation and a recent viewable CT scan of the abdomen and pelvis were enrolled prospectively. Patients with a stoma, fistula, or soft-tissue infection were excluded. Surgeon-reviewed CT was treated as the gold standard. Patients were stratified by body mass index into nonobese (body mass index <30) and obese groups. Testing characteristics and real-world performance, including positive predictive value and negative predictive value, were calculated. One hundred and eighty-one patients (mean age 54 years, 68% female) were enrolled. Hernia prevalence was 55%. Mean area of hernias was 44.6 cm(2). Surgeon physical examination had a low sensitivity (77%) and negative predictive value (77%). This difference was more pronounced in obese patients, with sensitivity of 73% and negative predictive value 69%. Surgeon physical examination is inferior to CT for detection of incisional hernia, and fails to detect approximately 23% of hernias. In obese patients, 31% of hernias are missed by surgeon physical examination. This has important implications for clinical follow-up and design of studies evaluating hernia recurrence, as ascertainment of this result must be reliable and accurate.

An estimate of hernia prevalence in Sierra Leone from a nationwide community survey

A large number of unrepaired inguinal hernias is expected in sub-Saharan Africa where late presentation often results in incarceration, strangulation, or giant scrotal hernias. However, no representative population-based data are available to quantify the prevalence of hernias. We present data on groin masses in Sierra Leone to estimate prevalence, barriers to care, and associated disability. A cluster randomized, cross-sectional household survey of 75 clusters of 25 households with 2 respondents each was designed to calculate the prevalence of and disability caused by groin hernias in Sierra Leone using a verbal head-to-toe examination. Barriers to hernia repairs were assessed by asking participants the main reason for delay in surgical care. Information was obtained from 3,645 respondents in 1,843 households, of which 1,669 (46%) were male and included in the study. In total, 117 males or 7.01% (95% CI 5.64-8.38) reported a soft or reducible swelling likely representing a hernia with four men having two masses. Of the 93.2% who indicated the need for health care, only 22.2% underwent a procedure, citing limited funds (59.0%) as the major barrier to care. On disability assessment, 20.2% were not able to work secondary to the groin swelling. The results indicate groin masses represent a major burden for the male population in Sierra Leone. Improving access to surgical care for adult patients with hernias and early intervention for children will be vital to address the burden of disease and prevent complications or limitations of daily activity.

An estimation of inguinal hernia epidemiology adjusted for population age structure in Tanzania

Surgical conditions represent a significant source of global disease burden. Little is known about the epidemiology of inguinal hernia in resource-poor settings. We present a method to estimate inguinal hernia disease burden in Tanzania. Using data from the United States National Health and Nutrition Examination Survey (NHANES) prospective cohort study and Tanzanian demographic figures, we calculated inguinal hernia incidence and prevalence in Tanzanian adults under three surgical rate scenarios. Gender-specific incidence figures from NHANES data were adjusted according to Tanzanian population age structure. Hernia duration was adjusted for Tanzanian life expectancy within each age group. The prevalence of inguinal hernia in Tanzanian adults is 5.36% while an estimated 12.09% of men had hernias. Today, 683,904 adults suffer from symptomatic inguinal hernia in Tanzania. The annual incidence of symptomatic hernias in Tanzanian adults is 163 per 100,000 population. At Tanzania's current hernia repair rate, a backlog of 995,874 hernias in need of repair will develop over 10 years. 4.4 million disability-adjusted life-years would be averted with repair of prevalent symptomatic hernias in Tanzania. Our data indicate the extent of inguinal hernia disease burden in Tanzania. By adjusting our figures for the age structure of Tanzania, we have demonstrated that while the incidence of symptomatic cases may be lower than previously thought, prevalence of inguinal hernia in Tanzania remains high. This approach provides an update to our previously described methodology for calculation of inguinal hernia epidemiology in resource-poor settings that may be used in multiple country contexts.

The in vivo evaluation of tissue‐based biomaterials in a rat full‐thickness abdominal wall defect model

Hernias are defects in which an anatomical fascia is breached resulting in ectopic positioning of an organ into an orifice which routinely does not contain it. Intervention often involves repositioning translocated organs and repair of damaged fascia using exogenous grafts. Despite hernia prevalence, repairs can still fail due to postoperative complications, such as chronic pain and decreased mobility. This study compared repair capacities and characterized the foreign body response elicited by a number of hernia repair grafts to deduce their bulk inflammatory properties while also concluding the point in their fabrication when these are inferred. Materials derived from human dermis (Alloderm(®) ), porcine dermis (Permacol™, patch A, patch D and Strattice(®) ), porcine small-intestinal submucosa (Surgisis™) and a synthetic (multifilament Surgipro™) were implanted into a rat full-thickness abdominal wall excision model, incubated for up to 2 years and characterized histopathologically. Surgisis™ resorbed the fastest of the materials tested (1-3 months) resulting in a mechanically stable parietal peritoneum. Decellularization using sodium dodecyl sulfate (patch A) stimulated a large early inflammatory response which ultimately may have contributed to increased resorption of porcine dermal matrix however the remaining materials typically persisted throughout the 2-year incubation. Cross-linking porcine dermis using 1,6-hexamethylene disocyanate (vs. an identical noncross-linked counterpart) showed no difference in cell recruitment or material integration over 2 years. Typically Strattice(®) and Alloderm(®) recruited larger early populations of cells than Permacol™; however, over extended periods of time in vivo this response normalized.

Author’s Response: Anatomical Basis for the Low Incidence of Internal Hernia After a Laparoscopic Roux-en-Y Gastric Bypass Without Mesenteric Closure

Dear Editor: We thank Drs. Facchiano, Lucchese and Ianelli for their useful comments. These fine scholars have been motivated by this issue, and some of their work was referenced in our article. We are grateful for their comments regarding our surgical results. We are very proud of the very lowmorbidity and good follow-up that we reported; we think that these factors support our conclusions. Obviously, we share their opinions about the factors that reduce the incidence of postoperative internal hernia. We took these factors into account when we decided which method to implement with the laparoscopic approach. Our method was not original and did not state as such in our article [1].We took different aspects of the procedure from several authors (which is a very common strategy for all surgeons). We agree with Facchiano et al. that division of the omentum is not relevant in the long term. However, in our experience, it was not necessary in most of the cases. Also, an undivided omentum hinders herniation in the early postoperative period. We agree with Facchiano et al. that the position of the mesenteric defect is dependent upon the length of the gastric pouch and site of the gastrojejunal anastomosis, being higher if the pouch is small, and if the anastomosis is side-to-side. In our experience, the gastrojejunostomy did not show tension. We think that this feature was because of the 4-week hypocaloric diet administered before surgery, which reduced the volume of abdominal fat and enlarged the mesentery. In our method, the jejunojejunostomy was consistently above the common channel at the end of the procedure and was only slightly below the gastrojejunostomy (as can be seen in the figures). Of course, herniation of the biliopancreatic or alimentary loops is possible but is very unlikely. In our article, we did not advise against closing the mesenteric defect; we think that this is a good method if carried out correctly (as Facchiano et al. explained in their letter). However, we provided evidence of the very low prevalence of internal hernia in our patients without closure of the mesenteric defect. In our opinion, these results justify not closing the mesenteric defect. Of course, bowel obstructions because of internal hernias can occur in the long term, as is the case because of adhesions after any type of surgery. We described a stapled linear gastrojejunostomy and noted that it was another factor that helped safety. Compared with a circular mechanical anastomosis, simultaneous use of this suture with the stitch that hangs to the jejunal loop from the stomach makes the rotation of the alimentary limb more difficult. However, this is our personal opinion, and experimental or bibliographic evidence is lacking. In conclusion, we provided evidence that, after laparoscopic Roux-en-Y gastric bypass (LRYGB) is carried out with the technical details mentioned in the article, closing the mesenteric defect to avoid internal hernia is not necessary (at least at medium-term follow-up). We believe that the comments from Facchiano et al. are valuable and may help to improve outcomes.We agree that, in other versions of LRYGB, closing the mesenteric defect may be advisable as has been demonstrated.

Chronic kidney disease is associated with high abdominal incisional hernia rates and wound healing disturbances

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 a4-month follow-up period were determined. 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. 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 %). Chronic kidney disease is associated with impaired wound healing and constitutes an independent risk factor for incisional hernia development.

Lack of association between inguinal hernia and abdominal aortic aneurysm in a population-based male cohort

Previous studies have reported a higher prevalence of inguinal hernia in patients with abdominal aortic aneurysm (AAA). The aim of this study was to explore the association between inguinal hernia and AAA in a large population-based cohort of men who had screening for AAA. A total of 18,331 men aged 65-76 years had ultrasound screening for AAA in the Central Region of Denmark from 2008 to 2010. The Danish National Patient Registry was interrogated, and screened men registered with an inguinal hernia from 1977 to 2011 were identified. The association between inguinal hernia and AAA was assessed by multiple logistic regression analysis. The prevalence of AAA was 3.3 per cent (601 of 18,331). A total of 2936 (16.0 per cent) of the 18,331 patients were registered with a diagnosis of inguinal hernia or hernia repair. Inguinal hernia was not associated with AAA: crude odds ratio (OR) 0.86 (95 per cent confidence interval 0.68 to 1.09) and adjusted OR 0.94 (0.75 to 1.20). In contrast to smaller patient-based studies, this large population-based study found no association between inguinal hernia and AAA.

Gastro-oesophageal reflux disease in type 2 diabetics: symptom load and pathophysiologic aspects - a retro-pro study

BackgroundInformation about gastro-oesophageal reflux disease (GERD) in patients with Diabetes mellitus type 2 (T2D) is scarce, although the incidence of both disorders is increasing.We aimed to determine GERD symptoms and their underlying pathophysiologic characteristics in T2D patients.MethodsThis “retro-pro” study compared 65 T2D patients to a control group of 130 age- and sex-matched non-diabetics. GERD was confirmed by gastroscopy, manometry, pH-metry and barium swallow.ResultsIn patients with T2D compared to controls, dysphagia (32.3% vs. 13.1%; p = 0.001) and globus sensation (27.7% vs. 13.8%; p = 0.021) were found more frequently, whereas heartburn (76.9% vs. 88.5%; p = 0.046) and regurgitation (47.7% vs. 72.3%; p = 0.001) were predominant in non-diabetics. Despite higher body mass indices (31.1 ± 5.2 vs. 27.7 ± 3.7 kg/m2; p < 0.001), hiatal hernia was less frequent in T2D patients compared to controls (60.0% vs. 90.8%, p < 0.001). Lower oesophageal sphincter (LES) pressure was higher in patients with T2D (median 10.0 vs. 7.2 mmHg, p = 0.016). DeMeester scores did not differ between the groups. Helicobacter pylori infections were more common in T2D patients (26.2% vs. 7.7%, p = 0.001). Barrett metaplasia (21.5% vs. 17.7%), as well as low- (10.8% vs. 3.8%) and high-grade dysplasia (1.5% vs. 0%) were predominant in T2D patients.ConclusionsT2D patients exhibit different GERD symptoms, higher LES pressures and a decreased prevalence of hiatal hernia than non-diabetics, which may be related to worse oesophageal motility and, thus, a more functional rather than anatomical cause of GERD. Low-grade dysplasia was more than twice as high in T2D than in non-diabetics patients.Trial registrationEthics committee of the Medical University of Vienna, IRB number 720/2011.

Profile and economic impact of motorcycle injuries treated at a university referral hospital in Kigali, Rwanda

INTRODUCTION: Inguinal hernia repair (IHR) is frequently performed during humanitarian surgical missions due to the high prevalence of hernia in low income countries (LIC). It is unclear whether the allocation of resources aimed at IHR is justified as the burden of these hernias is unknown. We hypothesized that inguinal hernias result in significant reduction in activity and productivity in LIC.