Risk Factors For Hernia Development Research Articles

Prophylactic mesh to prevent incisional hernia in laparotomy for ovarian tumors

ObjectiveIncisional hernias are a common complication of midline laparotomies. The aim of this study was to determine the impact of prophylactic mesh placement after midline laparotomy for ovarian tumors on...

Trocar Entry Site Hernias in Laparoscopic Sleeve Gastrectomy Patients: A Retrospective Cross-Sectional Study.

Introduction There is insufficient data regarding trocar access site hernias (TSH) in laparoscopic sleeve gastrectomy (LSG). This retrospective study aimed to identify the incidence and risk factors for hernia development in patients who did not undergo fascia repair at trocar entry sites. Materials and methods We retrospectively reviewed the records of 284 patients with morbid obesity who underwent LSG between January 2016 and December 2021. The fascia of the trocar entry site was not closed in any of the patients. Weight, body mass index (BMI), percentage of excess weight loss (%EWL), percentage oftotal weight loss (%TWL), comorbidities, and the occurrence of complications were recorded at one, six, 12, 18, and 24 months after surgery. Ultrasonography (USG) was performed and supplemented with computed tomography (CT) when necessary. Results All patients underwent a 24-month follow-up, during which four patients developed trocar site hernias, resulting in an overall prevalence of 1.4%. Of the total hernias, two occurred within the first 30 days. A single patient required surgical intervention for an incarcerated hernia on the 18th day. Before undergoing laparoscopic sleeve gastrectomy (LSG), the mean weight and body mass index (BMI) of the participants were 124.2 ± 16.7 kg and 43.4 ± 5.7 kg/m², respectively. After one year, the participants experienced a mean percentage of excess weight loss (EWL) of 77.1 ± 12.2% and a mean total weight loss (TWL) of 33.2 ± 6.2%. Hernia formation has been found to be associated with both type 2 diabetes (T2D) and female gender. Conclusion In laparoscopic sleeve gastrectomy (LSG), repair of the trocar port closure is not always necessary. The rates of hernia at port entry sites were similar between cases with and without fascial repair.

Hernia in pregnancy—Does it matter?

AbstractIntroductionPregnancy is a risk factor for hernia development. This review studies the natural history and outcomes of hernias in pregnant women treated in the Hong Kong West Cluster.MethodsThis is a cluster‐wide, retrospective descriptive study. Electronic medical records of women attending Hernia Clinics at Tung Wah Hospital or Queen Mary Hospital or those emergently admitted into the surgical department between January 2002 and January 2022 were screened. Inclusion criteria were women with: (i) hernia developed during pregnancy; and (ii) known unrepaired hernia developed prior to pregnancy.ResultsForty‐one patients were included. Median age of hernia onset was 31 years old. All patients continued with pregnancy with no hernia complications. None received hernia repair before delivery. Nine out of 41 patients (22.0%) received Caesarean section. Fourteen out of 22 (63.6%) patients with inguinal hernias developed during pregnancy reported hernia disappearance after delivery, of whom five experienced hernia recurrence. One out of five patients with ventral hernia developed during pregnancy experienced hernia disappearance after delivery with no recurrence. 43.9% received hernia repair after delivery.ConclusionsIt is safe to adopt conservative management in pregnant women. Vaginal delivery is not contraindicated. We recommend watchful waiting during pregnancy and repair after delivery.

Komunikan Hidroseli Olan Yenidoğanlarda Cerrahi Gerekliliğini Öngörebilir miyiz?: Prospektif Kohort Çalışma

Objective: To determine the predictive factors for surgery need, non-resolution and development of hernia, in neonates with communicating hydrocele. Material and Methods: All newborn babies were examined. Patients who were diagnosed as having a communicating hydrocele by physical examination and ultrasonography (being able to squeeze or press fluid from the scrotum back into the abdomen) were included in the study. Resolution was accepted as no presence of swelling on physical examination and ultrasonography and on medical history in the last 3 months. Patients whose hydrocele did not disappear until at least one year of age or developed inguinal hernia were operated. Hydroceles were divided into three groups 20 cc according to size. Results: Fifty-seven patients and 89 hydroceles were included in the final analysis. Of that 89, 24 (27%) hydroceles were operated, 10 (11.2%) of them due to hernia, and 14 (15.8%) no resolution. The surgical requirement was 2.25 times higher in the unilateral cases than bilateral ones (p=0.017). Surgery need was 2.2 times higher in the right side than left (p=0.04); 12 times higher in the >20 cc and 4.3 times higher in the 10-20 cc than 20 cc) is an important risk factor for hernia development.

Intracorporeal Suturing of MESH and Peritoneum during TAPP as Substituting for Tackers

Abstract Background groin hernia repair is considered to be one of the most commonly performed operations by general surgeons however; there is no “gold standard” operation for treatment of inguinal hernias. The optimal surgical approach must be selected individually for the patient, taking into account patient age, hernia size, unilaterality or bilaterality, primary or recurrent status, and type of anesthesia, occupation, and leisure activities. Aim of the Work is to compare the outcome results of the laparoscopic total extraperitoneal TEP hernia repair with mesh or the transabdominal preperitoneal repair (TAPP) with mesh to those of open repair with mesh. Patients and Methods this is a prospective study conducted on those who are diagnosed to have inguinal hernia (direct, indirect). 40 cases with direct, indirect, unilateral or bilateral inguinal hernia and will be divided into two groups: Group A 20 cases fixation a mesh with Tackers . Group B 20 cases fixation a mesh with intracorporeal sutures. The study will be Conducted at Ain Shams University hospitals (El-Demerdash) and other authorized hospitals under supervision of thesis supervisors. Results smoking appears to be a risk factor for hernia development since almost 55% of the study group A and 65% of the study group B were smokers, obesity also appears to be a risk factor since BMI was about 30.20± 7.82 among group A and 32.05 ± 5.98 among group B. This is in contrast to age which seems not to be as strongly related. Conclusion we found the rate of postoperative early and late complications comparable in both groups. But in the LAP group we were able to discharge them from the hospital faster than the OPEN group, they also resumed full activity early.

Incidence and risk factors for incisional hernia after temporary loop ileostomy closure: choosing candidates for prophylactic mesh placement.

The primary aim of this study was to identify the incisional hernia rate after temporary loop ileostomy closure. Secondary outcomes were determining the risk factors linked to this incisional hernia, which could improve the patient selection for mesh prophylaxis. Retrospective cohort study of all consecutive patients with temporary loopileostomy reversal through a peristomal incision from 1st January 2011 to 1st January 2017 at our centre. Data were extracted from electronic clinical records: baseline patient characteristics, surgical factors and postoperative events. CT scans performed during follow-up were precisely analysed. Survival analysis was applied to identify risk factors for hernia development. 129 patients were analysed of whom 15 (11.6%) developed an incisional hernia at previous ileostomy site. The median time for incisional hernia development was 11months (IQR = 7-21) and the median follow-up time was 37months (IQR = 22-57). The identified patient risk factors for hernia development in survival analysis were female sex, older age, higher Body Mass Index, clinically significant parastomal hernia, clinically detectable midline incisional hernia and major postoperative complications ranked as Clavien-Dindo gradeIIIandIV. Incisional hernia after temporary loop ileostomy is a relevant problem that affects at least one in every ten patients. The previously cited risk factors might favour its development, therefore the use of a prophylactic mesh should be considered in those high-risk patients.

Factors affecting the development of ventral incisional hernia post abdominal surgery: a retrospective cohort study

Background: Ventral incisional hernia (VIH) is one of the most common post-operative complications following abdominal surgery. The objective of this study was to evaluate the rate and risk factors associated with development of a ventral incisional hernia (VIH).Methods: Patients who underwent major abdominal surgery between 2010 and 2012 at a single institution were included in this retrospective cohort study. Data were collected from medical records. The primary outcome was clinical or radiological evidence of incisional hernia; explanatory variables were patient demographics and potential clinico-pathological risk factors for hernia development.Results: A total of 295 patients who underwent laparotomy were analysed. 45 (15.25%) patients were found to have a ventral incisional hernia on follow-up. The median time to development of hernia was 351 days. There were equal numbers of elective (N=22) and emergency (N=23) operations that developed an incisional hernia. Of the explanatory variables considered diabetes, hypertension (HTN) and body mass index (BMI) had persistent significant positive associations with the development of an incisional hernia. On univariable analysis diabetes (HR = 2.73, p-value = 0.004) and hypertension (HR =2.17, p-value = 0.016) were identified as independent risk factors for hernia development. BMI was also significantly associated with development of an incisional hernia on univariate analysis, but due to missing data this did not reach statistical significance on multivariable analysis.Conclusions: Although there are several risk factors to development of VIH, diabetes and HTN were associated with development of incisional hernia in our study. BMI also appears to be an important determinant of development of VIH. Further research in this area is likely to identify an at-risk subset of patients, who may benefit from weight loss prior to surgery or prophylactic mesh post-laparotomy.

Incidence of Ostomy Site Incisional Hernias after Stoma Closure

This study sought to evaluate the incidence of ostomy site incisional hernias after stoma reversal at a single institution. This is a retrospective analysis from 2001 to 2011 evaluating the following demographics: age, gender, indication for stoma, urgent versus elective operation, time to closure, total follow-up time, the incidence of and reoperation for stoma incisional hernia, diabetes, postoperative wound infection, smoking status within six months of surgery, body mass index, and any immunosuppressive medications. A total of 365 patients were evaluated. The median follow-up time was 30 months. The clinical hernia rate was 19 percent. Significant risk factors for hernia development were age, diabetes, end colostomies, loop colostomies, body mass index >30, and undergoing an urgent operation. The median time to clinical hernia detection was 32 months. Sixty-four percent of patients required surgical repair of their stoma incisional hernia. A significant number of patients undergoing stoma closure developed an incisional hernia at the prior stoma site with the majority requiring definitive repair. These hernias are a late complication after stoma closure and likely why they are under-reported in the literature.

Incisional hernia rate after laparoscopic colorectal resection is reduced with standardisation of specimen extraction.

Incisional hernia is a common complication of laparoscopic colorectal surgery. Extraction site may influence the rate of incisional hernias. Major risk factors for the development of incisional hernias include age, diabetes, obesity and smoking status. In this study, we investigated the effect of specimen extraction site on incisional hernia rate. Two cohorts of patients who underwent laparoscopic colorectal resections in a single centre in 2005 (n=85) and 2009 (n=139) were studied retrospectively. In 2005 all specimens were extracted through transverse muscle cutting incisions. In 2009 all specimens were extracted through midline incisions. Demographic variables, rate of incisional hernias and risk factors for hernia development were compared between the year groups. All patients had been followed up clinically for two years. A total of 224 patients (mean age: 67.5 years, standard deviation: 16.35 years) were included in this study. Of these, 85 patients were in the 2005 transverse group and 139 were in the 2009 midline group. The total incisional hernia rate for the series was 8.0% at the two-year follow-up visit. For the 2005 group, the incisional hernia rate was 15.3% (n=13) and for the 2009 group, it was 3.6% (n=5) (p<0.01). The body mass index was higher in patients who developed incisional hernias than in those who did not (p=0.02). The 2005 group had a significantly higher incisional hernia rate than the 2009 group. This is due to the differences in the incision technique and extraction site between the two groups.

Incidence and risk factors for the development of incisional hernia following elective laparoscopic versus open colon resections

Background There are few studies that compare the incidence of incisional hernia following elective laparoscopic colon resection to open colectomy and determine the risk factors for its development. Methods Elective open and laparoscopic colon resections performed between February 2002 and May 2007 were reviewed. In the laparoscopic group, mesenteric transection was performed via intracorporeal division for left-sided colectomy and via extracorporeal technique for right-sided colectomy. The ileocolic anastomosis was performed by extracorporeal stapling for right colectomies and by intracorporeal for left colectomies. Results Two hundred eighteen patients (mean age 62 years, 52% male) underwent elective colon resection (50% open, 5% hand-assisted, and 45% laparoscopic). Six percent of the cases that started as laparoscopic were converted and are included in the open group. Mean follow-up was 26 months. The overall incisional hernia rate was 16% (open and minimally invasive group 17% vs 15%, P = .14). Hernia was not dependent on the type of resection, indication, or extraction site. Body mass index >36 kg/m 2, male gender, and surgical site infection were risk factors for hernia development. Conclusions Laparoscopic colectomy does not reduce the development of incisional hernia.

Inguinal hernia repair with polypropylene mesh during radical retropubic prostatectomy: an easy and practical approach

To report the results of the simultaneous inguinal hernia repair during radical retropubic prostatectomy (RRP) with the preperitoneal tension-free Stoppa technique, using a polypropylene mesh. During 855 consecutive RRPs, 40 (5%) patients (median age 66.9 years, range 52-81) with 49 inguinal hernias had a simultaneous inguinal hernioplasty. The RRP was performed according to the Walsh modified technique. After the prostate and seminal vesicles were removed and the urethrovesical anastomosis completed, a polypropylene mesh of maximum size 15 x 7.5 cm and a small slit on its medial side was then created and placed in the preperitoneal space, embracing the spermatic cord and covering the myopectinal orifice. Preoperative risk factors, e.g. constipation, pulmonary disease or urinary obstructive symptoms, were collected retrospectively from the files. Complications after surgery, including wound infection, pelvic collections, urinary fistula and recurrence of the hernia, were assessed. Preoperative risk factors for hernia development were identified in 23 (58%) patients; three had recurrent hernias. With a median 23.1 months of follow-up period two (4%) hernias recurred. There were no complications after surgery. Preperitoneal hernia repair with polypropylene mesh is safe, effective and practical. The procedure simultaneous with RRP gave a 96% success rate and with no significant increase in operating time or additional complications.