Surgery For Recurrent Hernia Research Articles

Role of general and local antibiotic prophylactic in hernia repair

The current study was designed to evaluate the effect of using prophylactic antibiotic in preventing wound infection post operatively in patients with non recurrent hernia surgery. A prospective study of 180 patients with inguinal hernia where divided into three groups -:first group of 90 patients were operated on with administration of three dose of ( third generation) cephalosporin. First dose given perioperatively Second dose given eight hours post operatively later. Third dose given 24 hour post operatively later , Second group 40 patients local Garamycine 80 MG diluted in 250 saline solution was used to wash the wound of each patients , third group fifty patients (27.7%) patients were remain without any antibiotic post operatively. Observation of all patients regarding site of surgery were done till ten days after removal of stitches, so Wound swab were taken whenever any signs of infection begin to show on wound and send for culture and drug sensitivity. Result :wound infection was occur 5.5 % (five patients ) out of ninety patients in the first group while it occur in 2.5% (one patients) in the second group and in the third group 6% ( three patients) conclusion :no difference in infection rate weather the patients receive prophylactic antibiotic or not . there is less infection by using local antibiotic in comparison with other two groups but this difference is not statically significant p-value(0.7082).

Outcomes of concomitant ventral hernia repair performed during bariatric surgery.

Currently there is no consensus on management of ventral hernias encountered during bariatric surgery (BS). This study aims to evaluate the incidence and outcomes of concomitant ventral hernia repair (VHR) during BS at our institution. Patients who had concomitant VHR during BS from 2004 to 2015 were identified. Data collected included baseline demographics, comorbidities, perioperative parameters, surgical approach and postoperative outcomes. A total of 159 patients underwent concomitant VHR during the study period at the time of BS. One hundred and one (64%) patients were female; median age was 53years (IQR 45.0-60.3) and median BMI was 48.2kg/m2 (IQR 41.6-54.1). Comorbidities included: hypertension (n=124, 78%), type 2 diabetes (n=103, 65%), hyperlipidemia (n=100, 63%), obstructive sleep apnea (n=98, 62%) and reflux disease (n=54, 34%). Out of 159 patients, 41 patients (26%) had a prior VHR. Out of 103 patients, 69 patients (67%) had a previous abdominal surgery. Of the concomitant VHR, 144 (91%) were completed laparoscopically, 12 (7%) patients were converted to open surgery and 3 (2%) patients underwent primary open procedures. Technique included primary suture closure in 115 (72%) and mesh repair in 44. Early postoperative complications (<30days) were reported in 16 (10%) patients, with superficial wound infection (n=9), bowel obstruction (n=2), marginal ulcer (n=2), DVT (n=1) and pneumonia (n=1). Hernia recurrence was reported in 3 patients (2%) in the early post-op period and in 40 patients (25%) as a late (>30days) complication. Surgery for recurrent hernia was performed in 31/42 patients during follow-up. At 12-month follow-up, median BMI and % excess weight loss were 34.2kg/m2 (IQR 29.5-40.9) and 59.6% (IQR 44.9-74.8%), respectively. Ventral hernia is a common finding in patients undergoing BS. Both primary suture repair and mesh repair result in acceptable results, both in terms of recurrence and perioperative complications.

Chronic groin pain, discomfort and physical disability after recurrent groin hernia repair: impact of anterior and posterior mesh repair.

Chronic pain and physical disability are well-known problems after primary groin hernia surgery, but the outcome after recurrent hernia surgery is much less known. To study the impact of anterior mesh repair (AMR) and posterior mesh repair (PMR) on chronic pain and disability after first recurrent groin hernia surgery in a population-based cohort derived from the Swedish Hernia Register. Consecutive unilateral, first and second recurrent hernia repairs, registered between 1998 and 2007, were included. Follow-up was performed in 2009 based on the Inguinal Pain Questionnaire (IPQ) and selective clinical examination, comparing prevalence of pain between AMR, endoscopic (E-PMR) and open posterior mesh repairs (O-PMR) after first recurrent repair. Chronic pain after a second recurrent repair was analysed. Altogether 671 first recurrent repairs were analysed: 329 AMRs, 161 E-PMRs and 181 O-PMRs. IPQ response rate was 70.6%. If the index repair was anterior, the E-PMR was associated with a lower risk of chronic pain and disability compared to AMR [OR 0.54 (CI 0.30-0.97), p = 0.039]. The risk of chronic pain increased after a second recurrent repair. A surgeon's annual volume >5 O-PMRs was related to a lower risk compared to ≤5 [OR 0.42 (CI 0.19-0.94), p = 0.034]. Endoscopic repair for first recurrent groin hernia surgery, after an index anterior repair, was associated with less chronic pain, discomfort and disability compared to anterior approach. Chronic pain increased after a second recurrent repair. A high surgeon's volume reduced the risk of chronic pain after open posterior mesh repair.

RELATIONSHIP BETWEEN BIOCHEMICAL PARAMETERS OF THE SPINAL MOTION SEGMENT AND OUTCOME OF SURGERY FOR HERNIATED LUMBAR INTERVERTEBRAL DISC

Objective. To analyze natural biochemical changes in proteoglycans and glycosaminoglycans of patients with recurrent and nonrecurrent herniations of lumbar intervertebral discs. Material and Methods. Biochemical parameters of primary intervertebral disc hernias were prospectively investigated in 50 patients who underwent repeated surgery for recurrent hernia at the same level, and in 50 patients without recurrence. The quantity and quality of glycosaminoglycans in tissues of the hernia and surrounding annulus fibrosus were determined by analytical biochemistry methods. The properties of proteoglycans in the hernia tissue were studied by composite gel electrophoresis. Results. Type 1 recurrent hernia tissues are characterized by high content of water and glycosaminoglycans, but relatively few glycosaminoglycans tightly bound within the extracellular matrix (ECM) are retained in the tissue after its treatment with 4 M guanidinium chloride. Type 2 hernia tissues showed reduced content of water and glycosaminoglycans, and increased content of neutral hexoses. More than a half of them were tightly bound to ECM structures. On MRI evidence, Type 1 hernias correspond to Grade III disc degeneration, and Type 2 – to Grade IV. Biochemical profile of glycosaminoglycans in intervertebral disc tissues of the recurrence group reliably differed from that of the nonrecurrence group by the higher content of chondroitin sulfates and proteoglycans loosely bound to ECM structures. Conclusion. The tissue structure of nucleus pulposus and annulus fibrosus in recurrent and nonrecurrent intervertebral disc differs in qualitative and quantitative characteristics of glycosaminoglycans.

Patient experience ratings in surgery for recurrent hernia

In evidence based medicine it is important to define goals and factors relevant to achieve those goals. The aim of the present study was to investigate patient satisfaction as an endpoint for the quality of groin hernia surgery, and to define factors relevant for this endpoint in patients operated on for recurrent groin hernia. Patient satisfaction questionnaires were mailed to 67 patients operated on for recurrent hernias at Mora hospital between 1995 and 1997, and to a control group of 152 patients operated on for primary inguinal hernias during 1996. The response rate was 88 and 91% respectively. The data revealed that the adequacy of information given to patients as well as the adequacy of analgesics for use at home are both important factors in patient satisfaction. In surgery for recurrent hernia, patients with few years since the operation were more dissatisfied than other patients. Most of our patients, however, thought that the reason for their hernia recurrence was related to themselves. The patients operated on for recurrent hernias showed no difference in overall satisfaction ratings when compared to the control group. However, it is suggested that better information and a better knowledge among patients concerning the reasons for hernia recurrence, will increase patient demands and further emphasis recurrence rate as the important end-point of patient satisfaction in hernia surgery.