Timing Of Hernia Repair Research Articles

Umbilical hernia repair in patients with cirrhosis: who, when and how to treat.

Hernia management in patients with cirrhosis is a challenging problem, where indication, timing and type of surgery have been a subject of debate. Given the high risk of morbidity and mortality following surgery, together with increased risk of recurrence, a wait and see approach was often advocated in the past. The purpose of this review was to provide an overview of crucial elements in the treatment of patients with cirrhosis and umbilical hernia. Perioperative ascites control is regarded as the major factor in timing of hernia repair and is considered the most important factor governing outcome. This can be accomplished by either medical treatment, ascites drainage prior to surgery or reduction of portal hypertension by means of a transjugular intrahepatic portosystemic shunt (TIPS). The high incidence of perioperative complications and inferior outcomes of emergency surgery strongly favor elective surgery, instead of a "wait and see" approach, allowing for adequate patient selection, scheduled timing of elective surgery and dedicated perioperative care. The Child-Pugh-Turcotte and MELD score remain strong prognostic parameters and furthermore aid in identifying patients who fulfill criteria for liver transplantation. Such patients should be evaluated for early listing as potential candidates for transplantation and simultaneous hernia repair, especially in case of umbilical vein recanalization and uncontrolled refractory preoperative ascites. Considering surgical techniques, low-quality evidence suggests mesh implantation might reduce hernia recurrence without dramatically increasing morbidity, at least in elective circumstances. Preventing emergency surgery and optimizing perioperative care are crucial factors in reducing morbidity and mortality in patients with umbilical hernia and cirrhosis.

Delaying surgery for inguinal hernia in neonates: Is it worthwhile?

ObjectiveThe incidence of inguinal hernia is high in premature infants; however, surgical repair is a high-risk procedure for these patients. The timing of hernia repair is still controversial. This study aimed to determine the optimal timing for inguinal herniotomy in neonates in a general hospital.MethodsA prospective cohort study was conducted from March 2014 to September 2018. A total of 127 neonates and preterm infants were admitted to the paediatric surgery clinic with uncomplicated inguinal hernia. Herniotomy was performed in all neonates, and the patients were followed up for up to 8 months after surgery for perioperative and postoperative complications. The timing of surgery was based on the surgeon's decision along with the consent of the family to the surgical intervention.ResultsOf 118 neonates, as many as 53 (45%) underwent early repair and 65 (55%) underwent late repair of inguinal hernia. The demographic data were similar between the 2 groups with no significant difference. There were no significant differences in the incidence of inguinal hernia incarceration and hydrocele formation (p = 0.11 and p = 0.8, respectively); however, there was a higher incidence of inguinal hernia recurrence (p = 0.05) and postoperative apnoea (p = 0.02) in the early repair group.ConclusionSurgical repair of inguinal hernia is feasible with low morbidity in preterm babies. The risk of hernia incarceration and testicular atrophy did not increase with delayed elective hernia repair in neonates. Delayed hernia repair decreased the risk of perioperative and postoperative complications. This study recommends delaying elective hernia repair in neonates and preterm babies.

Direct and Recurrent Inguinal Hernias Are Associated with Ventral Hernia Repair: A Database Study

In their well-designed presentation, Henriksen et al. [1] use a massive sample of over 92,000 patients from the Danish Hernia Database to explore the association between inguinal and ventral hernias. The authors find that on multivariate analysis direct and recurrent inguinal hernias are associated with ventral hernias. The odds ratios are statistically significant, but the effect sizes are modest and range from 1.28 to 1.76. In other words, even if the risk for a ventral hernia increases in the presence of an inguinal hernia, the increase is small, as shown by the fact that less than 1 % of inguinal hernia patients were found to have ventral hernias too. Readers should note that the Danish Hernia Database includes only hernias that were treated surgically. Therefore, this study reports on the association between inguinal and ventral hernias, requiring repair; the true association for all hernias in not known. Another puzzling piece of information is the timing of hernia repair as reported in this study. Only 8.7 % of ventral hernias were repaired before the inguinal hernia was repaired. It almost seems that there is a biologic clock by which the inguinal floor gives up first; then the abdominal wall follows. One could assume that an inguinal hernia is a forewarning of future anatomical defects. In any case, it only makes good common sense to assume that a disease of collagen structure, as is hernia, will not be localized only to a certain area of the body. Using the scientific lenses of this study, investigators should look into other possible associations between inguinal hernia and collagen abnormalities. Preventive methods could then be developed and additional surgical interventions could be planned. Until then, the conclusions of this study are interesting, but I would not know how to use them. The authors have provided us with great food for thought. Any plans for the next step?

Traumatic Lumbar Hernia: Report of Cases and Comprehensive Review of the Literature

Acute lumbar hernia secondary to blunt trauma is an uncommon injury of the abdominal wall and, when encountered, is a difficult challenge for the trauma surgeon. Three cases of lumbar hernia secondary to blunt trauma are described and a review of the literature was conducted for other such cases. Clinical, anatomic, and demographic data were extracted from these reports and analyzed. Sixty-three cases of lumbar hernia secondary to blunt trauma were found in the English literature and three cases are described here. Hernias occurred most commonly in the inferior lumbar triangle (70%) and were most frequently a result of a motor vehicle collision (71%). Physical examination findings were variable and reported in only a minority of cases (palpable hernia, 33%; flank hematoma, 27%) and associated intra-abdominal injuries were common (61%). Most traumatic lumbar hernias were diagnosed immediately, and computed tomography was 98% sensitive for diagnosis. Fifty-eight percent of patients were managed initially with exploratory laparotomy. Timing of hernia repair was variable. Traumatic lumbar hernias are associated with a high incidence of intra-abdominal injury and should be considered in all cases of severe blunt abdominal trauma. Computed tomography should be implemented when the diagnosis is suspected in a hemodynamically stable patient. Repair should be performed by mesh patching techniques at a time based on clinical correlation.

Ventral hernia repair in bariatric surgery.

Obesity is an important risk factor for perioperative complications including the development of ventral hernias. This retrospective study comprises patients who underwent abdominal hernia repair simultaneously with or following implantation of a Swedish Adjustable Gastric Band(R) (SAGB). 9 out of 415 patients (2.2%) who received a SAGB between January 1996 and June 2001 underwent ventral hernia repair. In 6 patients, hernias preexisted from previous abdominal surgery at the time of the bariatric procedure, and another 3 hernias occurred at the median and left upper abdominal trocar position following SAGB placement. Median BMI at time of SAGB implantation was 44 (range 35-52), and at time of hernia repair was 36 (range 25-46). 2 hernias were repaired during SAGB placement, 3 during redo surgery, and 2 during abdominoplasty. In 2 patients, significant weight loss with loss of soft tissue support of the hernia sac led to recurrent episodes of small bowel obstruction necessitating emergency repair. Repair included direct defect closure in 7 patients and sublay polypropylene net implantation in 2 patients. Recoveries have been uneventful without wound infections or recurrence in all patients after a median follow-up of 34 months (range 13-69). In morbidly obese patients, the optimal management and timing of incisional hernia repair should weigh the risk of recurrence and perioperative complications against the risk of hernia-associated complications.