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Prosthetic mesh hernioplasty versus primary repair in incarcerated and strangulated groin and abdominal wall hernias with or without organ resection. Retrospective study

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Kamer Tomaoğlu at Surp Pırgiç Hospital İstanbul
Kamer Tomaoğlu
  • Surp Pırgiç Hospital İstanbul
Hasan Okmen
Hasan Okmen
Hasan Okmen
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Abstract

Purpose The use of synthetic materials in emergency surgery for abdominal wall hernia in a potentially infected operating field has long been debated. In the present study, we evaluated the outcome of mesh prostheses in the management of incarcerated and strangulated abdominal wall hernias with or without organ resection. Methods Between March 2012 and January 2020, medical records of 301 patients who underwent emergency surgery for incarcerated and strangulated abdominal wall hernias were retrospectively evaluated. The interventions were exclusively realized by two surgical teams, one of which used polypropylene mesh prostheses (group I), whereas the second team performed primary hernia repair (group II). The outcome of patients was observed for a mean follow-up period of 18.2 months. Categorical data were analyzed with the χ2 test or likelihood ratio. Logistic regression was used for adjustments in multivariate analysis. Statistical analyses were realized with SPSS, version 18. P values < 0.05 were considered statistically significant. For multiple comparisons between types of hernia, the significance level was set to P < 0.0083 according to Bonferroni adjustment. Results Of the 301 patients, 190 were men (63.1%), and 111 were women (36.9%). The mean age was 59,98 years (range 17–92). Overall, 226 (75.1%) patients were treated with synthetic mesh replacement. One hundred two organ resections (34%) were performed involving the omentum, small intestine, colon, and appendix. No significant difference was identified in terms of postoperative complications, between the two groups both in patients who underwent organ resection and in patients who did not. Conclusion Synthetic materials may safely be used in the emergency management of incarcerated and strangulated groin and abdominal wall hernias in patients with or without organ resection, although they cannot formally be recommended due to the limited number of cases of the present study.
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ORIGINAL ARTICLE
Prosthetic mesh hernioplasty versus primary repair in incarcerated
and strangulated groin and abdominal wall hernias with or
without organ resection. Retrospective study
Kamer Tomaoglu
1
&Hasan Okmen
2
Received: 5 August 2020 /Accepted: 3 March 2021
#The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021
Abstract
Purpose The use of synthetic materials in emergency surgery for abdominal wall hernia in a potentially infected operating field
has long been debated. In the present study, we evaluated the outcome of mesh prostheses in the management of incarcerated and
strangulated abdominal wall hernias with or without organ resection.
Methods Between March 2012 and January 2020, medical records of 301 patients who underwent emergency surgery for
incarcerated and strangulated abdominal wall hernias were retrospectively evaluated. The interventions were exclusively realized
by two surgical teams, one of which used polypropylene mesh prostheses (group I), whereas the second team performed primary
hernia repair (group II).The outcome of patients was observed for a mean follow-up period of 18.2months. Categorical datawere
analyzed with the χ2 test or likelihood ratio. Logistic regression was used for adjustments in multivariate analysis. Statistical
analyses were realized with SPSS, version 18. Pvalues < 0.05 were considered statistically significant. For multiple comparisons
between types of hernia, the significance level was set to P< 0.0083 according to Bonferroni adjustment.
Results Of the 301 patients, 190 were men (63.1%), and 111 were women (36.9%). The mean age was 59,98 years (range 17–
92). Overall, 226 (75.1%) patients were treated with synthetic mesh replacement. One hundred two organ resections (34%) were
performed involving the omentum, small intestine, colon, and appendix. No significant difference was identified in terms of
postoperative complications, between the two groups both in patients who underwent organ resection and in patients who did not.
Conclusion Synthetic materials may safely be used in the emergency management of incarcerated and strangulated groin and
abdominal wall hernias in patients with or without organ resection, although they cannot formally be recommended due to the
limited number of cases of the present study.
Keywords Abdominal .Hernia .Incarcerated .Strangulated .Prosthetic repair .Polypropylene mesh
Introduction
The beneficial outcomes of different types of abdominal wall
hernias treated by prosthetic materials on an elective surgical
basis have been well documented [1–3]. However, many
patients remain undiagnosed or are reluctant to have surgical
correction of their hernias. Neglected hernias may become
incarcerated, which is defined as a hernia in which the content
has become manually irreducible. A certain proportion of in-
carcerated cases may subsequently become complicated and
strangulated. Strangulation occurs when the blood supply to
the hernia content is compromised. Strangulation subsequent-
ly leads to ischemia, necrosis, perforation, or abscess forma-
tion, thus transforming a relatively simple surgical procedure
into a highly challenging one.
The bacterial translocation in incarcerated or strangulated
surgical site makes the use of prosthetic materials question-
able. Their use in emergency surgery for abdominal incarcer-
ated and strangulated hernias has been studied so far with
conflicting results. Classic surgical teaching contraindicates
the use of prosthetic repair in the setting of acute incarceration
*Kamer Tomaoglu
kamertom@hotmail.com
Hasan Okmen
hasanokmen@hotmail.com
1
Faculty of Health Sciences, Department of General Surgery, School
of Medical Sciences, Esenyurt University, Istanbul, Turkey
2
Department of General Surgery, Istanbul Training and Research
Hospital, Istanbul, Turkey
https://doi.org/10.1007/s00423-021-02145-5
/ Published online: 17 March 2021
Langenbeck's Archives of Surgery (2021) 406:1651–1657
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... Among the studies that provided information on mesh explantation rates, 1.57% of the 508 patients required mesh explantation specifically due to mesh infection. It is important to note that all cases of mesh explantation were observed in patients who underwent bowel resections [1,8,12,14,18,21,22]. The baseline characteristics of the studies are described in Table 1. ...
... However, most are retrospective studies and have a strong selection bias due to surgeon preference for primary suture techniques in contaminated cases. [1,18,19,21,22,[28][29][30][31] Consequently, these results may not apply to contaminated or infected surgeries, such as when bowel resection is performed. To address this gap, we performed an analysis restricted to patients who did not undergo bowel resection and found that using mesh did not increase SSI rates. ...
... The use of mesh in contaminated cases is controversial due to the possibility of infectious complications. Prosthetic implants facilitate local infection through several pathophysiologic mechanisms [22]. The most common pathogen in SSI, Staphylococcus aureus, forms a biofilm around the prosthetic material that promotes immune escape and antibiotic resistance [32]. ...
Mesh repair versus non-mesh repair for incarcerated and strangulated groin hernia: an updated systematic review and meta-analysis
Article
Full-text available
  • Sep 2023
  • Hernia
Background Mesh repair in incarcerated or strangulated groin hernia is controversial, especially when bowel resection is required. We aimed to perform a meta-analysis comparing mesh and non-mesh repair in patients undergoing emergency groin hernia repair.Methods We performed a literature search of databases to identify studies comparing mesh and primary suture repair of patients with incarcerated or strangulated inguinal or femoral hernias who underwent emergency surgery. Postoperative outcomes were assessed by pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. Heterogeneity was assessed with I2 statistics.Results1095 studies were screened and 101 were thoroughly reviewed. Twenty observational studies and four randomized controlled trials comprising 12,402 patients were included. We found that mesh-based repair had reduced recurrence (OR 0.36; 95% CI 0.19, 0.67; P = 0.001; I2 = 35%), length of hospital stay (OR − 1.02; 95% CI − 1.87, − 0.17; P = 0.02; I2 = 94%) and operative time (OR − 9.21; 95% CI − 16.82, − 1.61; P = 0.02; I2 = 95%) without increasing surgical site infection, mortality or postoperative complications such as seroma, chronic, ileus or urinary retention. In the subgroup analysis of patients that underwent bowel resection, we found that mesh repair was associated with an increased risk of surgical site infection (OR 1.74; 95% CI 1.04, 2.91; P = 0.04; I2 = 9%).Conclusions Mesh repair for incarcerated and strangulated groin hernias reduces recurrence without an increase in postoperative complications and should be considered in clean cases. However, in the setting of bowel resection, mesh repair might increase the incidence of surgical site infection.
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... The use of prosthetic mesh is generally avoided, especially in contaminated environments, such as that may be present in patients undergoing concomitant bowel resection. However, several studies have reported that incarcerated/strangulated femoral hernias can be repaired safely with a prosthetic mesh [7][8][9][10]. The conscientious use of mesh is recommended in cases with worse contamination of the surgical field, and the risk/benefit ratio of mesh use must be carefully contemplated in these cases [1]. ...
Comparison of mesh repair and suture repair for the treatment of incarcerated femoral hernia: a retrospective, single-center study
Article
Full-text available
  • Aug 2022
  • SURG ENDOSC
Background Femoral hernias often present with incarceration or strangulation that requires emergency surgery. However, recommendations vary regarding optimal approaches for incarcerated femoral hernia. The aim of this study is to compare clinical efficacy between mesh repair and suture repair for the treatment of incarcerated femoral hernia. Methods Retrospective, single-center analysis of the clinical data from 48 patients with incarcerated femoral hernia, including 16 patients who underwent mesh repair (mesh repair group) and 32 patients who underwent traditional suture repair (suture repair group). Results The mean age, body mass index, incarceration duration, hernia sac size, operation duration, and the rates of postoperative incision infection, recurrence, chronic pain, and mortality were not significantly different between the suture repair and mesh repair groups (P > 0.05 for all). In contrast, the female/male ratio; the rates of bowel obstruction, coexisting diseases, and nighttime operation; and the American Society of Anesthesiologists grade were higher and the rate of prophylactic antibiotic use and the mean cost of hospitalization were lower in the suture repair group than in the mesh repair group (P < 0.05 for all). Conclusion The surgical approach should be chosen based on the patient’s condition. Mesh repair for the emergency treatment of incarcerated femoral hernia is safe and effective, whereas suture repair is suitable for elderly patients, those with more coexisting diseases, and those with limited life expectancy.
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... The WSES guidelines recommend the use of a synthetic mesh in cases of bowel strangulation or associated bowel resection, in the absence of massive enteric spillage (Grade 1A) [11]. In this study, only in two out of 48 (4.1%) resections performed, mesh placement was avoided, and low mesh-related complication rates (0.5%) were observed [40]. Furthermore, the tendency to place mesh is probably the cause of the low short-term recurrence rate (0.8%) observed. ...
Laparoscopic approach in emergency for the treatment of acute incarcerated groin hernia: a systematic review and meta-analysis
Article
Full-text available
  • May 2022
  • Hernia
Purpose Minimally invasive approach for acute incarcerated groin hernia repair is still debated. To clarify this debate, a literature review was performed. Methods Search was performed in PubMed, Embase, Scopus, Web of Science, and Cochrane databases, founding 28,183 articles. Results Fifteen articles, and 433 patients were included (16 bilateral hernia, range 3–8). Three hundred and eighty-eight (75.3%) and 103 patients (22.9%) underwent transabdominal preperitoneal and totally extraperitoneal repair, respectively, and in 5 patients, the defect was buttressed with broad ligament (1.1%) (not specified in 3 patients). Herniated structures were resected in 48 cases (range 1–9). Intraoperative complications and conversion occurred in 4 (range 0–1) and 10 (range 0–3) patients, respectively. Mean operative time and hospital stay ranged between 50 and 147 min, and 2 and 7 days, respectively. Postoperative complications ranged between 1 and 19. Five studies compared laparoscopic and open approaches (163 and 235 patients). Herniated structures were resected in 19 (11.7%) and 42 cases (17.9%) for laparoscopic and open approach, respectively (p = 0.1191). Intraoperative complications and conversion occurred in one (0.6%) and 5 (2.1%) patients (p = 0.4077), and in two (1.2%) and 19 (8.1%) patients (p = 0.0023), in case of laparoscopic or open approach, respectively. Mean operative time and hospital stay were 94.4 ± 40.2 and 102.8 ± 43.7 min, and 4.8 ± 2.2 and 11 ± 3.1 days, in laparoscopic or open approach, respectively. Sixteen (9.8%) and 57 (24.3%) postoperative complications occurred. Conclusion Laparoscopy seems to be a safe and feasible approach for the treatment of acute incarcerated groin hernia. Further studies are required for definitive conclusions.
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Emergency umbilical hernia management: scoping review
Article
  • Jun 2024
Background Umbilical hernias, while frequently asymptomatic, may become acutely symptomatic, strangulated or obstructed, and require emergency treatment. Robust evidence is required for high-quality care in this field. This scoping review aims to elucidate evidence gaps regarding emergency care of umbilical hernias. Methods EMBASE, MEDLINE and CENTRAL databases were searched using a predefined strategy until November 2023. Primary research studies reporting on any aspect of emergency umbilical hernia care and published in the English language were eligible for inclusion. Studies were excluded where emergency umbilical hernia care was not the primary focus and subsets of relevant data were unable to be extracted. Two independent reviewers screened abstracts and full texts, resolving disagreements by consensus or a third reviewer. Data were charted according to core concepts addressed by each study and a narrative synthesis was performed. Results Searches generated 534 abstracts, from which 32 full texts were assessed and 14 included in the final review. This encompassed 52 042 patients undergoing emergency umbilical hernia care. Most were retrospective cohort designs (11/14), split between single (6/14) and multicentre (8/14) with only one randomized trial. Most multicentre studies were from national databases (7/8). Themes arising included risk assessment (n = 4), timing of surgery (n = 4), investigations (n = 1), repair method (n = 8, four mesh versus suture; four laparoscopic versus open) and operative outcomes (n = 11). The most commonly reported outcomes were mortality (n = 9) and morbidity (n = 7) rates and length of hospital stay (n = 5). No studies included patient-reported outcomes specific to emergency umbilical hernia repair. Conclusion This scoping review demonstrates the paucity of high-quality data for this condition. There is a need for randomized trials addressing all aspects of emergency umbilical hernia repair, with patient-reported outcomes.
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Retrospective comparison of two surgical approaches for incarcerated inguinal hernia: Midline preperitoneal repair and laparoscopic transabdominal preperitoneal (TAPP) surgery
Preprint
Full-text available
  • May 2022
Background：Laparoscopic treatment for incarcerated inguinal hernia has gradually increased, while more surgeons preferred open surgery. Therefore, it is necessary to analyze the safety and effectiveness of the two surgical methods. Methods: The patients with incarcerated/strangulated inguinal hernia treated in Jinshan Hospital (Shanghai, China) from January 2018 to March 2021 were retrospectively analyzed. According to different surgical approaches, the patients were divided into lower abdominal midline incision group (LAMI) and laparoscopic transabdominal preperitoneal (TAPP) group. The characteristics, surgical outcomes and postoperative complications of the two groups were compared retrospectively. Results: 104 incarcerated/strangulated inguinal hernia cases were included in total. The average age was 64.4±16.8 years, 79 of them (76.0%) were male. 44 cases (42.3%) had obvious intestinal obstruction, and a total of 27 cases (26.0%) underwent intestinal resection. There were 62 cases (59.6%) in the LAMI group and 42 cases (40.4%) in the TAPP group. The operation time in the TAPP group was about 15 minutes longer (107.0min versus 92.8min; P =0.012), but postoperative length of hospitalization and time of return to normal activity were shorter in the TAPP group (2.7days versus 6.8days P<0.001 and 8.1 days versus 13.6days; P<0.001). There were 83 cases (79.8%) of 1st stage tension-free herniorrhaphy, including 37 cases (88.1%) in the TAPP group and 46 cases (74.2%) in the LAMI group (P=0.083). The surgical complications such as incision infection (4.8% versus 0 P=0.396), seroma/hematomas (11.3% versus 9.5%, P=1.000), intra-abdominal infection (16.1% versus 2.4% P=0.056), and recurrence (1.6% versus 0 P=1.000) were similar in the two groups. There were no cases of patch infection and chronic pain in the two groups. A total of 2 cases (1.9%) died of multiple organ dysfunction in the LAMI group and no death in the TAPP group. Conclusions: Lower abdominal midline incision approach and TAPP were safe and effective in the treatment of incarcerated inguinal hernia. TAPP showed more favorable short-term results for cases that were easy to retract without intestinal resection. Midline preperitoneal repair was more suitable for strangulated hernia requiring intestinal resection.
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Emergency repair of complicated abdominal wall hernias: WSES guidelines
Article
Full-text available
  • Apr 2020
  • Hernia
Purpose In July 2013, the World Society of Emergency Surgery (WSES) held the first Consensus Conference on emergency repair of abdominal wall hernias in adult patients with the intention of producing evidence-based guidelines to assist surgeons in the management of complicated abdominal wall hernias. Guidelines were updated in 2017 in keeping with varying clinical practice: benefits resulting from the increased use of biological prosthesis in the emergency setting were highlighted, as previously published in the World Journal of Emergency Surgery. This executive summary is intended to consolidate knowledge on the emergency management of complicated hernias by providing the broad readership with a practical and concise version of the original guidelines. Methods This executive manuscript summarizes the WSES guidelines reporting on the emergency management of complicated abdominal wall hernias; statements are highlighted focusing the readers’ attention on the main concepts presented in the original guidelines. Conclusions Emergency repair of complicated abdominal hernias remains one of the most common and challenging surgical emergencies worldwide. WSES aims to provide an essential version of the evidence-based guidelines focusing on the timing of intervention, laparoscopic approach, surgical repair following the Centers for Disease Control and Prevention (CDC) wound classification, antimicrobial prophylaxis and anesthesia in the emergency setting.
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Mesh versus non‐mesh for inguinal and femoral hernia repair
Article
Full-text available
  • Sep 2018
Background: This is an update of a Cochrane Review first published in 2001.Hernias are protrusions of all or part of an organ through the body wall that normally contains it. Groin hernias include inguinal (96%) and femoral (4%) hernias, and are often symptomatic with discomfort. They are extremely common, with an estimated lifetime risk in men of 27%. Occasionally they may present as emergencies with complications such as bowel incarceration, obstruction and strangulation. The definitive treatment of all hernias is surgical repair, inguinal hernia repair being one of the most common surgical procedures performed. Mesh (hernioplasty) and the traditional non-mesh repairs (herniorrhaphy) are commonly used, with an increasing preference towards mesh repairs in high-income countries. Objectives: To evaluate the benefits and harms of different inguinal and femoral hernia repair techniques in adults, specifically comparing closure with mesh versus without mesh. Outcomes include hernia recurrence, complications (including neurovascular or visceral injury, haematoma, seroma, testicular injury, infection, postoperative pain), mortality, duration of operation, postoperative hospital stay and time to return to activities of daily living. Search methods: We searched the following databases on 9 May 2018: Cochrane Colorectal Cancer Group Specialized Register, Cochrane Central Register of Controlled Trials (Issue 1), Ovid MEDLINE (from 1950), Ovid Embase (from 1974) and Web of Science (from 1900). Furthermore, we checked the WHO International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov for trials. We applied no language or publication restrictions. We also searched the reference lists of included trials and review articles. Selection criteria: We included randomised controlled trials of mesh compared to non-mesh inguinal or femoral hernia repairs in adults over the age of 18 years. Data collection and analysis: We used standard methodological procedures expected by Cochrane. Where available, we collected information on adverse effects. We presented dichotomous data as risk ratios, and where possible we calculated the number needed to treat for an additional beneficial outcome (NNTB). We presented continuous data as mean difference. Analysis of missing data was based on intention-to-treat principles, and we assessed heterogeneity using an evaluation of clinical and methodological diversity, Chi2 test and I2 statistic. We used GRADE to assess the quality of evidence for each outcome. Main results: We included 25 studies (6293 participants) in this review. All included studies specified inguinal hernias, and two studies reported that femoral hernias were included.Mesh repair probably reduces the risk of hernia recurrence compared to non-mesh repair (21 studies, 5575 participants; RR 0.46, 95% CI 0.26 to 0.80, I2 = 44%, moderate-quality evidence). In absolute numbers, one hernia recurrence was prevented for every 46 mesh repairs compared with non-mesh repairs. Twenty-four studies (6293 participants) assessed a wide range of complications with varying follow-up times. Neurovascular and visceral injuries were more common in non-mesh repair groups (RR 0.61, 95% CI 0.49 to 0.76, I2 = 0%, NNTB = 22, high-quality evidence). Wound infection was found slightly more commonly in the mesh group (20 studies, 4540 participants; RR 1.29, 95% CI 0.89 to 1.86, I2 = 0%, NNTB = 200, low-quality evidence). Mesh repair reduced the risk of haematoma compared to non-mesh repair (15 studies, 3773 participants; RR 0.88, 95% CI 0.68 to 1.13, I2 = 0%, NNTB = 143, low-quality evidence). Seromas probably occur more frequently with mesh repair than with non-mesh repair (14 studies, 2640 participants; RR 1.63, 95% CI 1.03 to 2.59, I2 = 0%, NNTB = 72, moderate-quality evidence), as does wound swelling (two studies, 388 participants; RR 4.56, 95% CI 1.02 to 20.48, I2 = 33%, NNTB = 72, moderate-quality evidence). The comparative effect on wound dehiscence is uncertain due to wide confidence intervals (two studies, 329 participants; RR 0.55, 95% CI 0.12 to 2.48, I2 = 37% NNTB = 77, low-quality evidence). Testicular complications showed nearly equivocal results; they probably occurred slightly more often in the mesh group however the confidence interval around the effect was wide (14 studies, 3741 participants; RR 1.06, 95% CI 0.63 to 1.76, I2 = 0%, NNTB = 2000, low-quality evidence). Mesh reduced the risk of postoperative urinary retention compared to non-mesh (eight studies, 1539 participants; RR 0.53, 95% CI 0.38 to 0.73, I2 = 56%, NNTB = 16, moderate-quality evidence).Postoperative and chronic pain could not be compared due to variations in measurement methods and follow-up time (low-quality evidence).No deaths occurred during the follow-up periods reported in the seven studies (2546 participants) reporting this outcome (high-quality evidence).The average operating time was longer for non-mesh repairs by a mean of 4 minutes 22 seconds, despite wide variation across the studies regarding size and direction of effect, thus this result is uncertain (20 studies, 4148 participants; 95% CI -6.85 to -1.60, I2= 97%, very low-quality evidence). Hospital stay may be shorter with mesh repair, by 0.6 days (12 studies, 2966 participants; 95% CI -0.86 to -0.34, I2 = 98%, low-quality evidence), and participants undergoing mesh repairs may return to normal activities of daily living a mean of 2.87 days sooner than those with non-mesh repair (10 studies, 3183 participants; 95% CI -4.42 to -1.32, I2 = 96%, low-quality evidence), although the results of both these outcomes are also limited by wide variation in the size and direction of effect across the studies. Authors' conclusions: Mesh and non-mesh repairs are effective surgical approaches in treating hernias, each demonstrating benefits in different areas. Compared to non-mesh repairs, mesh repairs probably reduce the rate of hernia recurrence, and reduce visceral or neurovascular injuries, making mesh repair a common repair approach. Mesh repairs may result in a reduced length of hospital stay and time to return to activities of daily living, but these results are uncertain due to variation in the results of the studies. Non-mesh repair is less likely to cause seroma formation and has been favoured in low-income countries due to low cost and reduced availability of mesh materials. Risk of bias in the included studies was low to moderate and generally handled well by study authors, with attention to details of allocation, blinding, attrition and reporting.
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2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias
Article
Full-text available
  • Aug 2017
  • World J Emerg Surg
Emergency repair of complicated abdominal wall hernias may be associated with worsen outcome and a significant rate of postoperative complications. There is no consensus on management of complicated abdominal hernias. The main matter of debate is about the use of mesh in case of intestinal resection and the type of mesh to be used. Wound infection is the most common complication encountered and represents an immense burden especially in the presence of a mesh. The recurrence rate is an important topic that influences the final outcome. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013 with the aim to define recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel. In 2016, the guidelines have been revised and updated according to the most recent available literature.
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Outcomes following repair of incarcerated and strangulated ventral hernias with or without synthetic mesh
Article
Full-text available
  • Jul 2017
  • World J Emerg Surg
Background The use of synthetic mesh for ventral hernia repair under contaminated conditions is a controversial issue due to the considerable risk of surgical site infection (SSI). This study aimed to review the outcomes of repair of incarcerated and strangulated ventral hernias with or without synthetic mesh in compliance with established clinical guidelines regarding the incidence of SSI and hernia recurrence. Methods The records of patients with complicated ventral hernias who were treated with or without synthetic mesh repair were reviewed. Variables collected included the characteristics of patients and of ventral hernias, type of repair, and incidence of SSI and recurrence. Results One hundred twenty-two patients (56 males) of a mean age of 56 years were included. Fifty-two (42.6%) and 70 (57.4%) patients presented with incarcerated and strangulated ventral hernias, respectively. Sixty-six (54%) patients were treated with on-lay mesh repair, and 56 (46%) were managed with suture repair. Twenty-one patients required bowel resection. SSI was detected in eight (6.5%) patients. There was no significant difference between both groups regarding the incidence of SSI (7.5% for mesh group vs 5.3% for suture group). Recurrence occurred in seven patients. Median follow-up period was 24 months. The suture repair group had a significantly higher incidence of recurrence than the mesh group. Diabetes mellitus, previous recurrence, and intestinal resection were significant predictors for SSI. Conclusion Following established guidelines, synthetic mesh repair of incarcerated and strangulated ventral hernias attained lower recurrence rate, comparable incidence of SSI, and higher rate of seroma formation than suture repair. Trial registration Research Registry, researchregistry1891
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Emergency groin hernia repair: Implications in elderly
Article
Full-text available
  • Oct 2013
  • BMC Surg
Background Groin hernia is one of the most frequently encountered pathologies occurring in old age and it is often the cause of emergency procedures. In our study we evaluate the impact of emergency procedures in over 75 patients compared to younger patients. Methods We conducted a retrospective study about patients who underwent emergency hernioplasty between September 2007 and January 2013. Bilateral hernias and recurrences were excluded. We divided patients into two groups by age (under and over 75 years old) and then analyzed the early postoperative surgical complications. Results A total of 48 patients were enrolled, 18 were included in under 75 group and 30 in over 75. In the older group we found a higher rate of comorbidity and also a significant higher rate of postoperative complications. Two patients of over 75 group died. Conclusions Our data suggests that a quick diagnosis and elective surgical procedures are desirable in order to avoid the complications that occur in emergency operations.
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Results of prosthetic mesh repair in the emergency management of the acutely incarcerated and/or strangulated groin hernias: a 10-year study
Article
Full-text available
  • Mar 2015
The aim of this prospective study was to present a 10-year experience with the use of prosthetic mesh repair in the management of the acutely incarcerated and/or strangulated groin hernias. Patients with acutely incarcerated and/or strangulated groin hernias were treated by emergency repair of the hernia using a Prolene mesh. The presence of non-viable intestine necessitating resection-anastomosis of the bowel was not considered a contraindication to the use of mesh. The present study included 234 patients. Their age ranged from 16 to 85 years with a mean of 55.9 ± 17.7 years. The hernia was indirect inguinal in 201 patients (85.9 %), direct inguinal in 5 patients 5 (2.1 %), hernia of canal of nuck in 13 patients (5.6 %) and femoral in 15 patients (6.4 %). Thirty patients (12.8 %) had recurrent hernias. Resection-anastomosis of non-viable small intestine was performed in 32 patients (13.7 %). There were 5 perioperative mortalities (2.1 %). Complications were encountered in 41 patients (17.5 %) and included wound infection in 14 patients (6 %), scrotal hematoma in 9 patients (3.8 %), chest infection in 8 patients (3.4 %), deep vein thrombosis in 2 patients (0.9 %), transient deterioration of liver function in 11 patients (4.7 %) and mesh infection in 1 patient (0.5 %). Follow-up duration ranged from 6 to 120 months with a mean of 62.5 ± 35.3 months. Two recurrences (0.9 %) were encountered throughout the study period. The use of prosthetic mesh repair in the emergency management of the acutely incarcerated and/or strangulated groin hernias is safe. The presence of non-viable intestine cannot be regarded as a contraindication for prosthetic repair.
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Partial versus complete removal of the infected mesh after abdominal wall hernia repair
Article
  • Nov 2016
Background: To compare the results with complete mesh removal (CMR) versus partial mesh removal (PMR) in the treatment of mesh infection after abdominal wall hernia repair (AWHR). Methods: Retrospective review of all patients who underwent surgery for mesh infection between January 2004 and May 2014 at a tertiary center. Results: Of 3470 cases of AWHR, we reported 66 cases (1.9%) of mesh infection, and 48 repairs (72.7%) required mesh explantation. CMR was achieved on 38 occasions, while PMR was undertaken ten times. We observed more postoperative complications in CMR than PMR group (p = 0.04). Three patients with intestinal fistula were reoperated in postoperative period after a difficult mesh removal; one of them died due to multiple organ failure. The overall recurrence rate after explantation was 47.9%: recurrence was more frequent in CMR group (p = 0.001), although persistent or new mesh infection was observed more frequently with PMR (p = 0.001). Conclusions: Although PMR has less postoperative morbidity, shorter duration of hospitalization and lower rate of recurrence than CMR, prosthetic infection persists in up to 50% of cases.
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Long-term Recurrence and Complications Associated With Elective Incisional Hernia Repair
Article
  • Oct 2016
Importance: Prosthetic mesh is frequently used to reinforce the repair of abdominal wall incisional hernias. The benefits of mesh for reducing the risk of hernia recurrence or the long-term risks of mesh-related complications are not known. Objective: To investigate the risks of long-term recurrence and mesh-related complications following elective abdominal wall hernia repair in a population with complete follow-up. Design, setting, and participants: Registry-based nationwide cohort study including all elective incisional hernia repairs in Denmark from January 1, 2007, to December 31, 2010. A total of 3242 patients with incisional repair were included. Follow-up until November 1, 2014, was obtained by merging data with prospective registrations from the Danish National Patient Registry supplemented with a retrospective manual review of patient records. A 100% follow-up rate was obtained. Exposures: Hernia repair using mesh performed by either open or laparoscopic techniques vs open repair without use of mesh. Main outcomes and measures: Five-year risk of reoperation for recurrence and 5-year risk of all mesh-related complications requiring subsequent surgery. Results: Among the 3242 patients (mean age, 58.5 [SD, 13.5] years; 1720 women [53.1%]), 1119 underwent open mesh repair (34.5%), 366 had open nonmesh repair (11.3%), and 1757 had laparoscopic mesh repair (54.2%). The median follow-up after open mesh repair was 59 (interquartile range [IQR], 44-80) months, after nonmesh open repair was 62 (IQR, 44-79) months, and after laparoscopic mesh repair was 61 (IQR, 48-78) months. The risk of the need for repair for recurrent hernia following these initial hernia operations was lower for patients with open mesh repair (12.3% [95% CI, 10.4%-14.3%]; risk difference, -4.8% [95% CI, -9.1% to -0.5%]) and for patients with laparoscopic mesh repair (10.6% [95% CI, 9.2%-12.1%]; risk difference, -6.5% [95% CI, -10.6% to -2.4%]) compared with nonmesh repair (17.1% [95% CI, 13.2%-20.9%]). For the entirety of the follow-up duration, there was a progressively increasing number of mesh-related complications for both open and laparoscopic procedures. At 5 years of follow-up, the cumulative incidence of mesh-related complications was 5.6% (95% CI, 4.2%-6.9%) for patients who underwent open mesh hernia repair and 3.7% (95% CI, 2.8%-4.6%) for patients who underwent laparoscopic mesh repair. The long-term repair-related complication rate for patients with an initial nonmesh repair was 0.8% (open nonmesh repair vs open mesh repair: risk difference, 5.3% [95% CI, 4.4%-6.2%]; open nonmesh repair vs laparoscopic mesh repair: risk difference, 3.4% [95% CI, 2.7%-4.1%]). Conclusions and relevance: Among patients undergoing incisional repair, sutured repair was associated with a higher risk of reoperation for recurrence over 5 years compared with open mesh and laparoscopic mesh repair. With long-term follow-up, the benefits attributable to mesh are offset in part by mesh-related complications.
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Use of a preperitoneal prosthesis for strangulated groin hernia
Article
  • Mar 1997
Background: Prostheses are widely used in the elective treatment of adult groin hernias. Their use for strangulated hernias remains controversial because of the potential risk of sepsis. Methods: Thirty-five patients with a strangulated groin hernia were treated by insertion of a prosthetic mesh via a midline preperitoneal approach. Nine patients needed an intestinal resection for irreversible necrosis without peritonitis, and an appendicectomy was carried out in three others. Results: There were two postoperative wound infections, neither in patients who had an intestinal resection. No mesh had to be removed. The recurrence rate was one of 35 after mean follow-up of 4.2 years. Conclusion: A strangulated groin hernia can be repaired safely with prosthetic mesh. When an intestinal resection is carried out with sufficient care to minimize infective complications, the use of mesh is not contraindicated.
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