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Lars N. Jorgensen - One of the best experts on this subject based on the ideXlab platform.
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Direct and Recurrent Inguinal Hernias are Associated with Ventral Hernia Repair: A Database Study
World Journal of Surgery, 2013Co-Authors: Nadia A. Henriksen, Lars T. Sorensen, Morten Bay-nielsen, Lars N. JorgensenAbstract:Background A systemically altered connective tissue metabolism has been demonstrated in patients with abdominal wall Hernias. The most pronounced connective tissue changes are found in patients with direct or recurrent inguinal Hernias as opposed to patients with indirect inguinal Hernias. The aim of the present study was to assess whether direct or recurrent inguinal Hernias are associated with an elevated rate of ventral Hernia surgery. Methods In the nationwide Danish Hernia Database, a cohort of 92,457 patients operated on for inguinal Hernias was recorded from January 1998 until June 2010. Eight-hundred forty-three (0.91 %) of these patients underwent a ventral Hernia operation between January 2007 and June 2010. A multivariate logistic regression analysis was applied to assess an association between inguinal and ventral Hernia repair. Results Direct (Odds Ratio [OR] = 1.28 [95 % CI, 1.08–1.51]) and recurrent (OR = 1.76, [95 % CI, 1.39–2.23]) inguinal Hernias were significantly associated with ventral Hernia repair after adjustment for age, gender, and surgical approach (open or laparoscopic). Conclusions Patients with direct and recurrent inguinal Herniation are more prone to ventral Hernia repair than patients with indirect inguinal Herniation. This is the first study to show that herniogenesis is associated with type of inguinal Hernia.
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unsuspected femoral Hernia in patients with a preoperative diagnosis of a recurrent inguinal Hernia author reply
Hernia, 2012Co-Authors: Nadia A. Henriksen, J. Thorup, Lars N. JorgensenAbstract:We would like to thank Dr. R. Bendavid for the thoroughcomment on our paper ‘Unsuspected femoral Hernia inpatients with a preoperative diagnosis of recurrent inguinalHernia’. However, we are afraid that Dr. R. Bendavid mayhave missed the aim of the study from which we quote:‘The aim of this study was to examine the incidence ofunsuspected femoral Hernia discovered at transabdominalpreperitoneal (TAPP) laparoscopic inguinal Hernia repairin two well-defined groups: (1) patients with bilateralprimary inguinal Hernia and (2) patients with recurrentinguinal Hernia’. When the aim is to examine unsuspectedfemoral Hernias, it would be paradoxical to include patientswith a preoperative diagnosis of a femoral Hernia.Dr. R. Bendavid prefers to mention his series of 508 openfemoral Hernia repairs [1, 2], which is of course notewor-thy; however, it does not cover unsuspected femoral her-nias and is therefore not within the subject of our article.Dr. R. Bendavid claims that the article is in favour oflaparoscopic Hernia surgery. In fact, the majority ofinguinal Hernia repairs are performed by open approach inour department. Firstly, referring to the aim of the studyagain, we examined unsuspected femoral Hernias inpatients undergoing laparoscopic Hernia repair. Secondly,we do believe that laparoscopic approach is preferable inselected cases such as bilateral primary inguinal Hernias,recurrent inguinal Hernias after Lichtenstein repair andgroin Hernias in women. This selection is based on theguidelines of the European Hernia Society (EHS) [3] andnot on our own personal experience. However, we notedthat Dr. R. Bendavid does not agree with the EHS guide-lines on several points including the definition of a femoralHernia.Furthermore, we have been misunderstood byDr. R. Bendavid and must clarify that we do not operate onpatients with asymptomatic inguinal Hernias. Finally,Dr. R. Bendavid has cited us incorrectly. We have stated inour paper that we do not find the Lichtenstein repair to beherniogenic.References
Nadia A. Henriksen - One of the best experts on this subject based on the ideXlab platform.
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Direct and Recurrent Inguinal Hernias are Associated with Ventral Hernia Repair: A Database Study
World Journal of Surgery, 2013Co-Authors: Nadia A. Henriksen, Lars T. Sorensen, Morten Bay-nielsen, Lars N. JorgensenAbstract:Background A systemically altered connective tissue metabolism has been demonstrated in patients with abdominal wall Hernias. The most pronounced connective tissue changes are found in patients with direct or recurrent inguinal Hernias as opposed to patients with indirect inguinal Hernias. The aim of the present study was to assess whether direct or recurrent inguinal Hernias are associated with an elevated rate of ventral Hernia surgery. Methods In the nationwide Danish Hernia Database, a cohort of 92,457 patients operated on for inguinal Hernias was recorded from January 1998 until June 2010. Eight-hundred forty-three (0.91 %) of these patients underwent a ventral Hernia operation between January 2007 and June 2010. A multivariate logistic regression analysis was applied to assess an association between inguinal and ventral Hernia repair. Results Direct (Odds Ratio [OR] = 1.28 [95 % CI, 1.08–1.51]) and recurrent (OR = 1.76, [95 % CI, 1.39–2.23]) inguinal Hernias were significantly associated with ventral Hernia repair after adjustment for age, gender, and surgical approach (open or laparoscopic). Conclusions Patients with direct and recurrent inguinal Herniation are more prone to ventral Hernia repair than patients with indirect inguinal Herniation. This is the first study to show that herniogenesis is associated with type of inguinal Hernia.
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unsuspected femoral Hernia in patients with a preoperative diagnosis of a recurrent inguinal Hernia author reply
Hernia, 2012Co-Authors: Nadia A. Henriksen, J. Thorup, Lars N. JorgensenAbstract:We would like to thank Dr. R. Bendavid for the thoroughcomment on our paper ‘Unsuspected femoral Hernia inpatients with a preoperative diagnosis of recurrent inguinalHernia’. However, we are afraid that Dr. R. Bendavid mayhave missed the aim of the study from which we quote:‘The aim of this study was to examine the incidence ofunsuspected femoral Hernia discovered at transabdominalpreperitoneal (TAPP) laparoscopic inguinal Hernia repairin two well-defined groups: (1) patients with bilateralprimary inguinal Hernia and (2) patients with recurrentinguinal Hernia’. When the aim is to examine unsuspectedfemoral Hernias, it would be paradoxical to include patientswith a preoperative diagnosis of a femoral Hernia.Dr. R. Bendavid prefers to mention his series of 508 openfemoral Hernia repairs [1, 2], which is of course notewor-thy; however, it does not cover unsuspected femoral her-nias and is therefore not within the subject of our article.Dr. R. Bendavid claims that the article is in favour oflaparoscopic Hernia surgery. In fact, the majority ofinguinal Hernia repairs are performed by open approach inour department. Firstly, referring to the aim of the studyagain, we examined unsuspected femoral Hernias inpatients undergoing laparoscopic Hernia repair. Secondly,we do believe that laparoscopic approach is preferable inselected cases such as bilateral primary inguinal Hernias,recurrent inguinal Hernias after Lichtenstein repair andgroin Hernias in women. This selection is based on theguidelines of the European Hernia Society (EHS) [3] andnot on our own personal experience. However, we notedthat Dr. R. Bendavid does not agree with the EHS guide-lines on several points including the definition of a femoralHernia.Furthermore, we have been misunderstood byDr. R. Bendavid and must clarify that we do not operate onpatients with asymptomatic inguinal Hernias. Finally,Dr. R. Bendavid has cited us incorrectly. We have stated inour paper that we do not find the Lichtenstein repair to beherniogenic.References
L. N. Jorgensen - One of the best experts on this subject based on the ideXlab platform.
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Unsuspected femoral Hernia in patients with a preoperative diagnosis of recurrent inguinal Hernia
Hernia, 2012Co-Authors: N. A. Henriksen, J. Thorup, L. N. JorgensenAbstract:Purpose Small femoral Hernias may be difficult to diagnose by physical examination and are sometimes identified unexpectedly by laparoscopy. The aim of this study was to examine the incidence of unsuspected femoral Hernia discovered during laparoscopic inguinal Hernia repair in two well-defined patient groups. Methods Patients undergoing laparoscopic transabdominal preperitoneal inguinal Hernia repair from April 2000 until December 2009 ( n = 561) were prospectively registered including data on previous Hernia operations and identified type of Hernia during surgery. We included patients whose preoperative diagnosis was either bilateral primary inguinal Hernia (Primary Group) or recurrent inguinal Hernia (Recurrent Group). Results Four hundred and sixty-one (82.2 %) patients were included in the study, of whom 211 (45.8 %) was in the Primary Group and 250 (54.2 %) in the Recurrent Group. The incidence of unsuspected femoral Hernia in the Recurrent Group [23/250, 9.2 % (95 % CI 5.9–13.5 %)] was significantly higher than in the Primary Group [8/211, 3.8 % (95 % CI 1.7–7.3 %)], p = 0.02. Furthermore, 38.1 % of women operated on for a recurrent inguinal Hernia, presented with an unsuspected femoral Hernia at surgery as opposed to 6.6 % of the men, p = 0.003. Conclusion Unsuspected femoral Hernias are more prevalent in patients with recurrent Hernia than in patients with primary Hernia in the inguinal region. Femoral Hernias may be unrecognized at the primary inguinal Hernia operation, or the previous inguinal Hernia operation may facilitate the formation of a femoral Hernia. Unsuspected femoral Hernias are especially frequent in women with recurrent inguinal Hernia. In women with a groin Hernia, a femoral Hernia should always be excluded by laparoscopy or by open exploration of the preperitoneal space.
K. Ueno - One of the best experts on this subject based on the ideXlab platform.
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Single-incision laparoscopic transabdominal preperitoneal mesh hernioplasty: results in 182 Japanese patients
Hernia, 2016Co-Authors: K. Tanoue, H. Okino, M. Kanazawa, K. UenoAbstract:Background We introduced single-incision transabdominal preperitoneal (S-TAPP) herniorrhaphy (described herein) at our institution in June 2010. We recently conducted a retrospective study to assess the feasibility and safety of the procedure. Methods The study involved 182 patients (159 men, 23 women) who underwent S-TAPP herniorrhaphy between June 2010 and February 2015 for 202 groin Hernias (162 unilateral Hernias, 20 bilateral Hernias). We examined patient characteristics, Hernia type and presentation, operation time, conversion to another repair procedure, intraoperative blood loss, postoperative pain, morbidities, and postoperative hospital stay. We further evaluated operation time and morbidity by comparison between cases of simple unilateral Hernia and cases of complicated unilateral Hernia, which was defined as (1) a recurrent Hernia, (2) Hernia following radical prostatectomy, or (3) an incarcerated omental or bowel Hernia. Results Five types of Hernia were treated: indirect inguinal, direct inguinal, femoral, combined inguinal, and other (a urinary bladder Hernia). Operation time was 92.5 ± 29.1 min for the unilateral Hernias and 135.7 ± 24.5 min for the bilateral Hernias. No major bleeding occurred. Postoperative pain was short-lived and easily managed. Overall morbidity was 8.2% (15/182 patients), and only one postoperative complication (recurrence) required surgical intervention (repeat S-TAPP). Average postoperative stay was 6.7 ± 2.6 days. Two patients experienced numbness in the outer thigh, but this resolved naturally. One superficial surgical site infection developed and was easily treated. Operation times were greater for the complicated vs. simple Hernias, but the time differed significantly ( p = 0.02) only between radical prostatectomy-associated Hernia and simple Hernia. No complicated Hernia required conversion to traditional laparoscopic repair, but in simple unilateral Hernia group one conversion to traditional laparoscopic repair was required for difficulties encountered in the dissection of the large indirect inguinal Hernia sac. The incidence of seroma was higher, though not statistically, in the complicated ( n = 3) vs. simple Hernia group. Conclusions S-TAPP repair of groin Hernia was shown to be a feasible, safe procedure. The advantages are well understood, and further studies are warranted to confirm the long-term benefits suggested by our study.
A. S. Y. Wong - One of the best experts on this subject based on the ideXlab platform.
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Does primary closure of direct inguinal Hernia defect during laparoscopic mesh repair reduce the risk of early recurrence?
Hernia, 2020Co-Authors: A. Y. Ng, S. S. Ching, A. S. Y. WongAbstract:Purpose Hernia recurrence is an important complication following inguinal Hernia repair. Primary closure of ventral Hernia defects laparoscopically has been shown to reduce the risk of recurrence and seroma formation. The results for ventral Hernias may potentially be applied to direct inguinal Hernias. Our aim was to evaluate the value of primary closure of direct defects during laparoscopic inguinal Hernia mesh repair in reducing the incidence of early recurrence. Methods A retrospective, single-center cohort study was conducted on cases performed from August 2016 to February 2018. Patients with direct inguinal Hernias undergoing elective laparoscopic mesh repair were included. When performed, the direct Hernia defect was primarily closed with extracorporeal non-absorbable interrupted sutures followed by standard placement of a lightweight mesh covering myopectineal orifices. Early recurrence was defined as occurring within 1 year of surgery. Results A total of 75 direct inguinal Hernias in 53 patients who underwent surgery and completed at least 1 year of follow-up were analyzed. The mean age of patients was 63 years (range 44–82 years); with majority of patients being male (98.1%). There were no significant differences observed between the two patient populations in terms of demographics, mean operative time and risk factors. In 9 (16.9%) patients, the direct Hernias were recurrent Hernias and all underwent open mesh repair during the index Hernia surgery. The majority of Hernia repairs (63 Hernias in 45 patients, 85%) were performed via the totally extraperitoneal (TEP) approach. 19 patients (35.8%) with 28 direct inguinal Hernias underwent primary closure of the direct defect prior to mesh placement; while, 34 patients (64.2%) with 47 direct Hernias did not undergo primary closure. There were 3 direct Hernia recurrences (6.4%) at 1 year post-operatively, and all occurred in the non-closure group. In comparison, there were no recurrences in the closure group; however, this difference was not statistically significant ( p = 0.289) in our study due to the small sample size. Conclusion Closure of direct inguinal Hernia defects during laparoscopic mesh repair has been shown to reduce the incidence of early Hernia recurrence in our retrospective study but future randomized controlled trials with large numbers would enable us to draw more robust conclusions and perhaps change the way we perform laparoscopic inguinal Hernia repair.
