Effect of Body Mass Index on Groin Hernia Surgery

Rosemar, Anders; Angerås, Ulf; Rosengren, Annika; Nordin, Pär

doi:10.1097/sla.0b013e3181e985a1

Cited by 99 publications

(77 citation statements)

References 19 publications

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“…The patients included in this study were not found to exhibit any statistically significant differences in terms of sex, age, comorbidities, ASA scores or body mass indices when compared to the general population [25,26]. The majority of patients was male, of normal weight and demonstrated ASA scores of either I or II.…”

Section: Discussionmentioning

confidence: 99%

The Italian Register of Biological Prostheses

Catena

Bertoli²,

Gossetti³

et al. 2013

Eur Surg Res

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Background: A wide variety of meshes are available for surgical treatment of abdominal wall defects. These meshes are constructed with different materials with different biological properties. Methods: A prospective database was instituted (January 2009-December 2010) to register biological prostheses (BPs) implanted in Italy. Results: A total of 193 cases were registered. The mean age of the patients was 53.1 years (SD ±7.4). The ratio of males to females was 1.3 to 1. The mean body mass index was 28.2 (SD ±4.1). The breakdown of American Society of Anesthesiologists (ASA) scores was as follows: ASA I, 35.7%; ASA II, 27.5%; ASA III, 31.6%, and ASA IV, 5.2%. For ventral-incisional hernias, the mean duration of surgery was 101.1 min (SD ±25.3), while for inguinal-femoral hernias it was 49.2 min (SD ±19.1). The rate of urgent procedures was 36.7%. The surgical field was clean in 57.4% of cases, clean-contaminated in 21.3%, contaminated in 12.3% and dirty in 9%. Techniques used for inguinal-femoral hernias were as follows: Lichtenstein in 66.7%, plug and mesh in 3.8%, transabdominal-preperitoneal in 25.7% and intraperitoneal onlay mesh in 3.8%. The following prostheses were used: swine intestinal submucosa in 54.9%, porcine dermal collagen in 39.9% and bovine pericardium in 5.2%. In 45.1% of cases the prostheses were cross-linked. Techniques used for ventral-incisional hernias were as follows: onlay in 3.6%, inlay in 5.5%, sublay in 62.7% and underlay via laparoscopy in 28.2%. The mean overlap was 4.1 cm (SD ±1.2). No intestinal anastomosis was necessary in 65.3% of cases; however, small/large bowel resection and anastomoses were necessary in 22.3 and 12.4% of cases, respectively. Intraoperative blood transfusion was necessary in 10.4% of procedures. The skin was completely closed in 84% of procedures. At the 1-month follow-up, there were no complications in 54.4% of cases. Among the cases with complications, 10 patients (5.8%) experienced recurrence, and the postoperative readmission rate was 12.9%. The average visual analog scale (VAS) score for pain was 2.9 (SD ±1.2) at rest. At the 1-year follow-up, there were no complications in 96.4% of cases. Two patients experienced recurrence, and the postoperative readmission rate was 3.6%. The average VAS score for pain was 1.8 (SD ±0.8) at rest. Conclusions: This register shows that BPs are highly versatile and can be used in either open or laparoscopic surgery in all kinds of patients and in contaminated surgical fields. However, due to the very good outcomes of synthetic meshes and the high costs of BPs, the latter should only be used in selected cases.

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Section: Discussionmentioning

confidence: 99%

The Italian Register of Biological Prostheses

Catena

Bertoli²,

Gossetti³

et al. 2013

Eur Surg Res

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“…al. 2007;Rosemar, et. al., 2010) en el estudio predominó el grupo de obreros y campesinos, aunque no demostraron riesgo significativo de recurrencia (p>0.05).…”

Section: Discussionunclassified

“…La tasa de recurrencias aumenta con el número de intentos previos a causa de pérdida de tejidos, friabilidad y retracción cicatrizal; (Flum, Horvath & Koepsell, 2003;Bisgaard, Bay-Nielsen, Christensen, & Kehlet, 2007) evidentemente la primera reparación tendrá mayor posibilidad de éxito, y la recidiva es frecuente tras cualquier reparación secundaria de una hernia recurrente. Los factores desencadenantes han sido muy bien estudiados, y uno de los principales es la hiperpresión intraabdominal, originada por tos crónica, prostatismo y estreñimiento; (Lau, Fang, Yuen & Patil, 2007;Jansen, Klinge, Jansen, & Junge, 2009;Rosemar, Angerås, Rosengren, & Nordin, 2010), otros factores asociados constituye un defecto del metabolismo de colágena, debilidad muscular y tensión de la línea de sutura. (Arregui, & Young, 2005).…”

Section: Introduccionunclassified

Factores de riesgo de recurrencia de hernias inguinales

2017

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Analizar factores relacionados con recurrencia de hernias Inguinal en Hospital Humberto Alvarado Vásquez. Pacientes y Método: Estudio de Casos y Controles. Periodo Enero 2003 - Diciembre 2010, se efectuaron 805 hernioplastias; 57 casos recurrieron, controles 114 asignados al azar. Criterios de exclusión: menor de 15 años, cirugía de urgencia. El análisis estadístico aplicado, pruebas de Chi cuadrado, ANOVA, y razón de probabilidades (OR) con intervalos de confianza del 95%. Resultados: Factores asociados a recurrencia hernia: sexo masculino (p=0.03), mayor de 65 años (p=0.007), obesidad (p=0.0006). Según clasificación de Bendavid los tipos de hernias predominantes en casos T1S3D3 y T2S3D3. La técnica quirúrgica más utilizada en casos fue Bassini OR: 2.68 (1.26-5.72; p=0.005). Se evidenció que las técnicas de Shouldice (p=0.007) y hernioplastia con malla (p=0.0001) constituyen un factor protector. Asimismo hubo una relación significativa de casos con uso nylon 2-0 (p=000.2). El promedio tiempo quirúrgico 50.63 (±26.8) en casos y 41.86(±19.5) en controles. La media tiempo de aparición de recurrencia 2 años (±1.02). Conclusiones: Factores de riesgo de recurrencia: masculino, >65 años, obesidad, técnica quirúrgica Bassini y MacVay; factores protectores técnicas de Shouldice y Hernioplastia con malla. Utilizar siempre hilo monofilamento no absorbible

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“…This is in line with observations from Rosemer et al who could demonstrate a similar U-shaped correlation between BMI and postoperative complication, with higher risks for BMI < 20 as well as for BMI > 25. A BMI, which is too high, obviously is as bad as when it is too low [20]. Ignorance of this U-shaped relation will likely end up in non-significant results, when comparing means or testing 2 × 2 tables with Chi [2].…”

Section: Limitation 5: Mode Of Interference Often Is Not Defined For mentioning

confidence: 99%

Bias-Variation Dilemma Challenges Clinical Trials: Inherent Limitations of Randomized Controlled Trials and Meta-Analyses Comparing Hernia Therapies

Klinge¹,

Koch²,

Weyhe³

et al. 2014

IJCM

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Purpose: Evaluation of hernia therapies according to the current rules of Evidence Based Medicine is widely reduced to results of RCTs or meta-analyses. RCTs have been accepted as a most important tool to confirm a superior effect of an intervention. Unfortunately, in hernia surgery, comparisons of RCTs and correspondingly their use in meta-analyses, are not, surprisingly often, able to confirm any significant impact of a specific procedure due to intrinsic restrictions in a multi-causal setting with its web of influences. Methods: Based on our own experiences of clinical studies in surgery, the present article outlines several situations, with their respective reasons, which argue the severe limitations of RCTs and meta-analysis to define an optimum treatment. Results: Metaanalyses accumulate the variations of each trial, which then may cover any clear causal relationship. RCTs usually are dealing with subgroups of standard patients thus excluding the majority of our patients. Low statistical power of current cohort sizes restricts the analysis of subgroups or of effects with low incidences. Simple comparisons of means frequently are hampered by nonlinear relationships to outcome. The relevance of a specific variable is difficult to separate from other influences. The limited surveillance period of studies ignores a delayed change in outcome. Randomization cannot guarantee a standardized patient's condition. All the arguments have to be con-* Corresponding author. U. Klinge et al. 779sidered as a crucial and fundamental consequence of the bias-variance dilemma or principle of uncertainty in medicine, and underline the many limitations of RCTs to evaluate any specific impact of hernia therapies on e.g. infection, pain or recurrence. Conclusions: Many surgical issues cannot be and should not be investigated by RCTs, in particular, if a marked patients' heterogeneity has to be considered or the low incidences of the outcome readout cannot be addressed with sufficient statistical power without getting lost in the variation mire. Registries with their non-restricted data-acquisition should be regarded as reliable alternatives for postoperative outcome quality surveillance studies.

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Effect of Body Mass Index on Groin Hernia Surgery

Cited by 99 publications

References 19 publications

The Italian Register of Biological Prostheses

The Italian Register of Biological Prostheses

Factores de riesgo de recurrencia de hernias inguinales

Bias-Variation Dilemma Challenges Clinical Trials: Inherent Limitations of Randomized Controlled Trials and Meta-Analyses Comparing Hernia Therapies

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