ABSTRACT
PURPOSE: Sliding hernia is a rare finding and it remains controversial if a laparoscopic or an open (Lichenstein) technique is preferable for repair of sliding hernias. The aim of this study was to investigate the risk of post-operative complications and risk of reoperation due to recurrence in patients with sliding hernia based on surgical technique. METHOD: The study included male patients receiving hernia repair between 1 January 2010 and 31 December 2017. The data was obtained from the National Danish Hernia Database. RESULTS: A total of 32,396 hernia repairs were included. 13.5% presented with sliding hernia. No difference was found in postoperative complications comparing sliding and non-sliding lateral hernias (5.1% vs 4.2% at 90 days of follow up). Patients treated with a Lichenstein repair had a higher risk of minor complications compared to a laparoscopic repair, however the risk was overall low (1.9% vs 0.8%). Overall 3.1% had surgical repair of recurrence, a higher risk was found among patients with sliding hernia (4.3% vs 2.9%), particularly among those having a Lichenstein repair (OR 2.07, 95% CI 1.11-3.85). CONCLUSION: A low risk of complications and recurrence after repair of both sliding and non-sliding hernia was found. Among patients with sliding hernia the risk of recurrence was lower in patient having hernia repair using laparoscopic technique although in both groups the risk was low. Sliding hernias can be treated safely using both Lichenstein and laparoscopic techniques.
Subject(s)
Hernia, Inguinal , Laparoscopy , Hernia, Inguinal/etiology , Hernia, Inguinal/surgery , Herniorrhaphy/adverse effects , Herniorrhaphy/methods , Humans , Laparoscopy/adverse effects , Laparoscopy/methods , Male , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/surgery , Recurrence , Reoperation , Retrospective StudiesABSTRACT
BACKGROUND: There is no consensus regarding the impact of oncoplastic surgery (OPS) on rates of re-excision and conversion to mastectomy following breast-conserving surgery (BCS). Here these two outcomes after BCS and OPS were compared in a nationwide population-based setting. METHODS: In Denmark, all OPS is registered and categorized into volume displacement, volume reduction or volume replacement. Patients who underwent BCS or OPS between 2012 and 2018 were selected from the Danish Breast Cancer Group database. Multivariable analyses were performed to adjust for confounders, and propensity score matching to limit potential confounding by indication bias. RESULTS: A total of 13 185 patients (72·5 per cent) underwent BCS and 5003 (27·5 per cent) OPS. Volume displacement was used in 4171 patients (83·4 per cent), volume reduction in 679 (13·6 per cent) and volume replacement in 153 (3·1 per cent). Re-excision rates were 15·6 and 14·1 per cent after BCS and OPS respectively. After adjusting for confounders, patients were less likely to have a re-excision following OPS than BCS (odds ratio (OR) 0·80, 95 per cent c.i. 0·72 to 0·88), specifically after volume displacement and reduction. The rate of conversion to mastectomy was similar after OPS and BCS (3·2 versus 3·7 per cent; P = 0·105), but with a lower risk in adjusted analysis (OR 0·69, 0·58 to 0·84), specifically after volume displacement and reduction procedures. Findings were similar after propensity score matching. CONCLUSION: A modest decrease in re-excision rate and less frequent conversion to mastectomy were observed after OPS compared with BCS.
ANTECEDENTES: No existe consenso con respecto al impacto de la cirugía oncoplástica (oncoplastic surgery, OPS) en las tasas de re-exéresis y conversión a mastectomía tras la cirugía conservadora de la mama (breast conserving surgery, BCS). En este estudio se compararon los dos resultados después de BCS y OPS en una base de datos poblacional de ámbito nacional. MÉTODOS: En Dinamarca, todas las OPS se registran y clasifican en procedimientos que incluyen 1) desplazamiento (o remodelación) de volumen, 2) reducción de volumen o 3) restitución de volumen. Todas las pacientes sometidas a BCS o OPS entre 2012 y 2018 fueron seleccionadas de la base de datos del Grupo de Cáncer de Mama Danés. Se realizaron análisis multivariables para ajustar por factores de confusión y un emparejamiento por puntaje de propensión para limitar las variables de confusión potenciales por el sesgo en la indicación. RESULTADOS: Un total de 13.185 (72,5%) pacientes fueron sometidos a BCS y 5.003 (27,5%) a OPS. Se utilizó el desplazamiento de volumen en 4.171 (83,4%) pacientes, reducción de volumen en 679 (13,6%) pacientes y restitución de volumen en 153 (3,1%) pacientes. Las tasas de re-exéresis fueron del 15,6% y 14,1% tras BCS y OPS, respectivamente. Tras ajustar por factores de confusión, las pacientes tuvieron menos probabilidad (razón de oportunidades, odds ratio, OR 0,80, i.c. del 95%. 0,72-0,88) de requerir re-exéresis tras OPS, específicamente después de desplazamiento y reducción de volumen, en comparación con BCS. La tasa de conversión a mastectomía fue inferior (3,2% versus 3,7%, P = 0,04) y menos probable (OR 0,71, i.c. del 95% 0,58-0,87) tras OPS, específicamente en el desplazamiento y reducción de volumen, en comparación con BCS. Los resultados fueron similares después del emparejamiento por puntuación de propensión. CONCLUSIÓN: Se observó un descenso modesto en las tasas de re-exéresis y una menor frecuencia de conversiones a mastectomía después de la cirugía oncoplástica cuando se comparó con la cirugía conservadora de la mama.
