ABSTRACT
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.
Subject(s)
Hernia, Umbilical , Humans , Hernia, Umbilical/surgery , Herniorrhaphy/methods , EmergenciesSubject(s)
Education, Medical, Undergraduate/methods , Otolaryngology/education , Peer Group , Curriculum , England , Humans , Pilot Projects , TeachingABSTRACT
INTRODUCTION: Obesity usually depreciates early results of abdominal operations performed in an open way, but not always after laparoscopic operations. Aim of the study is to compare early results and quality of life after most common abdominal operations (cholecystectomy and appendectomy) performed on obese and non-obese patients. MATERIAL AND METHODS: 166 patients who were operated in academic teaching hospital, were analyzed in groups: cholecystectomy - laparoscopic (74) and open (30), appendectomy - laparoscopic (30) and open (32). Every group was divided into subgroups with normal body mass, obesity I obesity II and was assessed retrospectively and investigated by Gastrointestinal Quality of Life Index (GQLI) up to 5 months after intervention by registered nurse specialized in surgery. Number and gravity of complications were assessed as well as hospital stay and convalescence time. RESULTS: There were 7/19 and 4/13 complications after laparoscopic vs 8/12 and 7/19 after open cholecystectomies and appendectomies respectively in groups with normal body weight (BMI 18.5-24.9kg/m2), and 28/56 and 8/20 complications after laparoscopic vs 14/18 and 9/12 after open cholecystectomies and appendectomies respectively in obese groups (above 25 kg/m2). One conversion to open surgery occured in patient with obesity I for laparoscopic cholecystectomy and one in normal body mass patient for laparoscopic appendectomy. There was one case of common bile duct lesion in obese patient during laparoscopic intervention and two cases of intestinal obstruction after open cholecystectomy in obese patients. Mean hospital stay time was 3.2 and 3.8 days after laparoscopic operations vs 5.4 and 5.4 days after open ones respectively. Mean convalescence time was 14 and 14 days after laparoscopic operations vs 21 and 14 days after open cholecystectomy and appendectomy respectively. Quality of life was significantly better after laparoscopic than open cholecystectomy in obese patients (128.4 +/- 12.7 vs 120.6 +/- 12.2 respectively) but significantly worse after laparoscopic than open appendectomy (121 +/- 15.2 vs 133.8 +/- 12.9 respectively). In groups with normal body mass differences were not significant. CONCLUSIONS: There is the influence of obesity on number and burden of postoperative complications after laparoscopic and open operations, however laparoscopic access seems more effective. Although hospital stay time was shorter after both types of laparoscopic operations, convalescence time was shorter only after laparoscopic cholecystectomy. The choice of type of operation (open or laparoscopic) influences the quality of life of obese patients but not on those with normal body mass. Although these conclusions seem rather clear, verification of them on larger group of patients is mandatory.
