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1.
Hernia ; 20(1): 43-53, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26590934

ABSTRACT

UNLABELLED: Chronic pain and physical disability are well-known problems after primary groin hernia surgery, but the outcome after recurrent hernia surgery is much less known. PURPOSE: To study the impact of anterior mesh repair (AMR) and posterior mesh repair (PMR) on chronic pain and disability after first recurrent groin hernia surgery in a population-based cohort derived from the Swedish Hernia Register. METHODS: Consecutive unilateral, first and second recurrent hernia repairs, registered between 1998 and 2007, were included. Follow-up was performed in 2009 based on the Inguinal Pain Questionnaire (IPQ) and selective clinical examination, comparing prevalence of pain between AMR, endoscopic (E-PMR) and open posterior mesh repairs (O-PMR) after first recurrent repair. Chronic pain after a second recurrent repair was analysed. RESULTS: Altogether 671 first recurrent repairs were analysed: 329 AMRs, 161 E-PMRs and 181 O-PMRs. IPQ response rate was 70.6%. If the index repair was anterior, the E-PMR was associated with a lower risk of chronic pain and disability compared to AMR [OR 0.54 (CI 0.30-0.97), p = 0.039]. The risk of chronic pain increased after a second recurrent repair. A surgeon's annual volume >5 O-PMRs was related to a lower risk compared to ≤5 [OR 0.42 (CI 0.19-0.94), p = 0.034]. CONCLUSION: Endoscopic repair for first recurrent groin hernia surgery, after an index anterior repair, was associated with less chronic pain, discomfort and disability compared to anterior approach. Chronic pain increased after a second recurrent repair. A high surgeon's volume reduced the risk of chronic pain after open posterior mesh repair.


Subject(s)
Chronic Pain/etiology , Hernia, Inguinal/surgery , Herniorrhaphy/adverse effects , Laparoscopy/adverse effects , Pain, Postoperative/etiology , Registries/statistics & numerical data , Aged , Chronic Pain/surgery , Cohort Studies , Female , Groin/surgery , Hernia, Femoral/surgery , Herniorrhaphy/methods , Herniorrhaphy/statistics & numerical data , Humans , Laparoscopy/methods , Laparoscopy/statistics & numerical data , Male , Middle Aged , Pain, Postoperative/surgery , Reoperation , Surgical Mesh , Surveys and Questionnaires
3.
Hernia ; 19(6): 863-9, 2015 Dec.
Article in English | MEDLINE | ID: mdl-26238397

ABSTRACT

BACKGROUND: Chronic groin postherniorrhaphy pain (CGPP) is common and sometimes so severe that surgical treatment is necessary. The aim of this study was to identify risk factors for being reoperated due to CGPP. METHODS: All 195,707 repairs registered in the Swedish Hernia Register between 1999 and 2011 were included in the study. Out of these, 28,947 repairs were excluded since they were registered as procedures on the same patient after a previous repair. Age, gender, hernia anatomy (indirect reference), method of repair (anterior sutured repair reference) and postoperative complications were included in a multivariate Cox analysis with reoperation due to CGPP as endpoint. RESULTS: Of the patients included in the study cohort, 218 (0.13%) later underwent reoperation due to CGPP, including 31 (14%) women. Median age at the primary repair was 61.5 years. Risk factors for being reoperated were age < median [hazard ratio (HR) 3.03, 95% confidence interval (CI) 2.22-4.12], female gender (HR 2.13, CI 1.41-3.21), direct hernia (HR 1.35, CI 1.003-1.81), other hernia (HR 6.03, CI 3.08-11.79), Lichtenstein repair (HR 2.22, CI 1.16-4.25), plug repair (HR 3.93, CI 1.96-7.89), other repair (HR 2.58, CI 1.08-6.19), bilateral repair (HR 2.58, CI 1.43-4.66) and postoperative complication (HR 4.40, CI 3.25-5.96). CONCLUSIONS: Risk factors for being reoperated due to CGPP in this cohort included low age, female gender, a direct hernia, a previous Lichtenstein or plug repair, bilateral repair and postoperative complications. Further research on how to avoid CGPP and explore the effectiveness of surgery for CGPP is necessary.


Subject(s)
Chronic Pain/surgery , Hernia, Femoral/surgery , Hernia, Inguinal/surgery , Herniorrhaphy/adverse effects , Pain, Postoperative/surgery , Chronic Pain/etiology , Cohort Studies , Female , Groin/surgery , Humans , Male , Middle Aged , Pain, Postoperative/etiology , Registries , Reoperation , Risk Factors
4.
World J Surg ; 39(2): 315-22; discussion 323-4, 2015 Feb.
Article in English | MEDLINE | ID: mdl-25561189

ABSTRACT

BACKGROUND: According to the Swedish Hernia Register (SHR), the reoperation rate is more than doubled after recurrent groin hernia repair compared with primary repair. The aim was to study the impact of type of mesh repair used in recurrent groin hernia surgery on a 2nd recurrence in a population-based cohort derived from the SHR. MATERIAL AND METHOD: All 1st recurrent hernia repairs in the south-west region of Sweden, registered in SHR between 1998 up to 2007 were included. A questionnaire was sent in 2009. Patients stating a new lump or persisting problems were examined. A 2nd recurrence was identified as a 2nd reoperation or at physical examination. The incidence was analysed comparing anterior mesh repair (AMR) and posterior mesh repairs (PMR) (endoscopic and open). RESULTS: Eight hundred and fifteen recurrent operations in 767 patents were analysed, 401 AMRs and 414 PMRs. PMR had a lower 2nd recurrence rate compared with AMR (5.6 vs. 11.0 %) (p = 0.025). An increased risk [3.21 (CI 1.33-7.44) (p = 0.009)] of a subsequent 2nd recurrence was seen after anterior index repair followed by AMR and a decreased risk [0.08 (CI 0.01-0.94) (p = 0.045)] after posterior index repair followed by AMR. CONCLUSION: PMR in recurrent groin hernia surgery was associated with a lower 2nd recurrence rate compared to anterior. A posterior approach for 1st recurrent operation is recommended after an anterior index repair and an anterior approach after a posterior index operation.


Subject(s)
Hernia, Inguinal/surgery , Herniorrhaphy/methods , Surgical Mesh , Aged , Female , Herniorrhaphy/instrumentation , Humans , Male , Middle Aged , Recurrence , Registries , Reoperation/methods , Risk Factors , Surveys and Questionnaires , Sweden
5.
Br J Surg ; 98(10): 1489-94, 2011 Oct.
Article in English | MEDLINE | ID: mdl-21618495

ABSTRACT

BACKGROUND: The reoperation rate after recurrent groin hernia surgery is more than twice that recorded for primary groin hernia procedures. The aim was to define the outcome from routine redo hernia surgery by analysing a large population-based cohort from a national hernia register. METHODS: All recurrent groin hernia operations registered in the Swedish Hernia Register from 1992 to 2008 were analysed using multivariable analysis with stratification for preceding repair. RESULTS: Altogether 174,527 hernia operations were recorded in the Swedish Hernia Register between 1992 and 2008, including 19 582 reoperations. The preceding repair was included in the register for 5565 of these recurrent repairs. With laparoscopic repair as reference standard, the hazard ratio for recurrence was 2·55 (95 per cent confidence interval 1·66 to 3·93) after sutured repair, 1·53 (1·20 to 1·95) after Lichtenstein repair, 2·31 (1·76 to 3·03) after plug repair, 1·36 (0·95 to 1·94) after open preperitoneal mesh and 3·08 (2·22 to 4·29) after other repairs. Laparoscopic and open preperitoneal repair were associated with a lower risk of reoperation following a preceding open repair (P < 0·001), but no technique differed significantly from the others following a preceding preperitoneal repair. CONCLUSION: The laparoscopic and the open preperitoneal mesh methods of repair for recurrent groin hernias were associated with the lowest risk of reoperation. Although the method of repair in previous surgery must be considered, these techniques are the preferred methods for recurrent groin hernia surgery.


Subject(s)
Hernia, Inguinal/surgery , Aged , Female , Hernia, Inguinal/epidemiology , Humans , Laparoscopy/statistics & numerical data , Male , Middle Aged , Multivariate Analysis , Prospective Studies , Recurrence , Registries , Reoperation/statistics & numerical data , Risk Factors , Sweden/epidemiology
6.
Hernia ; 13(6): 581-3, 2009 Dec.
Article in English | MEDLINE | ID: mdl-19590818

ABSTRACT

PURPOSE: The aim of this study was to assess the impact of the degree of difficulty and quality of hernia repair, as perceived by the surgeon, and operative time on the reoperation rate. METHODS: All hernia repairs performed during the period 1994­1995 at the Department of Surgery, University Hospital of Lund, Sweden, were recorded prospectively. The degree of difficulty and the degree of difficulty in relation to the preoperative expectation of the surgeon were graded on a three-degree scale, the final outcome graded as optimal or suboptimal, and the time required to perform the hernia repair was recorded. Recurrence repairs prior to 1998 were traced in a retrospective review of the patient notes. The Swedish Hernia Register was checked for reoperations from 1998 and later. RESULTS: Altogether, 184 hernia repairs were recorded during the study period, including 14 repairs on women. The mean age of the patients was 58 years and the standard deviation was 15 years. Subsequent reoperation for recurrence was identified in 21 (11.4%) of these patients. The operative time correlated significantly with the surgeon's perception of the degree of difficulty (P < 0.05). Operative time less than 20 min (n = 4) was significantly associated with increased risk for reoperation (P < 0.05). The degree of difficulty, the degree of difficulty in relation to preoperative expectation, and the assessment of the final outcome were not associated with the risk for reoperation. CONCLUSIONS: Although neither the grade of difficulty nor the surgeon's perception of the quality of repair significantly predicted the final outcome, the risk for reoperation increased if the repair was performed rapidly.


Subject(s)
Hernia, Inguinal/surgery , Physicians/psychology , Quality of Health Care , Adult , Aged , Female , Humans , Male , Middle Aged , Personal Satisfaction , Reoperation , Time Factors , Treatment Outcome
7.
Eur J Surg ; 168(11): 592-6, 2002.
Article in English | MEDLINE | ID: mdl-12699094

ABSTRACT

OBJECTIVE: To audit the effect of changes in treatment of inguinal hernias on recurrence rate. DESIGN: Retrospective analysis of consecutive patients operated on in 1990 and prospective analysis of consecutive patients operated on in 1996. Follow up with questionnaire followed by selective clinical examination. SETTING: County hospital, Sweden. SUBJECTS: 144 patients with 147 inguinal hernias operated on in 1990 and 154 patients with 165 inguinal hernias operated 1996. on in INTERVENTIONS: In 1993, we changed many aspects of the treatment of inguinal hernia. We introduced new techniques such as Shouldice, Lichtenstein, and laparoscopic hernia repair. Non-absorbable polypropylene sutures replaced the braided absorbable sutures previously used. Inguinal herniorrhaphy went from a "low status" operation to a high status operation and became a primary teaching operation for surgical residents. MAIN OUTCOME MEASURES: Recurrence rate at 5 year follow up. RESULTS: The 5 year recurrence rate decreased from 28% in 1990 to 3% in 1996 (p < 0.001). The m edian operating time increased from 35 minutes in 1990 to 78 minutes in 1996 (p < 0.001). CONCLUSION: Changing the strategy of inguinal hernia surgery by introducing uniform operating techniques and new materials dramatically improved the results and allowed us to achieve recurrence rates comparable to those seen in specialised hernia centres.


Subject(s)
Hernia, Inguinal/surgery , Case-Control Studies , Female , Follow-Up Studies , Hernia, Inguinal/epidemiology , Hospitals, County/statistics & numerical data , Humans , Iceland/epidemiology , Laparoscopy , Male , Middle Aged , Postoperative Complications/epidemiology , Prospective Studies , Recurrence , Retrospective Studies , Suture Techniques , Sutures , Time Factors
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