Outcome of incisional hernia repair in patients 80 years and older: results from the Herniamed-Registry.

INTRODUCTION: More and more often complex abdominal surgeries are performed in the elderly. Together with the ageing population these patients are at risk for incisional hernias. We aimed on assessing outcomes following incisional hernia surgery in patients 80 years and older. MATERIAL AND METHODS: Using the Herniamed-Registry, a prospective multi-institutional database, data on patients undergoing surgery for incisional hernias were retrospectively assessed. 46,040 patients were included and divided by age. Intraoperative-, general-, and postoperative complications as well as 1-year follow-up outcomes were assessed and compared between patients 80 years and older vs younger than 80 years. RESULTS: Intra- (2.3% vs 1.5%; p < 0.001) and postoperative (8.6% vs 7.2%; p = 0.001) complications, general complications (5.5% vs 3.0%; p < 0.001), as well as reoperations (3.8% vs 3.0%; p = 0.007) were more likely to occur in elderly patients. By contrast, recurrences (3.6% vs 4.5%; p = 0.007), pain at rest (7.3% vs 10.1%; p < 0.001) and on exertion (11.3% vs 18.3%; p < 0.001), as well as pain requiring treatment (5.4% vs 7.7%; p < 0.001) was less likely in the group of patients aged ≥ 80 years. CONCLUSION: Incisional hernia repair in patients 80 years and older is associated with a slightly higher complication risk but is quite acceptable and also have improved pain scores. The recurrence difference is also clinically unimportant.

Transverse closure of mesenterico-portal vein after vein resection in pancreatoduodenectomy.

BACKGROUND: Resection of the involved mesenteric-portal vein (MPV) is increasingly performed in pancreatoduodenectomy. The primary aim of this study is to assess the rate of R0 resection in transverse closure (TC) versus segmental resection with end-to-end (EE) closure and the secondary aims are to assess the short-term morbidity and long-term survival of TC versus EE. METHODS: Patients undergoing pancreatoduodenectomy with MPV resection were identified from a prospectively database. The reconstruction technique were examined and categorized. Clinical, pathological, short-term and long-term survival outcomes were compared between groups. RESULTS: 110 patients underwent PD with MPV resection of which reconstruction was performed with an end-to-end technique in 92 patients (84%) and transverse closure technique in 18 patients (16%). Patients undergoing transverse closure tended to have had a shorter segment of vein resected (≤2 cm) compared to the end-to-end (83% vs. 43%; P = 0.004) with no difference in R0 rate. Short-term morbidity was similar. The median and 5-year survival was 30.0 months and 18% respectively for patients undergoing transverse closure and 28.6 months and 7% respectively for patients undergoing end-to-end reconstruction (P = 0.766). CONCLUSION: Without compromising the R0 rate, transverse closure to reconstruct the mesenteric-portal vein is shown to be feasible and safe in the setting when a short segment of vein resection is required during pancreatoduodenectomy. Synopsis - We describe a vein closure technique, transverse closure, which avoids the need for a graft, or re-implantation of the splenic vein when resection of the mesenteric-portal vein confluence is required during pancreatoduodenectomy.

Simple questionnaire for assessing core outcomes in inguinal hernia repair.

BACKGROUND: Patient-oriented questionnaires are indispensable in the assessment of surgical outcome. The psychometric properties of a brief multidimensional instrument were examined in patients with inguinal hernia undergoing surgery. METHODS: Fifty-one patients (mean(s.d.) age 50·6(17·4) years; 48 men) participated. The following questionnaire properties were assessed for the Core Outcome Measures Index adapted for patients with hernia (COMI-hernia) and the EuroQol: practicability, floor and ceiling effects, test-retest reliability (over 2 weeks), construct validity (by comparison with other relevant scales) and responsiveness 9 months after surgery as standardized response mean (SRM). RESULTS: The questionnaires were easy to implement and well accepted by the patients. Ceiling effects at baseline were 2 per cent for the COMI-hernia, 8 per cent for EuroQol-visual analogue scale (EQ-VAS) and 35 per cent for EuroQol-Five Dimensions (EQ-5D); no instrument showed floor effects. The reproducibility of individual COMI-hernia items was good, with test-retest differences within one grade ranging from 41 of 45 for 'social/work disability' to 44 of 45 for 'general quality of life'. The intraclass correlation coefficients were moderately high for COMI-hernia (0·74) and EQ-VAS (0·77), but low for EQ-5D (0·43). COMI-hernia scores correlated in the expected manner with related scales (r = 0·42-0·72, P < 0·050). COMI-hernia was the most responsive instrument (SRM 1·42). CONCLUSION: The COMI-hernia and EQ-VAS general health scale represent reliable, valid and sensitive tools for assessing multidimensional outcome in patients with inguinal hernia undergoing surgical treatment.

Predictors of multidimensional outcome after spinal surgery.

The variables identified as predictors of surgical outcome often differ depending on the specific outcome variable chosen to designate "success". A short set of multidimensional core outcome measures was recently developed, in which each of the following domains was addressed with a single question and then combined in an index: pain, function, symptom-specific well-being, general well-being (quality of life), disability (work and social). The present study examined the factors that predicted surgical outcome as measured using the multidimensional core measures. 163 spinal surgery patients (mixed indications) completed questionnaires before and 6 months after surgery enquiring about demographics, medical/clinical history, fear-avoidance beliefs (FABQ), depression (Zung self-rated depression), and the core measures domains. Multiple regression analyses were used to identify predictor variables for each core domain and for the multidimensional combined core-set index. The combination of baseline symptoms, medical variables (pain duration, previous spine operations, number of levels treated, operative procedure) and psychosocial factors (FABQ and Zung depression) explained 34% of the variance in the core measures index (P < 0.001). With regard to the individual domain items, the medical variables were better in predicting the items "pain" and "symptom-specific well-being" (R (2) = 6-7%) than in predicting "function", "general well-being" or "disability" (each R (2) < 4%). The inverse pattern was shown for the psychosocial predictors, which accounted for in each case approximately 20% variance in "function", "general well-being" and "disability" but only 12-14% variance in "pain" and "symptom-specific well-being". Further to previous studies establishing the sensitivity to change of the core-set, we have shown that a large proportion of the variance in its scores after surgery could be predicted by "well-known" medical and psychosocial predictor variables. This substantiates the recommendation for its further use in registry systems, quality management projects, and clinical trials.