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1.
J Surg Res ; 245: 656-662, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31585352

RESUMO

BACKGROUND: Incisional hernia (IH) is one of the most frequent complications after abdominal surgery. Follow-up with regard to IH remains challenging. Physical examination and imaging to diagnose IH are time-consuming and costly, require devotion of both the physician and patient, and are often not prioritized. Therefore, a patient-reported diagnostic questionnaire for the diagnosis of IH was developed. Objective of this study was to validate this questionnaire in a consecutive sample of patients. METHODS: All patients above 18 y of age who underwent abdominal surgery with a midline incision at least 12 mo ago were eligible for inclusion. Included patients visited the outpatient clinic where they filled out the diagnostic questionnaire and underwent physical examination. The questionnaire answers were compared with the physical examination results. The diagnostic accuracy of the entire questionnaire was assessed by multivariable logistic regression. RESULTS: In total, 241 patients visited the outpatient clinic prospectively. 54 (22%) patients were diagnosed with IH during physical examination. The area under the receiver operating characteristic curve of the diagnostic questionnaire was 0.82. Sensitivity and specificity were respectively 81.5% and 77.5%. The positive and negative predictive values were 51.2% and 94%, respectively. Ten (19%) patients with IH were missed by the questionnaire. CONCLUSIONS: The patient-reported diagnostic questionnaire as currently proposed cannot be used to diagnose IH. However, given the high negative predictive value, the questionnaire might be used to rule out an IH. Long-term follow-up for the diagnosis of IH should be performed by clinical examination.


Assuntos
Assistência ao Convalescente/métodos , Hérnia Incisional/diagnóstico , Medidas de Resultados Relatados pelo Paciente , Exame Físico , Ferida Cirúrgica/complicações , Idoso , Estudos de Viabilidade , Feminino , Humanos , Hérnia Incisional/etiologia , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos
2.
Int J Surg ; 44: 255-259, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28689863

RESUMO

BACKGROUND: In case of complex ventral hernias, Rives-Stoppa and component separation technique are considered as favourable treatment techniques. However, mesh-related complications like recurrence, infection and chronic pain are still a common problem after mesh repair. Previous studies have reported promising results of the use of a self-gripping mesh (ProGrip™) in incisional hernia repair. This study aimed to evaluate the long term results of this mesh for complex ventral hernia treatment. MATERIALS AND METHODS: Patients with complex ventral hernia undergoing repair between June 2012 and June 2015, using the ProGrip™-mesh in retromuscular position, were included. All patients visited the outpatient clinic to evaluate short term complications and recurrence. After at least one year, telephone interviews were conducted to evaluate long term results. RESULTS: A total of 46 patients (median age 59 years) were included. 40 patients (87%) were diagnosed with incisional hernia. Seven patients (18%) had incisional hernia combined with another hernia. Four patients (8.7%) had an umbilical hernia, one patient (2.2%) had an epigastric hernia and one patient (2.2%) had rectus diastasis. 39 patients completed follow-up. Median follow-up was 25 months (IQR: 19-35 months). 28 patients (72%) did not report any complaints. Nine patients reported pain (average VAS of 1.7). Two patients developed a recurrence requiring reoperation. One patient developed mesh infection requiring reoperation. CONCLUSION: Long term results of the use of a self-gripping mesh for complex abdominal wall hernias show a low recurrence rate, even in complex hernia cases. This makes the mesh a good choice in this difficult patient group.


Assuntos
Hérnia Ventral/cirurgia , Herniorrafia/instrumentação , Hérnia Incisional/cirurgia , Telas Cirúrgicas , Parede Abdominal/cirurgia , Adulto , Idoso , Feminino , Hérnia Abdominal/cirurgia , Hérnia Ventral/etiologia , Herniorrafia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
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