Perioperative factors associated with pain following open ventral hernia repair
AbstractBackgroundEffective pain control following open ventral and incisional hernia repair (VHR) impacts all aspects of patient recovery. To reduce opioid use and enhance pain management, multimodal therapy is thought to be beneficial. The purpose of this study was to identify patient characteristics associated with perioperative patient-reported pain scores.MethodsWith IRB approval, surgical databases were searched for cases of open VHR performed over 3 years. Based on a retrospective chart review, modes of pain management and visual analog scale (VAS) pain scores were recorded in 12-h intervals to hospital discharge or to 8 days post-operation. Forward stepwise multivariable regression assessed the independent contribution of the perioperative factors to VAS pain scores.ResultsIncluded in the analyses were 175 patients that underwent VHR. Average age was 55 years (+/− 12.8), and half were female (50.9%). Factors independently associated with increased preoperative VAS pain scores included preoperative opioid use, preoperative open wound, CDC Wound Class II, and prior hernia repair(s). Patients with epidural for postoperative pain had significantly decreased VAS pain scores across the time continuum. Operative factors significantly associated with increased preoperative VAS pain score included median hernia defect size, concomitantly performed procedure(s), duration of operation, and estimated blood loss. Greater preoperative VAS pain score pr edicte...
ConclusionOur study suggests that AF had a significantly improved hernia-specific quality of life in all domains at 30-days postoperatively. We also identified that pain as a binary variable is inadequate for its states purpose. Thus, the overall well-being and morbidity should be taken into account when evaluating hernia patients postoperatively.
ConclusionMorgagni hernia is a rare form of congenital diaphragmatic hernia. It is commonly found either in the first few hours of life or in the antenatal period. It is less common in adults and is usually diagnosed accidentally in asymptomatic patients. Symptomatic adult cases are extremely rare. Respiratory symptoms are the most common presenting symptoms. The primary management for both symptomatic and incidentally discovered asymptomatic cases of Morgagni hernia is surgical correction. Various thoracic and abdominal surgical approaches have been described without a clear consensus on preference for operative repair technique.
CONCLUSIONS: LA repair of PUH is feasible for patients with a raised BMI and does not result in higher postoperative pain scores or the need for higher doses of LA. PMID: 31951146 [PubMed - as supplied by publisher]
Conditions: Hernia, Inguinal; Hernia, Femoral Interventions: Procedure: Totally ExtraPeritoneal (TEP) repair; Procedure: TransAbdominal PrePeritoneal (TAPP) repair; Procedure: Open anterior mesh repair (OAM); Procedure: Combined Anterior and Posterior technique (CAP); Procedure: Open PrePeritoneal Mesh technique (OPPM); Procedure: Sutured Repair Sponsors: Umeå University; Region Jamtland Harjedalen Completed
ConclusionThe use of CST versus No-CST in the repair of large VHs results in an increased risk of wound complications but does not increase the hernia recurrence rate. In the largest QOL comparative study to date, CST ’s generation of myofascial advancement flaps does not negatively impact patient QOL in the repair of large ventral hernias in the short or long term.
This study compares the impact of open (OIHR) versus laparoscopic (LIHR) inguinal hernia repair on healthcare spending and postoperative outcomes.MethodsThe TRUVEN database was queried using ICD9 procedure codes for open, laparoscopic, and robotic-assisted IHR, from 2012 to 2013. Patients > 18 years of age and continuously enrolled for 12 months postoperatively were included. Demographics, patient comorbidities, postoperative complications, pain medication use, length of hospital stay, missed work hours, postoperative visits, and overall expenditure were collected, and assessed at time of surge...
CONCLUSION: When performed by an experienced surgeon with excellent technique, the TAPP technique is safe and effective for recurrent hernia after surgical treatment via the anterior repair, and maybe a good alternative for recurrent hernia after surgical treatment via the posterior repair. PMID: 31932156 [PubMed - as supplied by publisher]
ConclusionTEP repair in patients with LIH using a synthetic long-term resorbable mesh was found to be encouraging respecting chronic post-operative pain at 3-year follow-up but at the cost of an increased risk of recurrence.
CONCLUSIONS: Mini-mesh and Lichtenstein repairs have reasonable results in the patients with femoral hernia in this study, with a reduced operation time compared with a modified Kugel repair. The trial was registered with the Chinese Clinical Trails Registry: ChiCTR1900022264. PMID: 31918557 [PubMed - as supplied by publisher]
AbstractLoop ileostomy (LI) is a widely used temporary stoma technique. Reversal of LI is generally considered a minor and safe procedure, with very low short-term postoperative mortality and morbidity rates. Complications include incisional hernia (IH), carrying a high probability of surgical repair. Clinical measures to reduce the IH rate warrant consideration. Recent researches suggest the use of a prophylactic non-absorbable mesh to reduce IH rate; however, surgeons are reluctant to implant a permanent foreign material in contaminated operative fields, because of a higher risk of mesh-related complications, infection, ...