| 1. |
- Dahlstrand, Ursula, 1976-, et al.
(författare)
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Chronic pain after femoral hernia repair : a cross-sectional study
- 2011
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Ingår i: Annals of Surgery. - Philadelphia : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 254:6, s. 1017-1021
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore the prevalence of and to identify possible risk factors for chronic pain after surgery for femoral hernia.Background: Chronic pain has become a very important outcome in quality assessment of inguinal hernia surgery. There are no studies on the risk for chronic pain after femoral hernia surgery. Methods: The Inguinal Pain Questionnaire was sent to 1967 patients who had had a repair for primary unilateral femoral hernia between January 1, 1997 and December 31, 2006. A follow-up period of at least 18 months was chosen. Answers from 1461 patients were matched with data recorded in the Swedish Hernia Register and analyzed.Results: Some degree of pain during the previous week was reported by 24.2% (354) of patients. Pain interfered with daily activities in 5.5% (81) of patients. Emergency surgery (OR = 0.54; 95% CI = 0.40-0.74) and longer time since surgery (OR = 0.93; 95% CI = 0.89-0.98 for each year added) were associated with lower risk for chronic postoperative pain, whereas a high level of preoperative pain was associated with a higher risk for chronic pain (OR = 1.17; 95% CI = 1.10-1.25). Surgical technique was not found to influence the risk for chronic pain in multivariate logistic regression analysis.Conclusions: Chronic postoperative pain is as important a complication after femoral hernia surgery as it is after inguinal hernia surgery. In contrast to inguinal hernia surgery, no risk factor related to surgical technique was found. Further investigations into the role of preoperative pain are necessary.
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| 2. |
- Dahlstrand, Ursula, et al.
(författare)
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Emergency femoral hernia repair : a study based on a national register.
- 2009
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Ingår i: Annals of Surgery. - : Lippincott, Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 249:4, s. 672-676
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe the characteristics of femoral hernias and outcome of femoral repairs, with special emphasis on emergency operations. BACKGROUND: Femoral hernias account for 2% to 4% of all groin hernias. However, the lack of large-scale studies has made it impossible to draw conclusions regarding the best management of these hernias. METHODS: The study is based on patients 15 years or older who underwent groin hernia repair 1992 to 2006 at units participating in the Swedish Hernia Register. RESULTS: Three thousand nine hundred eighty femoral hernia repairs were registered, 1490 on men and 2490 on women: 1430 (35.9%) patients underwent emergency surgery compared with 4.9% of the 138,309 patients with inguinal hernias. Bowel resection was performed in 22.7% (325) of emergent femoral repairs and 5.4% (363) of emergent inguinal repairs. Women had a substantial over risk for undergoing emergency femoral surgery compared with men (40.6% vs. 28.1%). An emergency femoral hernia operation was associated with a 10-fold increased mortality risk, whereas the risk for an elective repair did not exceed that of the general population. In elective femoral hernias, laparoscopic (hazard ratio, 0.31; 95% confidence interval, 0.15-0.67) and open preperitoneal mesh (hazard ratio, 0.28; confidence interval, 0.12-0.65) techniques resulted in fewer re-operations than suture repairs. CONCLUSIONS: Femoral hernias are more common in women and lead to a substantial over risk for an emergency operation, and consequently, a higher rate of bowel resection and mortality. Femoral hernias should be operated with high priority to avoid incarceration and be repaired with a mesh.
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| 3. |
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| 4. |
- Lundström, Karl-Johan, et al.
(författare)
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Risk factors for complications in Groin Hernia surgery : A National register study
- 2012
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Ingår i: Annals of Surgery. - Philasdelphia, PA, USA : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 255:4, s. 784-788
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This study aims to analyze and identify risk factors for postoperative complications and analyze the relative risk of reoperation for recurrence for respective complication. Background: The outcome of groin hernia surgery is evaluated mostly by comparing recurrence rates and long-term pain. The aim of this observational population-based registry study was to identify risk factors for postoperative complications and analyze the relative risk of reoperation for recurrence for respective complication. Methods: Using data from the nationwide Swedish Hernia Register between 1998 and 2009, 150,514 herniorrhaphies were analyzed with respect to postoperative complications occurring within 30 days of surgery. Results: Risk factors significantly affecting the rate of postoperative complications were laparoscopic repair (odds ratio [OR] 1.35, 95% confidence interval [CI] 1.24-1.47) and open preperitoneal techniques (OR: 1.31, 95% CI: 1.15-1.49), with open anterior mesh as reference category. Other significant risk factors were general (OR: 1.30, 95% CI: 1.23-1.37) and regional anesthesia (OR: 1.53, 95% CI: 1.43-1.63), with local anesthesia as reference category, emergency procedures (OR: 1.53, 95% CI: 1.43-1.63); recurrent hernia repair (OR: 1.39, 95% CI: 1.27-1.52); femoral hernia (OR: 1.30, 95% CI: 1.14-1.48); aged older than 65 years (OR: 1.26, 95% CI: 1.21-1.31); and duration of surgery exceeding 50 minutes (OR: 1.27, 95% CI: 1.22-1.33). Conclusions: Open anterior approach and surgery under local anesthesia are associated with less risk of postoperative complications.
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| 5. |
- Sevonius, Dan, et al.
(författare)
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Repeated groin hernia recurrences.
- 2009
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Ingår i: Annals of Surgery. - : Lippincott, Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 249:3, s. 516-518
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe the characteristics of patients undergoing multiple groin hernia repairs and to identify strategies that prevent further recurrence. SUMMARY BACKGROUND DATA: Although relatively infrequent, recurrent groin hernias where several repairs have previously been undertaken constitutes a major problem in hernia surgery. Low numbers and heterogeneity have made it difficult to perform large prospective studies on this group. METHODS: The study was designed as an observational population-based register study. All repairs for recurrent hernia recorded in the Swedish Hernia Register (SHR) 1992-2006 were identified. Risk for reoperation by number of previous repairs, with adjustment for gender and age, and risk for reoperation by unit responsible for previous repair were determined using Cox proportional hazard analysis. RESULTS: There were 12,104 cases of hernia repaired once, 2 repairs in 4199 cases, 3 repairs in 310 cases, 4 repairs in 32 cases, and 5 repairs in 3 cases. The risk for further reoperation increased with the number of previous repairs (P < 0.001). The hazard ratios for reoperation following open preperitoneal mesh repair and laparoscopic repair decreased; whereas, the hazard ratio for sutured repair increased with the number of previous repairs. The difference between Lichtenstein repair and laparoscopic repair was significant for the first 2 repairs (P < 0.05). CONCLUSION: Laparoscopic preperitoneal repair provides the best surgical outcome in repeated groin hernia recurrence.
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| 6. |
- Westin, Linn, et al.
(författare)
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Less Pain 1 Year After Total Extra-peritoneal Repair Compared With Lichtenstein Using Local Anesthesia Data From a Randomized Controlled Clinical Trial
- 2016
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Ingår i: Annals of Surgery. - : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 263:2, s. 240-243
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Tidskriftsartikel (refereegranskat)abstract
- Objective:The aim was to compare long-term postoperative pain after inguinal hernia surgery using 2 techniques that have shown favorable long-term outcome in previous randomized studies: Lichtenstein using local anesthesia (LLA) and endoscopic total extra-peritoneal repair (TEP) under general anesthesia.Background:Patients often experience pain after inguinal hernia surgery. These 2 methods in their optimal state have not yet been sufficiently compared.Methods:A randomized controlled trial was conducted to detect any difference in long-term postoperative inguinal pain. Altogether 384 patients were randomized and operated using either TEP under general anesthesia (n=193) or LLA (n=191). One year postoperatively, patients were examined by an independent surgeon and requested to complete the Inguinal Pain Questionnaire (IPQ), a validated questionnaire for the assessment of postoperative inguinal pain.Results:Three hundred seventy-five (97.7%) patients completed follow-up at 1 year. In the TEP group, 39 (20.7%) patients experienced pain, compared with 62 (33.2%) patients in the LLA group (P=0.007). Severe pain was reported by 4 patients in the TEP group and 6 patients in the LLA group (2.1% and 3.2%, respectively, P=0.543). Pain in the operated groin limited the ability to exercise for 5 TEP patients and 14 LLA patients (2.7% and 7.5%, respectively, P=0.034).Conclusions:Patients operated with TEP experienced less long-term postoperative pain and less limitation in their ability to exercise than those operated with LLA. The present data justify recommending TEP as the procedure of choice in the surgical treatment of primary inguinal hernia.
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