| 1. |
- Ali, Fathalla, 1963-, et al.
(författare)
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Effect of the SARS-CoV-2 pandemic on planned and emergency hernia repair in Sweden : a register-based study
- 2023
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Ingår i: Hernia. - : Springer. - 1265-4906 .- 1248-9204. ; 27:5, s. 1103-1108
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The COVID-19 has had a profound impact on the health care delivery in Sweden, including deprioritization of benign surgeries during the COVID-19 pandemic. The aim of this study was to assess the effect of COVID-19 pandemic on emergency and planned hernia repair in Sweden.METHODS: Data on hernia repairs from January 2016 to December 2021 were retrieved from the Swedish Patient Register using procedural codes. Two groups were formed: COVID-19 group (January 2020-December 2021) and control group (January 2016-December 2019). Demographic data on mean age, gender, and type of hernia were collected.RESULTS: This study showed a weak negative correlation between the number of elective hernia repairs performed each month during the pandemic and the number of emergency repairs carried out during the following 3 months for inguinal hernia repair (p = 0.114) and incisional hernia repair (p = 0.193), whereas there was no correlation for femoral or umbilical hernia repairs.CONCLUSION: The COVID-19 pandemic had a great impact on planned hernia surgeries in Sweden, but our hypothesis that postponing planned repairs would increase the risk of emergency events was not supported.
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| 2. |
- Ali, Fathalla, 1963-, et al.
(författare)
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Laparoscopic ventral and incisional hernia repair using intraperitoneal onlay mesh with peritoneal bridging
- 2022
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Ingår i: Hernia. - : Springer. - 1265-4906 .- 1248-9204. ; 26:2, s. 635-646
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of this study was to assess the feasibility and safety of a novel IPOM procedure with peritoneal bridging (IPOM-pb) for laparoscopic ventral hernia repair, and to compare the outcomes of this procedure with IPOM with- (IPOM-plus) and IPOM without (sIPOM) defect closure.Method: A single-centre retrospective study comparing a novel IPOM technique with peritoneal bridging (IPOM-pb) with the two commonly used IPOM techniques, IPOM with defect closure (IPOM-plus) and without defect closure (sIPOM). The intraoperative and postoperative data of patients who underwent laparoscopic IPOM ventral hernia repair were reviewed. Preoperative data, recurrence, and postoperative seroma, surgical site infection, and pain, were compared.Results: From January 2017 to June 2020, a total of 213 patients underwent laparoscopic ventral and incisional hernia repair with IPOM technique. The mean length and width of the ventral hernia was 4.4 +/- 1.8 cm and 3.6 +/- 1.4 cm, respectively, and the mean BMI was 30.1 +/- 5.2 kg/m(2). The mean operating time was 67 +/- 28 min and was longer for IPOM-pb (71 +/- 27 min), less for IPOM-plus (63 +/- 28 min), and least for sIPOM (61 +/- 26 min). The incidence of early postoperative seroma was least in IPOM-pb (1/98, 1%), and similar in the IPOM-plus (4/94, 4%) and sIPOM (1/21, 5%) group. Late postoperative seroma was found only in IPOM-plus (2, 2%). The incidence of early and late postoperative pain was relatively higher in sIPOM (3, 14%; 1, 5%, respectively) compared to IPOM-pb and IPOM-plus in the early (5, 5% and 6, 6%) and late (2, 2% and 1, 1%) postoperative period, respectively. Surgical site infection was higher in sIPOM group (3, 14%), compared to IPOM-pb (1, 1%), and IPOM-plus (3, 3%). Recurrence rates were similar in IPOM-pb group (3/98, 3%) and IPOM-plus (3/94, 3%), and none in sIPOM (0/21).Conclusion: IPOM with peritoneal bridging is as feasible and safe as conventional IPOM with defect closure and simple non-defect closure. However, a large randomised controlled trial is required to confirm this finding.
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| 3. |
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| 4. |
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| 5. |
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| 6. |
- Bringman, S, et al.
(författare)
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Hernia repair: the search for ideal meshes
- 2010
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Ingår i: Hernia : the journal of hernias and abdominal wall surgery. - : Springer Science and Business Media LLC. - 1248-9204. ; 14:1, s. 81-87
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Tidskriftsartikel (refereegranskat)
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| 7. |
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| 8. |
- Bringman, S., et al.
(författare)
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Location of recurrent groin hernias at TEP after Lichtenstein repair : a study based on the Swedish Hernia Register
- 2016
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Ingår i: Hernia. - : Springer Science and Business Media LLC. - 1265-4906 .- 1248-9204. ; 20:3, s. 387-391
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Tidskriftsartikel (refereegranskat)abstract
- To investigate which type of hernia that has the highest risk of a recurrence after a primary Lichtenstein repair. Male patients operated on with a Lichtenstein repair for a primary direct or indirect inguinal hernia and with a TEP for a later recurrence, with both operations recorded in the Swedish Hernia Register (SHR), were included in the study. The study period was 1994-2014. Under the study period, 130,037 male patients with a primary indirect or direct inguinal hernia were operated on with a Lichtenstein repair. A second operation in the SHR was registered in 2236 of these patients (reoperation rate 1.7 %). TEP was the chosen operation in 737 in this latter cohort. The most likely location for a recurrence was the same as the primary location. If the recurrences change location from the primary place, we recognized that direct hernias had a RR of 1.51 to having a recurrent indirect hernia compared to having a direct recurrence after an indirect primary hernia repair. Recurrent hernias after Lichtenstein are more common on the same location as the primary one, compared to changing the location.
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| 9. |
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| 10. |
- Clay, Leonard, et al.
(författare)
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Full-thickness skin graft vs. synthetic mesh in the repair of giant incisional hernia : a randomized controlled multicenter study
- 2018
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Ingår i: Hernia. - : Springer. - 1265-4906 .- 1248-9204. ; :2, s. 325-332
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Repair of large incisional hernias includes the implantation of a synthetic mesh, but this may lead to pain, stiffness, infection and enterocutaneous fistulae. Autologous full-thickness skin graft as on-lay reinforcement has been tested in eight high-risk patients in a proof-of-concept study, with satisfactory results. In this multicenter randomized study, the use of skin graft was compared to synthetic mesh in giant ventral hernia repair.METHODS: Non-smoking patients with a ventral hernia > 10 cm wide were randomized to repair using an on-lay autologous full-thickness skin graft or a synthetic mesh. The primary endpoint was surgical site complications during the first 3 months. A secondary endpoint was patient comfort. Fifty-three patients were included. Clinical evaluation was performed at a 3-month follow-up appointment.RESULTS: There were fewer patients in the skin graft group reporting discomfort: 3 (13%) vs. 12 (43%) (p = 0.016). Skin graft patients had less pain and a better general improvement. No difference was seen regarding seroma; 13 (54%) vs. 13 (46%), or subcutaneous wound infection; 5 (20%) vs. 7 (25%). One recurrence appeared in each group. Three patients in the skin graft group and two in the synthetic mesh group were admitted to the intensive care unit.CONCLUSION: No difference was seen for the primary endpoint short-term surgical complication. Full-thickness skin graft appears to be a reliable material for ventral hernia repair producing no more complications than when using synthetic mesh. Patients repaired with a skin graft have less subjective abdominal wall symptoms.
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| 11. |
- Dalenbäck, Jan, 1957, et al.
(författare)
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Long-term follow-up after elective adult umbilical hernia repair: low recurrence rates also after non-mesh repairs.
- 2013
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Ingår i: Hernia : the journal of hernias and abdominal wall surgery. - : Springer Science and Business Media LLC. - 1248-9204. ; 17:4, s. 493-497
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The purpose of this study was to establish long-term outcome after elective adult umbilical hernia (AUH) repair. METHODS: Peri- and postoperative data considering all consecutive procedures at our institution during the time span from 1999 to 2009 were retrospectively gathered and followed by a questionnaire and, if needed, a clinical investigation in early 2011. RESULTS: A total of 162 patients (female/male 35%/65%) were operated, and 144/162 (89%) answers were gathered, mean follow-up time 70months; 77% were sutured, non-mesh repairs; 94% of all AUHs were smaller than 3cm; and 49% of the operations were performed under local anaesthesia. No perioperative complications were encountered. Five postoperative complications were encountered, two serious, both after mesh-based repairs. Wound infection rate (SSI) was low, 2/144 (1.4%). 7/144 (4.9%) recurrences were registered, none if mesh-based techniques were used, giving a recurrence rate of 6.3% in suture-based repairs, the difference, however, not statistically significant (p=0.141); 2% reported persistent pain at follow-up, 89% were overall satisfied with the outcome. CONCLUSIONS: AUH repair could be performed with low early and long-term complication rates, with low recurrence rates also after non-mesh repairs. A substantial cohort of patients will unnecessary be implanted with meshes if mesh-reinforced repairs should be used on a routine basis, that is, 16 surplus meshes to prevent one recurrence in the present study. We recommend a tailored approach to AUH repair: suture-based methods with defects smaller than 2cm and mesh-based repairs considered if larger than that.
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| 12. |
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| 13. |
- Emanuelsson, Peter, et al.
(författare)
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Analysis of the abdominal musculo-aponeurotic anatomy in rectus diastasis : comparison of CT scanning and preoperative clinical assessment with direct measurement intraoperatively
- 2014
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Ingår i: Hernia. - Paris : Springer. - 1265-4906 .- 1248-9204. ; 18:4, s. 465-471
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To evaluate and compare the consistency of agreement of two methods for measuring abdominal rectus diastasis (ARD), preoperative computed tomography (CT) scanning and preoperative clinical assessment were compared with direct measurement intraoperatively.METHODS: Fifty-five consecutive patients were retrieved from an ongoing prospective randomised trial comparing two operative techniques for the repair of ARD. All patients underwent a preoperative clinical assessment and CT scan, and the results were compared with intraoperative measurement of the ARD width. Agreement between methods was described with Bland-Altman plots (BA plots) and calculated using Lin's Concordance Correlation Coefficient (CCC).RESULTS: The median width of the diastasis was 4.0 cm in the upper midline and 3.0 cm in the lower midline for the intraoperative measurement. BA plots showed that measurements on CT and intraoperatively are not in agreement in the lower midline, whereas the agreement was stronger between the clinical and the intraoperative method. The CCC was higher for clinical vs. intraoperative measurement (0.479) than for CT vs. intraoperative measurement (-0.002) in the lower midline, although the agreement was over all low. CT scanning underestimated the width of the ARD when compared to 87 % of preoperative clinical assessments, and 83 % of intraoperative measurements. Preoperative clinical assessment overestimated ARD in 35 % when compared with intraoperative measurements.CONCLUSION: Clinical assessment prior to surgery provides more accurate information than CT scanning in the assessment of ARD width. CT scanning underestimates ARD width when compared with intraoperative measurement.
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| 14. |
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| 15. |
- Gu, Y, et al.
(författare)
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Quick Hot Shot & Young Surgeon Presentation
- 2015
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Ingår i: Hernia : the journal of hernias and abdominal wall surgery. - 1248-9204. ; 19 Suppl 1, s. S77-84
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Tidskriftsartikel (refereegranskat)
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| 16. |
- Gunnarsson, Ulf, 1967-, et al.
(författare)
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Assessment of abdominal muscle function using the Biodex System-4. Validity and reliability in healthy volunteers and patients with giant ventral hernia
- 2011
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Ingår i: Hernia. - Paris : Springer. - 1265-4906 .- 1248-9204. ; 15:4, s. 417-421
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The decrease in recurrence rates in ventral hernia surgery have led to a redirection of focus towards other important patient-related endpoints. One such endpoint is abdominal wall function. The aim of the present study was to evaluate the reliability and external validity of abdominal wall strength measurement using the Biodex System-4 with a back abdomen unit.MATERIAL AND METHOD: Ten healthy volunteers and ten patients with ventral hernias exceeding 10 cm were recruited. Test-retest reliability, both with and without girdle, was evaluated by comparison of measurements at two test occasions 1 week apart. Reliability was calculated by the interclass correlation coefficients (ICC) method. Validity was evaluated by correlation with the well-established International Physical Activity Questionnaire (IPAQ) and a self-assessment of abdominal wall strength.RESULTS: One person in the healthy group was excluded after the first test due to neck problems following minor trauma. The reliability was excellent (>0.75), with ICC values between 0.92 and 0.97 for the different modalities tested. No differences were seen between testing with and without a girdle. Validity was also excellent both when calculated as correlation to self-assessment of abdominal wall strength, and to IPAQ, giving Kendall tau values of 0.51 and 0.47, respectively, and corresponding P values of 0.002 and 0.004.CONCLUSION: Measurement of abdominal muscle function using the Biodex System-4 is a reliable and valid method to assess this important patient-related endpoint. Further investigations will be made to explore the potential of this technique in the evaluation of the results of ventral hernia surgery, and to compare muscle function after different abdominal wall reconstruction techniques.
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| 17. |
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| 18. |
- Haapaniemi, Staffan, et al.
(författare)
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Mortality after elective and emergency surgery for inguinal and femoral hernia
- 1999
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Ingår i: Hernia. - 1265-4906 .- 1248-9204. ; 3:4, s. 205-208
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate mortality following elective and emergency groin hernia surgery. Information concerning 17 591 inguinal and 579 femoral hernia operations, including death of patients within 30 days of surgery, were prospectively recorded in the Swedish Hernia Register over a period of six years. Elective surgery for groin hernia is known to be a low-risk procedure. Mortality within 30 days of surgery was compared with the mortality of the general Swedish population using the standard mortality rate (SMR). Of all inguinal and femoral hernia repairs 5.1 % and 35.2 % respectively, were performed as an emergency. Following elective inguinal hernia repair the SMR for men fell significantly below unity. No significant differences between observed and expected mortality were observed following inguinal hernia surgery on females or following elective femoral hernia surgery on either gender. The reduced SMR found after elective hernia repair in men is most likely attributable to patient selection. After elective surgery on patients 70 years or older there is a tendency towards a reduction in SMR of the same order of size as for patients analysed as one group which, however, did not reach statistical significance. Mortality following both inguinal and femoral emergency procedures is increased five- to ten-fold compared to the 30-day mortality in the general population. A further increase in postoperative mortality is noted following emergency surgery with bowel resection.
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| 19. |
- Hallén, Magnus, et al.
(författare)
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Risk factors for reoperation due to chronic groin postherniorrhaphy pain
- 2015
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Ingår i: Hernia. - : Springer. - 1265-4906 .- 1248-9204. ; 19:6, s. 863-869
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Tidskriftsartikel (refereegranskat)abstract
- 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. 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. 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). 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.
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| 20. |
- Hemberg, Anders, et al.
(författare)
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Tobacco use is not associated with groin hernia repair, a population-based study
- 2017
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Ingår i: Hernia. - : Springer. - 1265-4906 .- 1248-9204. ; 21:4, s. 517-523
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The pathogenesis of groin hernia is not fully understood and some suggested risk factors are debatable. This population-based study evaluates the association between groin hernia repair and tobacco use. Method An observational study based on register linkage between the Swedish Hernia Register and the Vasterbotten Intervention Program (VIP). All primary groin hernia repairs performed from 2001 to 2013 in the county of Vasterbotten, Sweden, were included. Results VIP provided data on the use of tobacco in 102,857 individuals. Neither smoking nor the use of snus, increased the risk for requiring a groin hernia repair. On the contrary, heavy smoking decreased the risk for men, HR 0.75 (95% CI 0.58-0.96), as did having a BMI over 30 kg/m 2 HR (men) 0.33 (95% CI 0.27-0.40). Conclusion Tobacco use is not a risk factor for requiring a groin hernia repair, whereas having a low BMI significantly increases the risk.
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| 21. |
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| 22. |
- Holmdahl, Viktor, et al.
(författare)
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Long-term follow-up of full-thickness skin grafting in giant incisional hernia repair : a randomised controlled trial
- 2022
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Ingår i: Hernia. - : Springer. - 1265-4906 .- 1248-9204. ; 26, s. 473-479
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Conventional repair of a giant incisional hernia often requires implantation of a synthetic mesh (SM). However, this surgical procedure can lead to discomfort, pain, and potentially serious complications. Full-thickness skin grafting (FTSG) could offer an alternative to SM, less prone to complications related to implantation of a foreign body in the abdominal wall. The aim of this study was to compare the use of FTSG to conventional SM in the repair of giant incisional hernia.Methods: Patients with a giant incisional hernia (> 10 cm width) were randomised to repair with either FTSG or SM. 3-month and 1-year follow-ups have already been reported. A clinical follow-up was performed 3 years after repair, assessing potential complications and recurrence. SF-36, EQ-5D and VHPQ questionnaires were answered at 3 years and an average of 9 years (long-term follow-up) after surgery to assess the impact of the intervention on quality-of-life (QoL).Results: Fifty-two patients were included. Five recurrences in the FTSG group and three in the SM group were noted at the clinical follow-up 3 years after surgery, but the difference was not significant (p = 0.313). No new procedure-related complication had occurred since the one-year follow-up. There were no relevant differences in QoL between the groups. However, there were significant improvemnts in both physical, emotional, and mental domains of the SF-36 questionnaire in both groups.Conclusion: The results of this long-term follow-up together with the results from previous follow-ups indicate that autologous FTSG as reinforcement in giant incisional hernia repair is an alternative to conventional repair with SM.
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| 23. |
- Holmdahl, Viktor, et al.
(författare)
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One-year outcome after repair of giant incisional hernia using synthetic mesh or full-thickness skin graft : a randomised controlled trial
- 2019
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Ingår i: Hernia. - : Springer. - 1265-4906 .- 1248-9204. ; 23:2, s. 355-361
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Repair of giant incisional hernia often requires complex surgery and the results of conventional methods using synthetic mesh as reinforcement are unsatisfactory, with high recurrence and complication rates. Our hypothesis was that full-thickness skin graft (FTSG) provides an alternative reinforcement material for giant incisional hernia repair and that outcome is improved. The aim of this study was to compare FTSG with conventional materials currently used as reinforcement in the repair of giant incisional hernia.METHODS: A prospective randomised controlled trial was conducted, comparing FTSG with synthetic mesh as reinforcement in the repair of giant (> 10 cm minimum width) incisional hernia. One-year follow-up included a blinded clinical examination by a surgeon and objective measurements of abdominal muscle strength using the Biodex-4 system.RESULTS: 52 patients were enrolled in the study: 24 received FTSG and 28 synthetic mesh. Four recurrences (7.7%) were found at 1-year follow-up, two in each group. There were no significant differences regarding pain, patient satisfaction or aesthetic outcome between the groups. Strength in the abdominal wall was not generally improved in the study population and there was no significant difference between the groups.CONCLUSION: The outcome of repair of giant incisional hernia using FTSG as reinforcement is comparable with repair using synthetic mesh. This suggests that FTSG may have a future place in giant incisional hernia repair.
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| 24. |
- Humes, D. J., et al.
(författare)
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Duration and magnitude of postoperative risk of venous thromboembolism after planned inguinal hernia repair in men : a population-based cohort study
- 2018
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Ingår i: Hernia. - : Springer. - 1265-4906 .- 1248-9204. ; 22:3, s. 447-453
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Little is known regarding the magnitude and timing of the risk of VTE following inguinal hernia surgery. We aimed to determine the absolute and relative rates of venous thromboembolism (VTE) following planned inguinal hernia repair.Methods: We analysed male adults with a first inguinal hernia repair with no prior record of VTE from the Clinical Practice Research Datalink, linked to the Hospital Episode Statistics (2001-2011). Crude rates and adjusted hazard ratios (HR) of the first VTE were calculated using Cox regression analysis to compare specific time periods following the surgery compared to the general population.Results: We identified 28,782 men who underwent an inguinal hernia repair with 53 (0.18%) having a first VTE in the 90 days following surgery. The overall rate of VTE in the first 90 days following surgery was 7.61 per 1000 person years (pyrs) (95% CI 5.82-9.96). Increasing age, a body mass index > 30 kg/m(2) and an in-patient procedure were associated with an increased risk of VTE, when compared to the general population. The risk of VTE was highest in the 1st month following the surgery with a 2.3- (aHR 2.33; 95% CI 1.09-4.99) and 3.5- (aHR 3.47; 95% CI 2.07-5.83) fold increased risk compared to the general population for both day case and planned in-patient procedures, respectively.Conclusions: Reassuringly, the absolute rates of VTE following inguinal hernia repair are low. Patients should be informed that their peak risk of VTE is during the 1st month following the surgery. Further studies on the optimum duration of thromboprophylaxis following surgery are required in high-risk patients undergoing hernia repair.
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| 25. |
- Israelsson, Leif A, et al.
(författare)
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Incisional hernia repair in Sweden 2002
- 2006
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Ingår i: Hernia. - : Springer. - 1265-4906 .- 1248-9204. ; 10:3, s. 258-261
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Tidskriftsartikel (refereegranskat)abstract
- Incisional hernia is a common problem after abdominal surgery. The complication and recurrence rates following the different repair techniques are a matter of great concern. Our aim was to study the results of incisional hernia repair in Sweden. A questionnaire was sent to all surgical departments in Sweden requesting data concerning incisional hernia repair performed during the year 2002. Eight hundred and sixty-nine incisional hernia repairs were reported from 40 hospitals. Specialist surgeons performed the repair in 782 (83.8%) patients. The incisional hernia was a recurrence in 148 (17.0%) patients. Thirty-three per cent of the hernias were subsequent to transverse, subcostal or muscle-splitting incisions or laparoscopic procedures. Suture repair was performed in 349 (40.2%) hernias. Onlay mesh repair was more common than a sublay technique. The rate of wound infection was 9.6% after suture repair and 8.1% after mesh repair. The recurrence rate was 29.1% with suture repair, 19.3% with onlay mesh repair, and 7.3% with sublay mesh repair. This survey revealed that there is room for improvement regarding the incisional hernia surgery in Sweden. Suture repair, with its unacceptable results, is common and mesh techniques employed may not be optimal. This study has led to the instigation of a national incisional hernia register.
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