Impact of Operative Times and Mesh Utilization on Paraesophageal Hernia Repair: Analysis of 30-Day Outcomes from the American College of Surgeons National Surgical Quality Improvement Project Database

Skancke, Matthew; Brody, Fred; Haskins, Ivy N.; Amdur, Richard; Schoolfield, Clint

doi:10.1089/lap.2018.0369

Cited by 8 publications

(4 citation statements)

References 23 publications

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“…In both surveys of the SAGES community, mesh types were heterogeneous although biologic meshes were most commonly used [4,5] . Similar results were found in a survey of the European Association for Endoscopic Surgery (EAES) in 2015, with higher use of mesh at 92.1% of European surgeons at least selectively using mesh although mesh types differed with most surgeons preferring either polypropylene, polyester or PTFE meshes and only 27.9% using biologic meshes [6] . In registry analyses, these survey results are further expanded: mesh is used frequently but in less than half of ARS cases overall [7][8][9][10] .…”

Section: Trends Of Mesh Use In Arssupporting

confidence: 77%

Mesh or no mesh in anti-reflux surgery

Bitner¹,

Filicori²

2022

Mini-invasive Surg

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Section: Trends Of Mesh Use In Arssupporting

confidence: 77%

Mesh or no mesh in anti-reflux surgery

Bitner¹,

Filicori²

2022

Mini-invasive Surg

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“…As a risk factor of postoperative morbidities and readmission ( 31 , 32 ), operative time also represents an important parameter examined in our study. Simplifying the step of closing the free peritoneal flap was expected to reduce the operative time and therefore, leaving the free peritoneal flap in place provides this advantage ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

Non-closure of the Free Peritoneal Flap During Laparoscopic Hernia Repair of Lower Abdominal Marginal Hernia: A Retrospective Analysis

Xiang

et al. 2021

Front. Surg.

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Background: During lower abdominal marginal hernia repair, the peritoneal flap is routinely freed to facilitate mesh placement and closed to conclude the procedure. This procedure is generally called trans-abdominal partial extra-peritoneal (TAPE). However, the necessity of closing the free peritoneal flap is still controversial. This study aimed to investigate the safety and feasibility of leaving the free peritoneal flap in-situ.Methods: A retrospective review was conducted on 68 patients (16 male, 52 female) who underwent laparoscopic hernia repair between June 2014 and March 2021. Patients were diagnosed as the lower abdominal hernia and all required freeing the peritoneal flap during the operation. Patients were divided into 2 groups: one group was TAPE group with the closed free peritoneal flap, another group left the free peritoneal flap unclosed. Analyses were performed to compare both intraoperative parameters and postoperative complications.Results: There were no significant differences in demographic, comorbidity, hernia characteristics and ASA classification. The intra-operative bleeding volume, visceral injury, hospital stay, urinary retention, visual analog scale (VAS) score, dysuria, intestinal obstruction, surgical site infection, mesh infection, recurrence rate and hospital stay were similar among the two groups. Mean operative time of the flap closing procedure was higher than for patients with the free peritoneal flap left in-situ (p = 0.002). Comparisons of postoperative complications showed flap closure resulted in a higher incidence of seroma formation (p = 0.005).Conclusion: Providing a barrier-coated mesh is used during laparoscopic lower abdominal marginal hernia repair, it is safe to leave the free peritoneal flap in-situ and this approach may prevent the occurrence of seromas.

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“…Applying the results of Skancke et al, 4 of the 5 cases would fall into the fourth quartile of all operative times for PEHR, whereas the remaining case would fall in the third quartile. 21 PEHR currently does not have a gold standard for describing case complexity. As it relates to predicting PEs, a number of other factors of case complexity could be considered such as reoperative surgery, acute presentation, hernia size, and need for the mesh.…”

Section: Discussionmentioning

confidence: 99%

“…11 Though, the 1 "moderate" risk patient also happened to be the patient with the longest case duration and arguably most technically challenging anatomy. In fact, the average PEHR patient in this country would be classified as "high" risk by the Caprini model for age, BMI, and operative length alone (age, 61 to 74 y: 2 points; laparoscopic surgery > 45 min: 2 points; BMI > 25, 1 point) as Skancke et al 21 reported mean age of 64 years, mean BMI of 31, and median operative length of 142 minutes. The ACCP guidelines recommend pharmacologic prophylaxis in "high" risk patients with the overwhelming majority of trials demonstrating benefit applying administration 2 hours preoperatively.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Paraesophageal Hernia Repair and Pulmonary Embolism

Davila

Stetler

Lee

et al. 2019

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Objective: Pulmonary embolism (PE) following laparoscopic paraesophageal hernia repair (PEHR) is rare but occurs at a higher frequency than other laparoscopic procedures. We describe a series of patients who developed PEs after PEHR in hopes of capturing potential risk factors for further study.Materials and Methods: Five cases of PE after PEHR were observed between 2017 and 2018. Individual and perioperative risk factors, and postoperative courses were reviewed.Results: Patients had a mean age of 73 years (range, 59 to 86). All were female. Two patients presented acutely. Three patients underwent revisional surgery. The average procedure duration was 248 minutes (range, 162 to 324). All patients had gastrostomy tubes placed. The diagnosis of PE occurred within 3 to 19 days postoperatively. Four were treated with 3 months of oral anticoagulation; 1 was managed expectantly.Conclusions: Highly complex cases, marked by revisional status, need for mesh, large hernia size, and percutaneous endoscopic gastrostomy placement are likely at increased risk for PEs. Preoperative venous thromboembolism chemoprophylaxis should be considered in the majority of laparoscopic PEHR patients.

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Impact of Operative Times and Mesh Utilization on Paraesophageal Hernia Repair: Analysis of 30-Day Outcomes from the American College of Surgeons National Surgical Quality Improvement Project Database

Abstract: Mesh utilization does not impact postoperative outcomes; however, as operative time increases, the incidence of postoperative morbidity also increases.

Cited by 8 publications

References 23 publications

Mesh or no mesh in anti-reflux surgery

Mesh or no mesh in anti-reflux surgery

Non-closure of the Free Peritoneal Flap During Laparoscopic Hernia Repair of Lower Abdominal Marginal Hernia: A Retrospective Analysis

Laparoscopic Paraesophageal Hernia Repair and Pulmonary Embolism

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