Incisional hernia in the elderly: Risk factors and clinical considerations

Caglià, Pietro; Tracia, Angelo; Borzì, Laura; Amodeo, Luca; Tracia, Lucio; Veroux, Massimiliano; Amodeo, C

doi:10.1016/j.ijsu.2014.08.357

Cited by 70 publications

(33 citation statements)

References 79 publications

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“…In the Spanish National Registry of Incisional Hernia (EVEREG) increasing incisional hernia complication rates was observed from age > 70 years [49]. Therefore, it is very reasonable that the indication for surgery of an incisional hernia in an older patient should be carefully and critically considered [50].…”

Section: Age > 80 Yearsmentioning

confidence: 99%

The reality of general surgery training and increased complexity of abdominal wall hernia surgery

Köckerling

Sheen

Berrevoet

et al. 2019

Hernia

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Introduction The Accreditation and Certification of Hernia Centers and Surgeons (ACCESS) Group of the European Hernia Society (EHS) recognizes that there is a growing need to train specialist abdominal wall surgeons. The most important and relevant argument for this proposal and statement is the growing acceptance of the increasing complexity of abdominal wall surgery due to newer techniques, more challenging cases and the required 'tailored' approach to such surgery. There is now also an increasing public awareness with social media, whereby optimal treatment results are demanded by patients. However, to date the complexity of abdominal wall surgery has not been properly or adequately defined in the current literature. Methods A systematic search of the available literature was performed in May 2019 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library, with 75 publications identified as relevant. In addition, an analysis of data from the Herniamed Hernia Registry was performed. The percentage of patients with hernia-or patient-related characteristics which unfavorably impacted the outcome of inguinal and incisional hernia repair was also calculated. Results All present guidelines for abdominal wall surgery recommend the utilization of a 'tailored' approach. This relies on the prerequisite that any surgical technique used has already been mastered, as well as the recognized learning curves for each of the several techniques that can be used for both inguinal hernia (Lichtenstein, TEP, TAPP, Shouldice) and incisional hernia repairs (laparoscopic IPOM, open sublay, open IPOM, open onlay, open or endoscopic component separation technique).Other hernia-and patient-related characteristics that have recognized complexity include emergency surgery, obesity, recurrent hernias, bilateral inguinal hernias, groin hernia in women, scrotal hernias, large defects, high ASA scores, > 80 years of age, increased medical risk factors and previous lower abdominal surgery. The proportion of patients with at least one of these characteristics in the Herniamed Hernia Registry in the case of both inguinal and incisional hernia is noted to be relatively high at around 70%. In general surgery training approximately 50-100 hernia repairs on average are performed by each trainee, with around only 25 laparo-endoscopic procedures. Conclusion A tailored approach is now employed and seen more so in hernia surgery and this fact is referred to and highlighted in the contemporaneous hernia guidelines published to date. In addition, with the increasing complexity of abdominal wall surgery, the number of procedures actually performed by trainees is no longer considered adequate to overcome any recognized learning curve. Therefore, to supplement general surgery training young surgeons should be offered a clinical fellowship to obtain an additional qualification as an abdominal wall surgeon and thus improve their clinical and operative experience under supervision in this field. Practicing general surgeons with a special int...

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Section: Age > 80 Yearsmentioning

confidence: 99%

The reality of general surgery training and increased complexity of abdominal wall hernia surgery

Köckerling

Sheen

Berrevoet

et al. 2019

Hernia

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“…It was also reported that recurrence rate is very low when prosthetic mesh repair was done and considered as a gold standard treatment. 4 Wound infection is another problem of mesh repair. In both type of surgical repairs ventral hernia and incisional Hernia type and method of repair is very important especially when prosthetic mesh repair planned.…”

Section: Introductionmentioning

confidence: 99%

Incisional Hernia Surgery

Liaquat¹,

Ahmad

Liaquat

2018

TPMJ

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… Objectives: To evaluate the postoperative complication of different incisional hernia repair techniques; preperitoneal repair, onlay repair, and laparoscopic IPOM. Study Design: Randomized control trial. Setting: Multan Medical and Dental College Multan. Period: One year duration from June 2016 to June 2017. Methodology: Collected data was analyzed by using SPSS statistical software), mean and standard deviation was calculated for continuous data and frequencies with percentages (%) were calculated and presented for qualitative data. P value ≤ 0.05 was considered as significant. Results: Total 90 patients enrolled in this study, both genders. There were 65.6% (n=59) men and 34.4% (n=31) women. Patients who were treated with preperitoneal repair were able to perform forceful activities in earlier time when compared to those who were treated with onlay repair at 11th weeks. The differences were statistically significant. Conclusion: The observations of our study revealed that Laproscopic IPOM was found to be effective and easy for patient compliance and level of satisfaction in terms of CCS scoring system with regard to occurrence of complications, appearance of the abdominal wall without laxity in a single sitting and to resume daily activities.

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“…The majority of models, however, use post-operative variables that limit their use for patient counseling and in implementing pre-operative or intra-operative interventions (1, 2, 4, 5, 6, 7). The HERNIAscore is a VIH risk assessment tool that utilizes only preoperative variables and predictable intra-operative variables: body mass index (BMI), chronic obstructive pulmonary disease (COPD), and incision length (laparoscopic, extended laparoscopy, or laparotomy) (8).…”

Section: Introductionmentioning

confidence: 99%

External Validation of the HERNIAscore: An Observational Study

Cherla

Moses

Mueck

et al. 2017

Journal of the American College of Surgeons

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Background The HERNIAscore is a ventral incisional hernia (VIH) risk assessment tool that utilizes only preoperative variables and predictable intraoperative variables. The aim of this study was to validate and modify, if needed, the HERNIAscore in an external dataset. Study Design This was a retrospective observational study of all patients undergoing resection for gastrointestinal malignancy 2011–2015 at a safety-net hospital. Primary outcome was clinical postoperative VIH. Patients were stratified into low, medium, and high risk based on HERNIAscore. A Revised HERNIAscore was formed with the addition of prior abdominal surgery as a categorical variable. Cox regression of incisional hernia with stratification by risk class was performed. Incidence rates of clinical VIH formation within each risk class were also calculated. Results 247 patents were enrolled. On Cox regression, in addition to the three variables of the HERNIAscore (BMI, incision length, and COPD), prior abdominal surgery was also predictive of VIH. The Revised HERNIAscore demonstrated improved predictive accuracy for clinical VIH. While the original HERNIAscore effectively stratified the risk of developing an incisional radiographic VIH, the Revised HERNIAscore provided a statistically significant stratification for both clinical and radiographic VIHs in this patient cohort. Conclusion We have externally validated and improved the HERNIAscore. The Revised HERNIAscore utilizes BMI, incision length, COPD, and prior abdominal surgery to predict risk of post-operative incisional hernia. Future research should assess methods to prevent incisional hernias in moderate-to-high risk patients.

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Incisional hernia in the elderly: Risk factors and clinical considerations

Cited by 70 publications

References 79 publications

The reality of general surgery training and increased complexity of abdominal wall hernia surgery

The reality of general surgery training and increased complexity of abdominal wall hernia surgery

Incisional Hernia Surgery

External Validation of the HERNIAscore: An Observational Study

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