Laparoscopic Versus Open Anterior Abdominal Wall Hernia Repair

Mason, Rodney J.; Moazzez, Ashkan; Sohn, Helen J.; Berne, Thomas V.; Katkhouda, Namir

doi:10.1097/sla.0b013e31823009e6

Cited by 98 publications

(27 citation statements)

References 29 publications

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“…In contrast to most studies in the literature that reported SSI rates after only single anatomic site procedures 5;6;8–13 or after procedures that included a mixture of anatomic sites, 7 we applied a uniform method to identify SSIs after categorizing the site and surgical approach in order to compare infection rates across different anatomical sites and surgical approaches. In addition, the use of claims data allowed identification of SSIs after discharge across the spectrum of health care providers.…”

Section: Discussionmentioning

confidence: 99%

Stratification of Surgical Site Infection by Operative Factors and Comparison of Infection Rates after Hernia Repair

Olsen

Nickel

Wallace

et al. 2014

Infect. Control Hosp. Epidemiol.

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Objective The National Healthcare Safety Network does not risk adjust surgical site infection (SSI) rates after hernia repair by operative factors. We investigated whether operative factors are associated with risk of SSI after hernia repair. Design Retrospective cohort study. Patients Commercially-insured enrollees aged 6 months–64 years with ICD-9-CM procedure or CPT-4 codes for inguinal/femoral, umbilical, and incisional/ventral hernia repair procedures from 1/1/2004–12/31/2010. Methods SSIs within 90 days after hernia repair were identified by ICD-9-CM diagnosis codes. Chi-square and Fisher’s exact tests were used to compare SSI incidence by operative factors. Results A total of 119,973 hernia repair procedures were included in the analysis. The incidence of SSI differed significantly by anatomic site, with rates of 0.45% (352/77,666) for inguinal/femoral, 1.16% (288/24,917) for umbilical, and 4.11% (715/17,390) for incisional/ventral hernia repair. Within anatomic sites, the incidence of SSI was significantly higher for open versus laparoscopic inguinal/femoral (0.48% [295/61,142] versus 0.34% [57/16,524], p=0.020) and incisional/ventral (4.20% [701/16,699] versus 2.03% [14/691], p=0.005) hernia repairs. The rate of SSI was higher following procedures with bowel obstruction/necrosis than procedures without obstruction/necrosis for open inguinal/femoral (0.89% [48/5,422] versus 0.44% [247/55,720], p<0.001) and umbilical (1.57% [131/8,355] versus 0.95% [157/16,562], p<0.001), but not incisional/ventral hernia repair (4.01% [224/5,585] versus 4.16% [491/11,805], p=0.645). Conclusions The incidence of SSI was highest after open procedures, incisional/ventral repairs, and hernia repairs with bowel obstruction/necrosis. Our findings suggest that stratification of hernia repair SSI rates by some operative factors may be important to facilitate accurate comparison of SSI rates between facilities.

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Section: Discussionmentioning

confidence: 99%

Stratification of Surgical Site Infection by Operative Factors and Comparison of Infection Rates after Hernia Repair

Olsen

Nickel

Wallace

et al. 2014

Infect. Control Hosp. Epidemiol.

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“…We tested the hypothesis that antibiotic treatment of uncomplicated acute appendicitis was noninferior to appendectomy. Based on prior studies, 13 we as-sumed that there would be a 24% difference in treatment efficacy between the surgical and antibiotic groups.…”

Section: Objectivementioning

confidence: 99%

Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis

Salminen

Paajanen

Rautio

et al. 2015

JAMA

681

694

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IMPORTANCE An increasing amount of evidence supports the use of antibiotics instead of surgery for treating patients with uncomplicated acute appendicitis. OBJECTIVE To compare antibiotic therapy with appendectomy in the treatment of uncomplicated acute appendicitis confirmed by computed tomography (CT). DESIGN, SETTING, AND PARTICIPANTS The Appendicitis Acuta (APPAC) multicenter, open-label, noninferiority randomized clinical trial was conducted from November 2009 until June 2012 in Finland. The trial enrolled 530 patients aged 18 to 60 years with uncomplicated acute appendicitis confirmed by a CT scan. Patients were randomly assigned to early appendectomy or antibiotic treatment with a 1-year follow-up period. INTERVENTIONS Patients randomized to antibiotic therapy received intravenous ertapenem (1 g/d) for 3 days followed by 7 days of oral levofloxacin (500 mg once daily) and metronidazole (500 mg 3 times per day). Patients randomized to the surgical treatment group were assigned to undergo standard open appendectomy. MAIN OUTCOMES AND MEASURES The primary end point for the surgical intervention was the successful completion of an appendectomy. The primary end point for antibiotic-treated patients was discharge from the hospital without the need for surgery and no recurrent appendicitis during a 1-year follow-up period. RESULTS There were 273 patients in the surgical group and 257 in the antibiotic group. Of 273 patients in the surgical group, all but 1 underwent successful appendectomy, resulting in a success rate of 99.6% (95% CI, 98.0% to 100.0%). In the antibiotic group, 70 patients (27.3%; 95% CI, 22.0% to 33.2%) underwent appendectomy within 1 year of initial presentation for appendicitis. Of the 256 patients available for follow-up in the antibiotic group, 186 (72.7%; 95% CI, 66.8% to 78.0%) did not require surgery. The intention-to-treat analysis yielded a difference in treatment efficacy between groups of −27.0% (95% CI, −31.6% to ϱ) (P = .89). Given the prespecified noninferiority margin of 24%, we were unable to demonstrate noninferiority of antibiotic treatment relative to surgery. Of the 70 patients randomized to antibiotic treatment who subsequently underwent appendectomy, 58 (82.9%; 95% CI, 72.0% to 90.8%) had uncomplicated appendicitis, 7 (10.0%; 95% CI, 4.1% to 19.5%) had complicated acute appendicitis, and 5 (7.1%; 95% CI, 2.4% to 15.9%) did not have appendicitis but received appendectomy for suspected recurrence. There were no intra-abdominal abscesses or other major complications associated with delayed appendectomy in patients randomized to antibiotic treatment. CONCLUSIONS AND RELEVANCE Among patients with CT-proven, uncomplicated appendicitis, antibiotic treatment did not meet the prespecified criterion for noninferiority compared with appendectomy. Most patients randomized to antibiotic treatment for uncomplicated appendicitis did not require appendectomy during the 1-year follow-up period, and those who required appendectomy did not experience significant complications.

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“…National Scandinavian registries, like the Swedish Hernia Database and the Danish Hernia Database on hernia surgery, have demonstrated this [1–4]. Also multicentre databases like the Veterans Affairs Medical Centers database and the National Surgical Quality Improvement Program database have been able to detect poor outcome results in hernia surgery [5–7]. …”

Section: Introductionmentioning

confidence: 99%

EuraHS: the development of an international online platform for registration and outcome measurement of ventral abdominal wall hernia repair

Muysoms

Campanelli

Champault

et al. 2012

Hernia

236

132

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BackgroundAlthough the repair of ventral abdominal wall hernias is one of the most commonly performed operations, many aspects of their treatment are still under debate or poorly studied. In addition, there is a lack of good definitions and classifications that make the evaluation of studies and meta-analyses in this field of surgery difficult.Materials and methodsUnder the auspices of the board of the European Hernia Society and following the previously published classifications on inguinal and on ventral hernias, a working group was formed to create an online platform for registration and outcome measurement of operations for ventral abdominal wall hernias. Development of such a registry involved reaching agreement about clear definitions and classifications on patient variables, surgical procedures and mesh materials used, as well as outcome parameters. The EuraHS working group (European registry for abdominal wall hernias) comprised of a multinational European expert panel with specific interest in abdominal wall hernias. Over five working group meetings, consensus was reached on definitions for the data to be recorded in the registry.ResultsA set of well-described definitions was made. The previously reported EHS classifications of hernias will be used. Risk factors for recurrences and co-morbidities of patients were listed. A new severity of comorbidity score was defined. Post-operative complications were classified according to existing classifications as described for other fields of surgery. A new 3-dimensional numerical quality-of-life score, EuraHS-QoL score, was defined. An online platform is created based on the definitions and classifications, which can be used by individual surgeons, surgical teams or for multicentre studies. A EuraHS website is constructed with easy access to all the definitions, classifications and results from the database.ConclusionAn online platform for registration and outcome measurement of abdominal wall hernia repairs with clear definitions and classifications is offered to the surgical community. It is hoped that this registry could lead to better evidence-based guidelines for treatment of abdominal wall hernias based on hernia variables, patient variables, available hernia repair materials and techniques.

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Laparoscopic Versus Open Anterior Abdominal Wall Hernia Repair

Abstract: Laparoscopic hernia repair is infrequently used and associated with lower 30-day morbidity, particularly when hernias are complicated.

Cited by 98 publications

References 29 publications

Stratification of Surgical Site Infection by Operative Factors and Comparison of Infection Rates after Hernia Repair

Stratification of Surgical Site Infection by Operative Factors and Comparison of Infection Rates after Hernia Repair

Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis

EuraHS: the development of an international online platform for registration and outcome measurement of ventral abdominal wall hernia repair

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