Luciano Tastaldi1, David M Krpata2, Ajita S Prabhu2, Clayton C Petro2, Ramona Ilie2, Ivy N Haskins2, Hemasat Alkhatib2, Chao Tu3, Steven Rosenblatt2, Michael J Rosen2. 1. Comprehensive Hernia Center, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH. Electronic address: tastall@ccf.org. 2. Comprehensive Hernia Center, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH. 3. Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH.
Abstract
BACKGROUND: Emergent groin hernia repair can be a challenging clinical scenario. We aimed to evaluate the perioperative and long-term outcomes of emergent groin hernia repair at our institution over the last 10 years, with particular interest in surgical approach and mesh use for such cases. METHODS: Adult patients who underwent emergent groin hernia repair from 2005-2015 were retrospectively reviewed. Outcomes included surgical site infections, perioperative complications, readmissions, reoperations, mortality, and long-term hernia recurrence. Predictors of surgical site infection and perioperative complications were investigated using multivariate logistic regression. RESULTS: A total of 257 patients met inclusion criteria (62% males, median age 72). Hernias were most often indirect inguinal (40.9%) and femoral (33.5%), and 45 cases (17.5%) required a bowel resection. Laparoscopic repair was performed in 3 patients (1.2%). Synthetic mesh was placed in 70% of repairs but in only 15% of cases associated with a bowel resection. The medical complications rate was 16.7%; 3.6% had an surgical site infection, and 30-day mortality rate was 3.1%. Older age (odds ratio 1.05) and gross contamination (odds ratio 4.3) were independently associated with complications. Mesh use was not associated with surgical site infection (odds ratio 1.83, P = .49) or perioperative complications (odds ratio 1.02, P = .96). With a median follow-up of 43 months, there were no mesh infections and recurrence rates were similar between mesh and tissue repairs (6.3% vs 6.8%, P = .91). CONCLUSION: Emergent groin hernia repair has high rates of morbidity and mortality most closely associated with increasing age and the presence of contamination. Although mesh use appears to be well tolerated when used in the absence of contamination during emergent groin hernia repair, recurrence rates were similar to tissue repairs.
BACKGROUND: Emergent groin hernia repair can be a challenging clinical scenario. We aimed to evaluate the perioperative and long-term outcomes of emergent groin hernia repair at our institution over the last 10 years, with particular interest in surgical approach and mesh use for such cases. METHODS: Adult patients who underwent emergent groin hernia repair from 2005-2015 were retrospectively reviewed. Outcomes included surgical site infections, perioperative complications, readmissions, reoperations, mortality, and long-term hernia recurrence. Predictors of surgical site infection and perioperative complications were investigated using multivariate logistic regression. RESULTS: A total of 257 patients met inclusion criteria (62% males, median age 72). Hernias were most often indirect inguinal (40.9%) and femoral (33.5%), and 45 cases (17.5%) required a bowel resection. Laparoscopic repair was performed in 3 patients (1.2%). Synthetic mesh was placed in 70% of repairs but in only 15% of cases associated with a bowel resection. The medical complications rate was 16.7%; 3.6% had an surgical site infection, and 30-day mortality rate was 3.1%. Older age (odds ratio 1.05) and gross contamination (odds ratio 4.3) were independently associated with complications. Mesh use was not associated with surgical site infection (odds ratio 1.83, P = .49) or perioperative complications (odds ratio 1.02, P = .96). With a median follow-up of 43 months, there were no mesh infections and recurrence rates were similar between mesh and tissue repairs (6.3% vs 6.8%, P = .91). CONCLUSION: Emergent groin hernia repair has high rates of morbidity and mortality most closely associated with increasing age and the presence of contamination. Although mesh use appears to be well tolerated when used in the absence of contamination during emergent groin hernia repair, recurrence rates were similar to tissue repairs.
Authors: A Sartori; A Balla; E Botteri; F Scolari; M Podda; P Lepiane; M Guerrieri; S Morales-Conde; A Szold; M Ortenzi Journal: Hernia Date: 2022-05-26 Impact factor: 4.739