Evaluation of 30-day outcomes for open ventral hernia repair using self-gripping versus nonself-gripping mesh.

BACKGROUND: The use of mesh is standard of care for large ventral hernias repaired on an elective basis. The most used type of mesh includes synthetic polypropylene mesh; however, there has been an increase in the usage of a new polyester self-gripping mesh, and there are limited data regarding its efficacy for ventral hernia. The purpose of the study is to determine whether there is a difference in surgical site occurrence (SSO), surgical site infection (SSI), surgical site occurrence requiring procedural intervention (SSOPI), and recurrence at 30 days after ventral hernia repair (VHR) using self-gripping (SGM) versus non-self-gripping mesh (NSGM). METHODS: We performed a retrospective study from January 2014 to April 2022 using the Abdominal Core Health Quality Collaborative (ACHQC). We collected data on patients over 18 years of age who underwent elective open VHR using SGM or NSGM and whom had 30-day follow-up. Propensity matching was utilized to control for variables including hernia width, body mass index, age, ASA, and mesh location. Data were analyzed to identify differences in SSO, SSI, SSOPI, and recurrence at 30 days. RESULTS: 9038 patients were identified. After propensity matching, 1766 patients were included in the study population. Patients with SGM had similar demographic and clinical characteristics compared to NSGM. The mean hernia width to mesh width ratio was 8 cm:18 cm with NSGM and 7 cm:15 cm with SGM (p = 0.63). There was no difference in 30-day rates of recurrence, SSI or SSO. The rate of SSOPI was also found to be 5.4% in the nonself-gripping group compared to 3.1% in the self-gripping mesh group (p < .005). There was no difference in patient-reported outcomes at 30 days. CONCLUSIONS: In patients undergoing ventral hernia repair with mesh, self-gripping mesh is a safe type of mesh to use. Use of self-gripping mesh may be associated with lower rates of SSOPI when compared to nonself-gripping mesh.

Idiopathic Spontaneous Pneumoperitoneum and Call for a Multi-Institutional Database.

Idiopathic spontaneous pneumoperitoneum (ISP) refers to intraperitoneal air of unknown origin when other more common etiologies such as traumatic, intrathoracic, and gynecologic etiologies have been excluded. We present a case of a 42-year-old woman with insignificant history presenting with ISP who underwent exploratory laparoscopy and thorough diagnostic workup that was ultimately unrevealing. This case report adds to the existing literature of ISP, and the authors recommend initiating a multi-institutional database to improve our understanding of ISP and contribute to developing consensus guidelines for presumed ISP.

Inguinal Hernia Repair in Older Persons.

Groin hernia repair is one of the most common surgeries performed in the United States, with more than 700,000 performed every year. These repairs are commonly performed in an elective setting to alleviate symptoms and prevent obstruction and/or strangulation. Prior studies have demonstrated that watchful waiting is a reasonable option compared with surgery, because of the low risk of life-threatening complications from groin hernias. However, other studies have demonstrated that there is increased risk of mortality after surgery in older persons (age ≥65 years). Therefore, the question is if and when older patients should pursue groin hernia repair. In this article, we provide an evidence-based overview on the management and treatment of inguinal hernia repair in older persons. Focusing on which patients should be repaired, the optimal timing of surgery, what is the best anesthesia, how the repair should be performed, and the importance of understanding frailty should help surgeons and primary care physicians determine the best management of inguinal hernias in older adults.

Do not roll the videotape: effects of the health insurance portability and accountability act and the law on trauma videotaping practices.

BACKGROUND: We hypothesized that trauma video practices would be affected as a result of Health Insurance Portability and Accountabilty Act (HIPAA) enactment. METHODS: A survey was distributed electronically to coordinators and/or directors of level 1 trauma centers. Centers were queried on demographics, trauma video use, and reasons for changes, if any, in their video practice patterns. Descriptive statistics and chi-square analysis were employed. RESULTS: Survey response rate was 75%. Prior to HIPAA, 58% of responding trauma centers used video compared to 18% now. On a Likert scale of 1-5, video analysis rated 3.80. For those using video currently, the most common purposes are education (91%) and quality assurance (83%). HIPAA has affected the way video is used at one third of these centers. Ten percent receive institutional review board approval for videotaping, 35% get patient consent, and more than half report capturing a poor patient outcome on tape. The most commonly cited reasons for stopping video use were HIPAA and legal concerns about patient privacy, consent, and discoverability (79%). Scarce resources were, in part, to blame at 70% of centers, while video technology was found to be ineffective at only 32%. CONCLUSIONS: A minority of level I trauma centers currently use video, although it is effective according to users. HIPAA and medicolegal concerns have affected its use at some centers and contributed to its abandonment at others.