Analysis of hospitalization costs in adult inguinal hernia: based on quantile regression model.

BACKGROUND: Inguinal hernia repair is a common surgical procedure with significant variability in hospitalization costs. Traditional cost analysis methods often overlook the distribution of costs across patient demographics and clinical factors. This study employs a quantile regression model to explore the determinants of hospitalization costs for adult inguinal hernia surgery, providing a detailed understanding of cost variations across different quantiles. METHODS: We analyzed data from adult patients who underwent inguinal hernia surgery at Beijing Chaoyang Hospital from January 2015 to June 2023. The study included patient demographics, hernia-related information, surgery-related details, and cost-related data. A quantile regression model was used to assess the impact of various factors on hospitalization costs at different quantiles (10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%). Data were processed using StataSE 15.0 software. RESULTS: Our study included 16,602 patients, predominantly male (91.86%) and Han Chinese (96.48%), with the 51-64 years age group being the largest (26.80%). The quantile regression analysis revealed significant cost variations across different quantiles. Younger patients incurred higher costs, with age coefficients ranging from -40.541 at the 90th quantile to -3.082 at the 10th quantile. Uninsured patients faced higher costs, with coefficients from 214.747 at the 80th quantile to 501.78 at the 10th quantile. Longer hospital stays correlated with increased costs, with coefficients from 342.15 at the 80th quantile to 405.613 at the 90th quantile. Patients hospitalized multiple times (≥3) had lower costs, with coefficients from -767.353 at the 40th quantile to -311.575 at the 80th quantile. Comorbidities significantly raised costs, with coefficients for three or more comorbidities ranging from 806.122 at the 80th quantile to 1,456.02 at the 40th quantile. Laparoscopic surgery was more expensive than open surgery, with coefficients from 1,834.206 at the 80th quantile to 2,805.281 at the 10th quantile. Bilateral surgeries and the use of biological mesh also resulted in higher costs, with coefficients for bilateral surgeries ranging from 1,067.708 at the 10th quantile to 2,871.126 at the 90th quantile and for biological mesh from 3,221.216 at the 40th quantile to 6,117.598 at the 90th quantile. CONCLUSIONS: Hospitalization costs for inguinal hernia surgery are influenced by multiple factors, with significant variations across different patient groups. Strategies to control costs should be tailored to address the specific needs of patients, optimize surgical methods, and improve perioperative care. Future research should extend these findings across different healthcare settings and consider the latest advancements in medical technology and policy changes.

Exploring serum N-glycome patterns as candidate non-invasive biomarkers in inguinal hernia.

Introduction: Although inguinal hernia (IH) is prevalent in elderly males, research on its specific diagnostic biomarkers is limited. Protein N-glycosylation is one of the most important and ubiquitous post-translational modifications and often results in a remarkable heterogeneity of protein glycoforms. Protein N-glycosylation often changes in a disease and holds great potential for discovering non-invasive biomarkers. This study aimed to gain insights into total serum protein N-glycosylation of IH to identify candidate non-invasive biomarkers for diagnosis and subtype classification of IH. Methods: Linkage-specific sialylation derivatization combined with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry detection was used to analyze serum protein N-glycosylation patterns in IH patients and healthy controls. Results: IH patients had abnormal glycan fucosylation and sialylation compared to healthy controls (HC), of which two glycan traits representing linkage-specific sialylation within monoantennary glycans showed high potential as diagnostic biomarkers for IH with an area under the curve (AUC) of 0.75. Additionally, serum N-glycans were different between indirect IH and direct IH in glycosylation features, namely complexity, fucosylation, galactosylation, sialylation, and α2,6-linked sialylation. Four distinctive glycans between the two subtypes showed good performance with AUC >0.8, suggesting that these glycan traits have potential as biomarkers for subtype classification. Conclusions: We first reported the serum N-glycomic features of IH patients. Furthermore, we identified several potential biomarkers for the diagnosis and subtype classification of IH. These findings can deepen the understanding of IH.

Application of bridging mesh repair in giant ventral incisional hernia.

Achieving ideal abdominal wall reconstruction in giant ventral incisional hernia has been a challenging for surgeons. This study aimed to verify the safety and efficacy of bridging repair by comparing it with primary fascial closure (PFC) repair in the treatment of giant ventral incisional hernia. We retrospectively analyzed the clinical data of 92 patients with giant ventral incisional hernia who underwent mesh repair at our medical institution from January 1, 2014 to December 31, 2020. Patients were divided into 2 groups: the bridging repair group with 40 patients in whom repair was completed using the bridging technique and the PFC group with 52 patients in whom primary fascial closure was achieved and all patients underwent mesh reinforcement during the operation. The main outcome measures were recurrence rate and morbidity, especially intra-abdominal hypertension (IAH). Follow-up time of both groups lasted at least 24 months after surgery. After a median of 46 months and 65 months of follow-up, respectively, in the two groups, bridging repair did not increase the long-term recurrence rate (2.56%) in the larger defect area group compared to the PFC group (1.96%). There were no significant differences in perioperative morbidity, IAH, incidence of postoperative chronic pain, and sensory impairment of the abdominal wall between both groups. The application of bridging surgery in the treatment of complex giant ventral incisional hernias is safe and effective and does not significantly increase the postoperative recurrence rate.

Comparison of open preperitoneal and transabdominal preperitoneal hernia repair for primary unilateral femoral hernia: a retrospective cohort study of 132 case.

BACKGROUND: Femoral hernia (FH) is traditionally treated by open surgery (OS). Laparoscopic treatment has also shown good results in treating FH. However, there have been few comparative studies of these two techniques. Therefore, our aim was to compare the outcomes of open and laparoscopic surgical FH treatment. METHODS: Adult patients with primary unilateral FH undergoing OS or transabdominal preperitoneal (TAPP) hernia repair at our hospital from January 2013 to June 2018 were included in this study. Patients with history of abdominal surgery, contraindications to general anesthesia and those not wishing to receive general anesthesia received OS. Demographics, operation details and complications were compared retrospectively between the two groups. RESULTS: A total of 132 patients were recruited to the study, 62 and 70 of whom underwent OS and TAPP, respectively. Compared to OS group, the TAPP group had a significantly shorter hospital stay (3.0 vs. 2.0 days, respectively, P < 0.05) and a lower postoperative pain score (3.0 vs. 1.0, P < 0.05), and took less time to return to normal activities (13.0 vs. 6.0 days, respectively, P < 0.05). The overall complication rates were equivalent between the groups (10 vs. 9.7%, OR = 1.037, 95% CI 0.329-3.270). CONCLUSIONS: Both laparoscopic and open surgery appear to be safe and effective in a cohort of patients with femoral hernia and laparoscopic surgery might offer some advantages in reducing length of hospital stay, lower postoperative pain score and quicker return to activities.

Initial results of an indigenous absorbable tacker for mesh fixation in laparoscopic ventral hernia repair: a retrospective analysis of 158 cases.

OBJECTIVE: The aim of this study was to evaluate the safety and effectiveness of a Chinese absorbable tack for mesh fixation in laparoscopic abdominal wall hernia repair compared to a widely used similar imported product. METHODS: From May 2019 to December 2020, the clinical data of 158 patients with abdominal wall hernias were analyzed. They were divided into two groups: 76 patients underwent surgery with local absorbable tacks for mesh fixation (experimental group) and 82 patients received a similar imported product (control group). Preoperative and postoperative variables, effectiveness of postoperative immediate fixation, and with ease of handling of instruments were analyzed statistically. Complications and adverse events were followed and analyzed statistically. Meanwhile, medical costs were recorded and evaluated. RESULTS: There were no statistically significant differences between the two groups in terms of demographic data, hernia types, hernia defects, or number of tacks used for mesh fixation during operation. The effect of postoperative immediate fixation and with ease of handling of instruments in both groups were not significantly different. During the follow-up period, no recurrence or adverse events occurred in either group. No significant differences were noted between the two groups for other complications, such as chronic pain, foreign body sensation, infection of the abdominal wall, hematoma and seroma. There was a significant difference in medical costs between the two groups: the costs associated with the experimental group using local tacks were lower. CONCLUSION: Chinese absorbable tacks for mesh fixation in laparoscopic abdominal wall hernia repair are effective, safe, and economical. They are worthy of clinical application.

Botulinum Toxin Type A Injection Improves the Intraperitoneal High Pressure in Rats Treated with Abdominal Wall Plasty.

The aim of the study is mainly to study the subject of BoNT-A injection to improve IAH in rats undergoing abdominal angioplasty. The study problem in surgery, especially in ICU, burn, and trauma centers, intra-abdominal hypertension (IAH), and abdominal compartment syndrome (ACS) are common complications. At present, there are various treatments for IAH. The intramuscular injection of Botulinum toxin type A (BoNT-A) into the abdominal wall has received a lot of attention. Based on this, this study proposes a method for measuring abdominal pressure, applies BoNT-A to reduce abdominal pressure in the IAH state of abdominal wall angioplasty, and explores a way to increase the compliance of the abdominal wall under the premise of maintaining the sealing of the abdominal cavity, so as to realize the expansion of the abdominal cavity. A method is achieved to reduce intra-abdominal pressure and eliminate or alleviate ACS. The results of the experiment showed that when the rats in the control group were injected with the same amount of normal saline as the rats in the experimental group, the IAP was significantly higher than that in the experimental group (P < 0.05). This shows that BoNT-A increases the compliance of the abdominal wall while maintaining the closure of the abdominal cavity, thereby increasing the volume of the abdominal cavity and alleviating the state of IAH in rats.

If laparoscopic technique can be used for treatment of acutely incarcerated/strangulated inguinal hernia?

PURPOSE: Laparoscopic treatment for acutely incarcerated/strangulated inguinal hernias is uncommon and controversial. In the present study, we assessed the safety and feasibility of transabdominal preperitoneal (TAPP) repair for the treatment of acutely incarcerated/strangulated inguinal hernias. METHODS: Patients with acutely incarcerated/strangulated inguinal hernias who underwent TAPP repair at the Department of Hernia and Abdominal Wall Surgery (Beijing Chaoyang Hospital) from January 2017 to December 2019 were retrospectively reviewed. Patients' characteristics, operation details, and postoperative complications were retrospectively analyzed. RESULTS: In total, 94 patients with acutely incarcerated/strangulated inguinal hernias underwent TAPP repair. The patients comprised 85 men and 9 women (mean age, 54.3 ± 13.6 years; mean operating time, 61.6 ± 17.7 min; mean hospital stay, 3.9 ± 2.2 days). No patients were converted to open surgery. Hernia reduction was successfully performed in all patients. The morbidity of complications was 20.2% (19/94). Two bowel resections were performed endoscopically. Nine (9.6%) patients avoided unnecessary bowel resections during laparoscopic procedures. All patients recovered well without severe complications. No recurrence or infection was recorded during a mean follow-up period of 26.8 ± 9.8 months. CONCLUSIONS: TAPP appears to be safe and feasible for treatment of patients with acutely incarcerated/strangulated inguinal hernias. However, it requires performed by experienced surgeons in laparoscopic techniques.

Multiple recurrent neurofibromas in the abdominal wall: A case report.

BACKGROUND: Neurofibroma can be a clinical manifestation of neurofibromatosis, which is a benign neurogenic tumor that occurs sporadically. Neurofibromas in the abdomen usually appear in the retroperitoneal space. Reports on neurofibromas in the abdominal wall are rare, and multiple recurrent neurofibromas in this area have not yet been reported. CASE SUMMARY: This is a case of a 73-year-old man who suffered from multiple recurrent neurofibromas in the abdominal wall for 16 years and received 13 surgical treatments. CONCLUSION: We need to pay due attention to its treatment, and primary surgery should be designed thoroughly.

Analysis of operation procedure and effect for emergency surgery in general hospital during novel coronavirus pneumonia period.

BACKGROUND: Novel coronavirus pneumonia (NCP) outbreak in Wuhan, China in early 2020, resulted in over 80 thousand infections in China. At present, NCP has an explosive growth in the world. Surgeons could refuse selective operation during the outbreak, but they must face the emergency operation. We hope to avoid the spread of NCP while ensuring efficient treatment of emergency cases. METHODS: The data of patients with incarcerated hernia admitted to Beijing Chaoyang Hospital during NCP epidemic were analyzed and compared with those in 2019. All cases were divided into NCP group and 2019 group. The operation data and inpatient protection process of emergency cases were analyzed. Result During the NCP epidemic, 17 cases with incarcerated hernia were treated in our department. A Total of 263 cases of the same disease were admitted in 2019. There was no significant difference in age, gender, BMI and hernia type between two groups. No significant difference was observed between the two groups in operation method and hospital stay. The waiting time for emergency operation of NCP group was significantly longer than that of 2019 group (P = 0.002). A buffer ward was set up by administrator of hospital during NCP outbreak. Hospitals were divided into "Red area, Yellow area and Green area" artificially, and strict screening consultation system was implemented. There was no case of SARS-nCoV-2 infection in medical staff. CONCLUSION: It was safe and effective to carry out emergency operation on the premise of screening, protection and isolation during the NCP epidemic. The increased waiting time for operation due to NCP screening did not threaten medical safety of emergency incarcerated hernia patients.

Porcine Small Intestinal Submucosa Mesh to Treat Inguinal Hernia in Young Adults Using Laparoscopic Inguinal Hernia Repair: A Retrospective Controlled Study.

BACKGROUND: The authors evaluated the effects and clinical value of small intestinal submucosa (SIS) mesh to treat inguinal hernia in young adults by the laparoscopic method. METHODS: The clinical data of 357 cases with inguinal hernia using SIS mesh in our hospital were analyzed retrospectively from June 2014 to June 2018. All cases were divided into 2 groups according to the surgical method. Operation time, hospital stay, cost, postoperative complications, and complications during follow-up were analyzed. RESULTS: Of the 357 patients, 202 (56.6%) underwent Lichtenstein repair and 155 (43.4%) underwent transabdominal preperitoneal (TAPP) repair. Operation time and hospital costs of the Lichtenstein group were significantly lower compared with the TAPP group (P<0.05). The incidence of seroma in the Lichtenstein group was lower than that in the TAPP group at 1 week, 1 month, and 3 months postoperatively with significant differences (P<0.05). Perioperative pain scores in the Lichtenstein group were higher than the TAPP group (P<0.05). No statistical difference was observed for hospital stay between 2 groups (P>0.05). In the Lichtenstein group, 1 case recurred during the follow-up period (0.5%). No intestinal obstruction or intestinal fistula occurred in any patient during the follow-up period. CONCLUSION: The effect of SIS mesh was positive whether the patient underwent a Lichtenstein or TAPP method. Seroma was more common in the TAPP method that may cause lower postoperative pain. Therefore, we recommend individualized treatment.

Tension-Free Mesh Repair for Incarcerated Groin Hernia: A Comparative Study.

Background. Management of emergent groin hernias remains challenging, due to limited consensus in surgical approach and repair options (eg, mesh vs nonmesh, biological mesh, and polypropylene [PP] mesh). Methods. A 5-year retrospective study was conducted on 118 patients who received emergency incarcerated groin hernia repair in Beijing Chaoyang Hospital. The incidence of surgical site infection (SSI), preoperative mortality, sepsis, and ileus was noted. In the follow-up, postoperative foreign body sensation, chronic pain, seroma/hematoma, and recurrence were recorded. The outcomes of different surgical procedures (with mesh/without mesh, biological mesh/PP mesh, transabdominal preperitoneal (TAPP)/Lichtenstein repair) were compared and analyzed. Results. Out of the 118 patients, 14 cases received suture repair (as group A); 104 cases had TAPP repair (n = 44) or Lichtenstein repair (n = 60) with meshes, including 23 cases of biological mesh (as group B); and 81 cases had repair with PP mesh (group C). There were no significant differences between the 3 groups regarding SSI, mortality, sepsis, and ileus. After 20.5 months of follow-up (range from 6 to 65 months), 21.4% of group A developed recurrence, a rate significantly higher than that of group B (4.3%) and group C (0). The incidence of seroma/hematoma in group B was higher than that in group A (7.1%) and group C (7.4%). The results between TAPP group and Lichtenstein group were comparable. Conclusion. Tension-free mesh repair in the treatment of emergency incarcerated groin hernia is safe and effective, which can reduce hernia recurrence without increasing infection risk. The results of biological mesh and PP mesh were comparable.

Randomized and Comparative Clinical Trial of Bovine Mesh Versus Polypropylene Mesh in the Repair of Inguinal Hernias.

BACKGROUND: The type of mesh (synthetic vs. biological) play integral roles in the recovery and long-term outcomes of patients undergoing hernia repair. The aim of this study was to determine whether a biological mesh from bovine pericardium is equivalent to a standard polypropylene mesh in an open inguinal hernia repair using the Lichtenstein technique. MATERIALS AND METHODS: A prospective, randomized, double-blinded, single-center trial was conducted to evaluate the safety and efficacy of a biological mesh compared with a commonly used polypropylene mesh using Lichtenstein's inguinal hernia repair in a 6-month study. Patients were evaluated for recurrence and complications by a blinded surgeon at 1 day, 1 week, 1 month, 3 months, and 6 months after surgery. RESULTS: A total of 132 patients were randomized into experimental group receiving the bovine mesh (n=66) and control group receiving the standard polypropylene mesh (n=66). No recurrences were diagnosed in both arms within 6-month follow-up. Patients in the experimental group reported markedly less groin pain during the 3-month postoperative assessment period compared with the control group. There were no statistically significant differences in other complications, such as incision inflammation, physical limitation, testicular problems, and foreign body sensation, between the 2 groups. CONCLUSIONS: Biological mesh is safe and effective in repairing inguinal hernia, with comparable intraoperative and early postoperative morbidity to the synthetic mesh.

The results of open preperitoneal prosthetic mesh repair for acutely incarcerated or strangulated inguinal hernia: a retrospective study of 146 cases.

BACKGROUND: Tension-free hernia repair has been regarded as the gold-standard treatment for selected inguinal hernias, but the use of prosthetic mesh in acutely incarcerated or strangulated inguinal hernias is controversial. Our aim was to evaluate the safety and efficacy of open prosthetic mesh repairs for emergency inguinal hernias. METHODS: Patients with acutely incarcerated or strangulated inguinal hernias who underwent open preperitoneal prosthetic mesh repairs during 2013 to 2016 at our department were included. Patients' characteristics, operative details, results, and complications were retrospectively analyzed. RESULTS: During a 4-year period, 146 cases who met the inclusion criteria were enrolled in our study. There were 127 males and 19 females of median age 75 years (range 19-95 years). The hernia was indirect inguinal in 104 (71.2%) patients, direct inguinal in 18 (12.3%), and femoral hernia in 24 (16.5%). Bowel resection was necessary in 20 patients (13.7%). Complications occurred in 15 (10.3%) patients, including wound infection in 6 (4.1%), scrotal hematoma in 2 (1.4%), bleeding in 1 (0.7%), deep vein thrombosis (DVT) in 2 (1.4%), and chest infection in 4 (2.7%). No mesh-related infections were detected. There were 2 mortalities. During the median follow-up of 26 months (range 6-53 months) 2 recurrences occurred, but there were no deaths or further infections. CONCLUSION: Open preperitoneal prosthetic mesh repair can be safely performed in patients with incarcerated or strangulated inguinal hernia without contaminated hernia content. Mesh repair is not contraindicated in patients with bowel resection.

Laparoscopic versus Lichtenstein hernioplasty for inguinal hernias: a systematic review and Meta-analysis of randomized controlled trials.

Background: This meta-analysis aimed to explore the safety and efficacy of Lichtenstein versus laparoscopic hernioplasty for inguinal hernias based on eligible randomized controlled trials (RCTs).Material and methods: We searched several electronic databases to identify eligible studies based on the index words updated to March 2018.We also searched related publication sources and only included eligible RCTs in the current analysis. Relative risk (RR) or mean difference (MD) along with 95% confidence interval (95% CI) were used for the main outcome of our analysis.Results: In total, 21 studies were included with 3772 patients in the laparoscopic group and 3910 patients in the Lichtenstein group. The results indicated that compared with the Lichtenstein group, the laparoscopic surgery group had significantly increased operative time. Besides, there was no significant difference in the rate of hematoma or seroma and complications between the two groups. However, compared with the Lichtenstein group, the laparoscopic group had a higher hernia recurrence rate, a lower incidence of chronic pain and a lower rate of wound infection, but no significant difference was found.Conclusion: The results demonstrated that laparoscopic repair reduced chronic pain and wound infection compared with Lichtenstein repair. But Lichtenstein could reduce the operative time and hernia recurrence.

Randomized Controlled Trial Of Lichtenstein Repair Of Indirect Inguinal Hernias With Two Biologic Meshes From Porcine Small Intestine Submucosa.

BACKGROUND: Biologic mesh is a newly developed material for hernia repairs which has been successfully used in clinical practices. This study aims to evaluate the clinical efficacy between patients undergoing a Lichtenstein's hernioplasty with a new biologic mesh derived from porcine small intestine submucosal (SIS) extracellular matrix versus a standard SIS mesh. METHODS: A prospective, randomized, double-blinded, multi-center trial was conducted in a 6-month study. Lichtenstein hernioplasty was performed using the new SIS mesh (Beijing Biosis Healing Biotechnology) or the standard SIS mesh (Biodesign Surgisis, Cook Biotech). The postoperative follow-up examinations were carried out at during hospitalization, 1st week, 1st, 3rd, and 6th month after surgery. The primary outcome was the excellent and good rate of recovery. Secondary outcomes included recurrence rate, complications, and patient-centered outcomes. RESULTS: A total of 194 patients were randomized into experimental group receiving the new SIS mesh (n=97) and control group receiving the standard SIS mesh (n=97). The excellent and good rate of rehabilitation in the experimental group was 98.97%, while it was 100.00% in the control group (P>0.05). One patient had a recurrence in the experimental group, while there was no recurrence in the control group (P>0.05). Other clinical outcomes, including the length of operation or hospitalization, foreign body sensation in the inguinal area, incision healing, infection, postoperative chronic pain, postoperative allergy, hydrocele, and orchitis, were similar between the two groups. CONCLUSION: Lichtenstein hernioplasty using the SIS mesh was safe and effective, and the new SIS mesh tested in this study had comparable safety and efficacy to the wildly used SIS mesh.

An acellular tissue matrix-based drug carriers with dual chemo-agents for colon cancer growth suppression.

BACKGROUND/AIMS: Relapse, metastasis, and chemo-resistance are the main factors responsible for the failure of surgical treatment of malignant tumors, and typically are the main obstacles to effective cancer treatment. Although significant advances have been made in the field of cancer chemotherapy, many patients still receive inadequate treatment due to the severe adverse effects of these drugs, resulting in an inability to reach therapeutic concentrations at the tumor site with systemic chemotherapy. Thus, a biological patch loaded with chemotherapeutic drugs could be an ideal strategy for the treatment of cancer at the tumor site. METHODS: We developed an acellular matrix using the submucosa of porcine jejunum, then loaded this matrix with different amounts of 5-fluorouracil (5-FU) and rapamycin nanoparticles. Cell proliferation and apoptosis were analyzed by flow cytometry and related markers were evaluated using real-time PCR and western blotting. The patches were evaluated in vitro to characterize their release kinetics and therapeutic feasibility. We then analyzed the therapeutic efficacy and systemic toxicity of these patches in vivo by using them in a mouse model of colon cancer. RESULTS: The patches delivered 5-FU and rapamycin in a controlled manner for more than 8 weeks, arrested the cell cycle of LoVo cells and sw480 cells at G2/M phase, and induced apoptosis in vitro. The patches also suppressed the growth of xenografted tumors in vivo with lower adverse effects than typically observed with systemic administration of these drugs. CONCLUSION: We demonstrated that patches loaded with 5-FU-RAPA-PLA-NP significantly inhibited the growth of colon cancer in vitro and in vivo. These results demonstrated the feasibility of the use of a multi-effect biological patch for cancer treatment.