Association of ventral incisional hernias with comorbid diseases.

BACKGROUND: Ventral incisional hernias are more commonly associated with comorbid diseases when compared to other hernia types. We investigate the hypothesis that unfavourable local factors related to comorbid diseases may lead to incisional hernia development. MATERIALS AND METHODS: The characteristics of incisional hernia (71 patients), primary ventral hernia (114 patients)and groin hernia groups (820 patients) were analysed and compared among each other. RESULTS: Advanced age, female gender, presence of coexisting disease, strangulation, incarceration, bowel or omentum resections, deep venous thrombosis, ileus, wound infections,ASA scores were significantly higher and the duration of hospital stay was longer in the incisional hernia group when compared to the other groups. Presence of coexisting diseases and ASA class scores were independent predictors of length of hospital stay in incisional hernia patients (p 0.05). CONCLUSIONS: Ventral incisional hernias are associated with higher incidence of comorbid diseases in comparison with other types of abdominal wall hernias. Patients with coexisting diseases might have unfavourable local factors that lead to incisional hernia development.

Prevalence of rectus diastasis is higher in patients with inguinal hernia.

PURPOSE: To determine the prevalence of rectus diastasis (RD) in patients with inguinal hernia. MATERIAL AND METHODS: Multicenter, cross-sectional study. Patients with inguinal hernia were included in the study group (IH) and those with benign proctologic complaints created the control group (CG). Age, gender, BMI, family history for inguinal hernias, comorbid diseases, alcohol use, smoking, constipation, malignancy, chemotherapy, number of births, multiple pregnancies and prostate hypertrophy history of all patients in both groups were recorded. All patients were evaluated for RD and umbilical hernias by physical examination. RESULTS: A total of 528 consecutive patients were included in the study (292 IH / 236 CG). Overall prevalence of RD was 35.6% and it was significantly higher in IH than in CG (46.9% vs 21.6%, p < 0.001). Also, umbilical hernia was more frequently detected in the patients with inguinal hernia. Other risk factors for RD were age, BMI, DM, BPH and smoking. The mean inter-rectus distance for 528 patients was 18.1 mm; it was 20.71 ± 10.68 mm in IH and 14.88 ± 8.82 in CG (p < 0.001). It was determined that the increase in age and BMI caused an increase in the inter-rectus distance, and that the presence of DM, inguinal hernia and umbilical hernia increased the inter-rectus distance quantitatively. CONCLUSIONS: The prevalence of RD seems to be higher in patients with inguinal hernia comparing to that in general population. Increased age, high BMI and DM were found to be independent risk factors for RD development.

Modified patch repair of femoral hernia after inguinal herniorrhaphy.

BACKGROUND AND AIM: It has been reported that femoral hernias are rather common after a previous repair of inguinal hernia. We herein present a modified patch repair technique for large femoral hernias that develop after a Lichtenstein operation for ipsilateral inguinal hernia. PATIENTS AND METHODS: The modified technique for femoral hernia was applied to three patients who had a Lichtenstein repair for inguinal hernia. All patients were male. Hernia sac is dissected completely and sent back into to the preperitoneal space. Special attention should be given to the prevascular component of the sac. It is dissected as deep as possible into the preperitoneal space over the femoral vein. The defect is quite wide in this particular type of femoral hernia following Lichtenstein repair. A prosthetic patch that matches the defect is prepared. The medial edge of the mesh is configured to correspond to the pubic corner and lacunar ligament. The lateral margin of the patch is cut to create several petals for inverting the mesh above and medial to the femoral vein to prevent prevascular herniation. The mesh is secured to inguinal ligament, ilioinguinal tract, lacunar ligament, and Cooper ligament. Few sutures are put on the pubic corner and lacunar ligament. RESULTS: One patient was discharged after two hours, other two stayed overnight. Readmission because of seroma development was recorded in two cases where standard polypropylene meshes were used. No complication was observed in the other patient who received lightweight meshes. No early recurrences were recorded after 4, 9, and 30 months. CONCLUSION: Femoral recurrence after previous inguinal hernia repair seems to be a specific entity. It has a prevascular component and the hernia defect can be much larger than that of a primary femoral hernia. A patch repair with infra-inguinal approach can be a valuable alternative with low complication rate.

Internet search by the patients undergoing hernia surgery about the disease and surgeon selection.

AIM: To find out the current status of the internet use of patients who undergo surgery for repair of their hernias. MATERIALS AND METHODS: The patients who were diagnosed with abdominal wall hernia and scheduled for elective hernia repair were requested to answer a questionnaire. The questions were directed face-to-face by the surgeons themselves. The age, gender, education status, American Society of Anesthesiologists (ASA) physical status, place of living, health insurance, access to the Internet, surgical method, the person who did the search, previous hernia surgery, recurrence of previous hernia surgery, surgery other than hernia, and the hernia type were the recorded parameters at the first stage. Then, the answers for three main questions were taken: "Did you make a search about your hernia?", "Did you make a search about your surgeon?", "Would you prefer another surgeon if you could?" RESULTS: A total of 200 patients were included in the study (146 male/54 female). 55.5% of the patients made an Internet search about their hernias. 58.5% of the patients made a search to find a proper surgeon. 12.5% of the patients stated that they would like to go to another surgeon for the hernia repair if it was possible. Internet search rate was significantly higher in younger patients in comparison with older patients. The higher the education level of the patients, the higher the rate of making Internet searches about the hernias and surgeons. Patients who live in the cities more frequently made Internet searches in comparison with those living in towns or villages. Internet searches about the hernias were similar in patients who had a history of hernia surgery (n = 23, 52%), and were even operated for recurrence of the same hernia (n = 30, 60%), compared to other patients (p = 0.569). Similarly, the rates of conducting surgeon research of the patients in these two groups (66.7%, 56.5%, respectively) were statistically similar (p = 0.450). The effect of ASA classification of patients on the Internet researches conducted about the disease and about the surgeons was not statistically significant (p = 0.799, p = 0.388, respectively). It was found that the rates of researching about the disease and about the surgeon on the Internet were significantly higher in patients who had undergone a minimally invasive surgery (p < 0.001, p < 0.001, respectively). CONCLUSIONS: Less than two-thirds of the hernia patients make Internet search about their disease. Higher education level, younger age, patient's preference for minimally invasive surgery and living in a city positively affect Internet search rates.

Prophylactic antibiotic use in elective inguinal hernioplasty in a trauma center.

PURPOSE: In this double-blind prospective randomized trial, our objective was to investigate the effect of antibiotic prophylaxis in patients undergoing elective inguinal hernia surgery with mesh repair in a large-volume tertiary referral trauma center. METHODS: Eligible patients were assigned randomly to either an antibiotic prophylaxis group or a control group. Patients in the prophylaxis group were given 1 g cefazolin by IV bolus injection whereas the placebo control group received an equal volume of sterile saline preoperatively. A Lichtenstein repair was done in all cases. The patients were examined for surgical site infection (SSI) and other postoperative local complications before discharge, and reexamined 3, 5, 7, and 30 days after discharge. RESULTS: Groups were well matched for age, sex, coexisting diseases, ASA scores, type of hernia, type of anesthesia, duration of surgery. Incidence of infection was 7% in the control group (7/100) and 5% in the prophylaxis group (5/100) (P = 0.38). All the infections were superficial and responded well to drainage and proper antibiotic therapy. All other postoperative complications were similar in the two groups. CONCLUSIONS: In our settings antibiotic prophylaxis has no significant effect on the incidence of SSI in elective repair of inguinal hernias with mesh. The most effective way to reduce the incidence of infection in prosthetic repair may be a specific center for treatment of abdominal wall hernias.