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Better outcome for female groin hernia patients when using preperitoneal techniques
Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: It is not known why women have higher frequencies of postoperative complications and reoperation than men after groin hernia repair. This study analyses postoperative results for female hernia in order to identify the appropriate techniques to attain adequate repair and improve operative outcome.

Method: A registry-based retrospective cohort study analysing data from 10 971 groin hernia repairs on women from the Swedish Hernia Register, 1992-2006.

Results: Our data showed that the risk for reoperation was significantly reduced (RR 0.6 95% CI 0.4-0.8) by using a preperitoneal repair, and three times as many femoral hernias were diagnosed in elective repairs. Time to reoperation was increased from a median of 1 year to 3.5 years (p=0.002) when using a preperitoneal repair, and time to reoperation for femoral recurrence after an inguinal primary hernia was increased from 1 year to 5.2 years (p=0.025).

Conclusions: Operative outcome for groin hernia repair in women was improved and risk for recurrence reduced by the utilisation of a preperitoneal approach. More femoral hernias were diagnosed in elective repairs and time to reoperation for femoral recurrence after an inguinal primary hernia was increased. We believe it is necessary to use a preperitoneal technique that visualizes all three locations for groin hernia in order to identify and adequately repair the hernia.

Keyword [en]
Female, groin hernia repair, recurrence, outcome, technique, preperitoneal
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-63642OAI: oai:DiVA.org:liu-63642DiVA: diva2:382046
Available from: 2010-12-29 Created: 2010-12-29 Last updated: 2010-12-29
In thesis
1. Audit of Groin Hernia Repair II
Open this publication in new window or tab >>Audit of Groin Hernia Repair II
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Groin hernia repair is one of the most common operations performed in general  surgery, and every fourth man is expected to have a hernia operation during his lifetime. Although 8% of all repairs are performed in women, there is little published literature relating specifically to female anatomy, risk factors and techniques. There is a continuing development of new mesh materials and health care reorganization with specialized surgical clinics changing the availability of basic surgery for surgeons under training.

In 1997 a thesis was published by Anders Kald, Audit of Groin Hernia Repair, which aimed to establish an audit of hernia surgery, evaluating management, risk factors, outcome and economy. The aim of this thesis was to continue the audit of hernia surgery in Sweden, allowing evaluation of gender issues, a new mesh material, and performance of surgeons under training.

Our data showed that women have a higher incidence of emergency groin hernia repair than men, and an increased rate of femoral recurrence after an inguinal hernia repair. Time to reoperation suggests that a primary misdiagnosis is common. Detection of femoral hernias could be increased by using preperitoneal techniques, visualizing all three groin hernia locations.

Patients who received a lightweight mesh at their hernia operation had a shorter convalescence, with faster return to work and normal activity.

It might be more efficient, but not necessarily better to let a specialized hernia surgeon perform the repair. Surgical trainees had more postoperative complications, but fewer patients had chronic pain at the long-term follow-up.

Abstract [sv]

Ljumskbråcksoperationen är en av de vanligaste operationerna inom allmänkirurgi och var fjärde man förväntas bli opererad för ett bråck under sin livstid. Trots att 8% av alla operationer utförs på kvinnor, finns det sparsamt med litteratur publicerat som rör kvinnlig anatomi, riskfaktorer och operationstekniker. Det utvecklas kontinuerligt nya nätmaterial och omorganisationer inom sjukvården med specialiserade kirurgiska kliniker har förändrat tillgängligheten på allmänkirurgi för kirurger under utbildning.

1997 publicerade Anders Kald sin avhandling, Audit of Groin Hernia Repair, vilken hade som syfte att etablera en kvalitetssäkring av bråckkirurgin, med utvärdering av handläggning, riskfaktorer, resultat och ekonomi. Syftet med denna avhandling var att fortsätta kvalitetssäkra bråckkirurgin i Sverige, med utvärdering av genusfrågor, ett nytt nätmaterial och prestationen hos kirurger under utbildning.

Våra data visade att kvinnor har högre incidens av akut bråckoperation än män, och ökad frekvens av femoralbråcksrecidiv efter en inguinalbråcksoperation. Tiden till reoperation tyder på en initial feldiagnos och preperitoneala tekniker rekommenderas för att öka identifieringen av femoralbråck.

Patienter som fått ett lättviktsnät vid sin bråckoperation hade en kortare konvalesens med snabbare återgång till arbete och normala aktiviteter.

Det kan vara effektivare, men inte nödvändigtvis bättre att låta en specialiserad bråckkirurg att utföra operationen. Kirurger under utbildning hade fler postoperativa komplikationer, men färre patienter med kronisk smärta vid långtidsuppföljningen.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2010. 45 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1221
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-63645 (URN)978-91-7393-262-2 (ISBN)
Public defence
2010-12-15, Katastrofmedicinskt centrum, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Note

On the day of the defence date the title of article III was: "Groin hernia repair with Titanium Coated Mesh compared to Prolene Mesh: A Prospective Randomized Controlled Trial".

Available from: 2010-12-29 Created: 2010-12-29 Last updated: 2015-06-05Bibliographically approved

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