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Femoral hernias: a register analysis of 588 repairs
Department of Surgery, Motala Hospital, Motala, Sweden.
Department of Surgery, Vrinnevi Hospital, Norrköping, Sweden.
Department of Surgery, Motala Hospital, Motala, Sweden.
1999 (English)In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 3, no 3, 131-134 p.Article in journal (Refereed) Published
Abstract [en]

From 1 January 1992 to 31 December 1997 18,281 inguinal hernias and 588 femoral hernias were recorded in the Swedish Hernia Register. The aim of the present study was to characterise these femoral hernias and to evaluate the reoperation rate following their repair. 64% of all femoral hernias were located in the right groin and 36% in the left groin (p < 0.001). The male to female ratio for femoral hernia was 1:1.6; mean ages of patients with femoral and inguinal hernia were 63.4 ± 17.1 and 59.1 ± 16.4 years, respectively (p < 0.001). Emergency surgery and bowel resection at emergency surgery were more common with femoral than with inguinal hernia. The rate of ambulatory surgery was lower for femoral hernia than for inguinal hernia, mainly due to the higher emergency rate for femoral hernia. At three years the cumulative incidence of reoperation was 4.6% (95% confidence interval 2.4–6.8%) for femoral hernia and 4.0% (95% confidence interval 3.6–4.4%) for inguinal hernia (p > 0.05). Male sex and postoperative complications were associated with a significantly increased risk of reoperation following femoral hernia repair. The relative risk of reoperation was not affected by patient age, elective/emergency surgery, primary/recurrent hernia or hernia side. Repair techniques using mesh were associated with a lower reoperation rate than techniques without mesh, although the difference did not reach statistical significance.

Place, publisher, year, edition, pages
1999. Vol. 3, no 3, 131-134 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-81232DOI: 10.1007/BF01195312OAI: oai:DiVA.org:liu-81232DiVA: diva2:551101
Available from: 2012-09-10 Created: 2012-09-10 Last updated: 2017-12-07Bibliographically approved
In thesis
1. Quality assessment in groin hernia surgery: the role of a register
Open this publication in new window or tab >>Quality assessment in groin hernia surgery: the role of a register
2001 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Ever since the Romans 2000 years ago the management of hernia surgery has remained a challenge to surgeons. Modern groin hernia treatment started with the Italian, Eduardo Bassini, around 1890 when he presented his method of repair. The most important innovations after Bassini are the Shouldice repair and introduction of prosthetic materials.

The last century has witnessed a continuous gap between, on the one hand excellent results repmted from dedicated hernia centres, and on the other outcome following hernia surgery in general surgical practice, in Sweden and elsewhere. One obstacle to quality assessment is the magnitude of hernia surgery. It is the most commonly performed procedure in Swedish general surgical practice with an incidence of around 17,000 to 20,000 repairs annually.

In 1992 a national quality register for hernia surgery was started, the Swedish Hernia Register (SHR). The general aim of this thesis is to study to what extent a quality register can be used for describing and analysing hernia surgery and can serve as a tool in the improvement process in non-specialised hospitals. Prospectively registered data in the SHR from 1992 to 1998 are the source of information for the six papers included.

The number of units participating in the SHR has increased from eight in 1992 to 65 in 2001, covering approximately 80% of units performing hernia surgery in Sweden. In January 2001 the database comprised almost 50,000 hernia repairs. Coverage of hernia operations in the SHR among participating units was high, 98%. Register participation, per se, improved the outcome of hernia surgery at aligned units during the early phase of the SHR.

In the studies forming the basis of this thesis we found that the use of mesh increased from 6 to 61% from 1992 to 1996-1998 and that the cumulative incidence of reoperation for recurrence decreased significantly during the same period. Recurrent hernia, absorbable suture, direct hernia and postoperative complication were identified as factors carrying an enhanced risk for reoperation.

SHR data show that femoral hernia is more common in females and associated with an enhanced risk for emergency operation. Mortality within 30 days of surgery, for men, was lower than that of the background population after elective inguinal hernia repair but increased after emergency operations, especially if bowel resection was undertaken.

Recurrent groin hernia still constitutes a significant quantitative problem for the surgical community, 15% of all repairs registered in 1996-1998 being repairs for recurrence. Anterior mesh repair according to Lichtenstein and laparoscopic methods were associated with a lower risk for reoperation following recurrent hernia repair.

In one hospital cohort from 1994, the recurrence rate was 10.5-14.6% 44 months after surgery, exceeding the reoperation rate by 1.7-2.3 times depending on definition of recurrence and method of follow-up. Fifteen per cent of patients in this cohort had pain related to previous hernia surgery, pain intensity being moderate or severe in 5 % of all patients followed-up.

The SHR, with reoperation as its main endpoint, may be used to describe and analyse hernia surgery and to stimulate local improvement. It has to be supplemented by questionnaire and/or physical examination in order to estimate rates of recurrence and chronic pain.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2001. 83 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 685
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-25653 (URN)10029 (Local ID)91-7219-974-1 (ISBN)10029 (Archive number)10029 (OAI)
Public defence
2001-09-21, Berzeliussalen, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-10Bibliographically approved

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