Emergency groin hernia repair: implications in elderly

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Abstract

Background

Groin hernia is one of the most frequently encountered pathologies occurring in old age and it is often the cause of emergency procedures. In our study we evaluate the impact of emergency procedures in over 75 patients compared to younger patients.

Methods

We conducted a retrospective study about patients who underwent emergency hernioplasty between September 2007 and January 2013. Bilateral hernias and recurrences were excluded. We divided patients into two groups by age (under and over 75 years old) and then analyzed the early postoperative surgical complications.

Results

A total of 48 patients were enrolled, 18 were included in under 75 group and 30 in over 75. In the older group we found a higher rate of comorbidity and also a significant higher rate of postoperative complications. Two patients of over 75 group died.

Conclusions

Our data suggests that a quick diagnosis and elective surgical procedures are desirable in order to avoid the complications that occur in emergency operations.

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Most cited references 16

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Surgical risk factors, morbidity, and mortality in elderly patients.

Florence E Turrentine, Hongkun Wang, Virginia B Simpson … (2006)

The aging population of the United States results in increasing numbers of surgical operations on elderly patients. This study observed aging related to morbidity, mortality, and their risk factors in patients undergoing major operations. We reviewed our institution's American College of Surgeons National Surgical Quality Improvement Program database from February 24, 2002, through June 30, 2005, including standardized preoperative, intraoperative, and 30-day postoperative data points. This required review and analysis of the prospectively collected data. We examined patient demographics, preoperative risk factors, intraoperative risk factors, and 30-day outcomes with a focus on those aged 80 years and older. A total of 7,696 surgical procedures incurred a 28% morbidity rate and 2.3% mortality rate, although those older than 80 years of age had a morbidity of 51% and mortality of 7%. Hypertension and dyspnea were the most frequent risk factors in those aged 80 years and older. Preoperative transfusion, emergency operation, and weight loss best predicted morbidity for those 80 years of age and older. Operative duration predicted "other" postoperative occurrences and emergent case status predicted respiratory occurrences across all age groups. Preoperative impairment of activities of daily living, emergency operation, and increased American Society of Anesthesiology classification predicted mortality across all age groups. A 30-minute increment of operative duration increased the odds of mortality by 17% in patients older than 80 years. Postoperative morbidity and mortality increased progressively with increasing age. Age was statistically significantly associated with morbidity (wound, p = 0.021; renal, p = 0.001; cardiovascular, p = 0.0004; respiratory, p < 0.0001) and mortality (p = 0.001). Although several risk factors for postoperative morbidity and mortality increase with age, increasing age itself remains an important risk factor for postoperative morbidity and mortality.

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Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials.

(2002)

To measure the effects of laparoscopic and open placement of synthetic mesh on recurrence and persisting pain following groin hernia repair. Synthetic mesh techniques are claimed to reduce the risk of recurrence but there are concerns about costs and possible long-term complications, particularly pain. Electronic databases were searched and experts consulted to identify randomized or quasi-randomized trials that compared mesh with non-mesh methods, or laparoscopic with open mesh placement. Individual patient data were sought for each trial. Aggregated data were used where individual patient data were not available. Meta-analyses of hernia recurrence and persisting pain were based on intention to treat. There were 62 relevant comparisons in 58 trials. These included 11,174 participants: individual patient data were available for 6,901 patients, supplementary aggregated data for 2,390 patients, and published data for 1883 patients. Recurrence and persisting pain were less after mesh repair (overall recurrences: 88 in 4,426 vs. 187 in 3,795; OR 0.43, 95% CI 0.34-0.55; P <.001) (overall persistent pain: 120 in 2,368 vs. 215 in 1,998; OR 0.36, 95% CI 0.29-0.46; P <.001), regardless of the non-mesh comparator. Whereas the reduction in recurrence was similar after laparoscopic and open mesh placement (OR 1.26, 95% CI 0.76-2.08; P =.36), persistent pain was less common after laparoscopic than open mesh placement (OR 0.64; 95% CI 0.52-0.78; P <.001). The use of synthetic mesh substantially reduces the risk of hernia recurrence irrespective of placement method. Mesh repair appears to reduce the chance of persisting pain rather than increase it.

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Direct inguinal herniation in men: a disease of collagen.

J. P. Wagh, Edward P Leverich, Tim Read … (1974)

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Author and article information

Contributors

Rita Compagna

Roberto Rossi

Francesca Fappiano

Tommaso Bianco

Antonello Accurso

Michele Danzi

Salvatore Massa

Giovanni Aprea

Bruno Amato

Conference

Journal ID (nlm-ta): BMC Surg

Journal ID (iso-abbrev): BMC Surg

Title: BMC Surgery

Publisher: BioMed Central

ISSN (Electronic): 1471-2482

Publication date Collection: 2013

Publication date (Electronic): 8 October 2013

Volume: 13

Issue: Suppl 2

Page: S29

Affiliations

[1 ]Department of Clinical Medicine and Surgery, University of Naples Federico II, Via S. Pansini, 5 - 80131 Napoli, Italy

Article

Publisher ID: 1471-2482-13-S2-S29

DOI: 10.1186/1471-2482-13-S2-S29

PMC ID: 3851200

PubMed ID: 24267391

SO-VID: 80f9e413-2fae-42c1-9ebf-63e5ba73a31b

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Conference name: 26th National Congress of the Italian Society of Geriatric Surgery

Emergency groin hernia repair: implications in elderly

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Abstract

Background

Methods

Results

Conclusions

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25th European Students' Conference

Most cited references 16

Surgical risk factors, morbidity, and mortality in elderly patients.

Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials.

Direct inguinal herniation in men: a disease of collagen.

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