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Little Chance of Preventing Emergency Surgery for Femoral Hernia: Symptoms and Signs Prior to Presentation are Often Not Present
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kolorektalkirurgi.
CLINTEC, Karolinska Institutet.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Gastrointestinalkirurgi.
CLINTEC, Karolinska Institutet.
2011 (Engelska)Artikel i tidskrift (Refereegranskat) Submitted
Ort, förlag, år, upplaga, sidor
2011.
Nyckelord [en]
hernia, femoral hernia, emergency surgery, emergency repair, symptoms, presentation
Nationell ämneskategori
Kirurgi
Identifikatorer
URN: urn:nbn:se:uu:diva-162201OAI: oai:DiVA.org:uu-162201DiVA, id: diva2:459666
Tillgänglig från: 2011-11-27 Skapad: 2011-11-26 Senast uppdaterad: 2012-01-03Bibliografiskt granskad
Ingår i avhandling
1. Femoral and Inguinal Hernia: How to Minimize Adverse Outcomes Following Repair
Öppna denna publikation i ny flik eller fönster >>Femoral and Inguinal Hernia: How to Minimize Adverse Outcomes Following Repair
2011 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Groin hernia is common, and each year 200 repairs per 100 000 adult inhabitants are performed in Sweden. Groin hernias are either inguinal or femoral (2-4%). Elective repair is not associated with an excess mortality, but adverse outcomes include recurrence and long-term pain. Emergency procedures have a 4% mortality rate with an increased risk for bowel resection and postoperative complications. The aim of this thesis was to identify risk factors for adverse outcomes and to propose measures to improve groin hernia treatment.

Twenty-three per cent of female hernias were femoral. Thirty-six per cent of femoral hernias, and 5% of inguinal hernias, have emergency procedures. Females (OR 1.47) and patients above 65 years-of-age (OR 2.24) were at higher risk for emergency repair. Bowel resection was performed in 23% of emergency femoral repairs, and the 30-day mortality was 10 times that of an age- and gender-matched population. The majority of emergency patients were unaware of their hernia, and one third had previously had no groin symptoms.

Femoral repairs were at larger risk for recurrence than inguinal repairs. The surgical techniques with least risk for recurrence were preperitoneal mesh repairs (open HR 0.28, and laparoscopic HR 0.31). Long-term pain was present in 24% of femoral hernia patients, of whom 5.5% described pain interfering with daily activities. The only factor predicting the risk for long-term pain was pain preoperatively. Pain decreased with time.

In a randomized study on inguinal hernia, TEP resulted in less pain six weeks after surgery than Lichtenstein repair performed under local anesthesia (LLA). TEP patients were to a larger extent able to perform sporting activities. No difference was seen in intra-operative complications.

Femoral hernias should be given high priority for repair and preperitoneal techniques should be used. Earlier diagnosis, in the elective setting, is probably difficult to attain. Heightened awareness in the emergency department is required. TEP is safe, and results in less pain than LLA six weeks after surgery. A widening of indications for TEP in primary inguinal hernia repair is justifiable.

Ort, förlag, år, upplaga, sidor
Uppsala: Acta Universitatis Uppsaliensis, 2011. s. 57
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 728
Nyckelord
femoral hernia, inguinal hernia, adverse outcome, complication, recurrence, chronic pain, long-term pain, emergency, mortality, TEP, Lichtenstein, local anesthesia
Nationell ämneskategori
Kirurgi
Forskningsämne
Kirurgi
Identifikatorer
urn:nbn:se:uu:diva-162203 (URN)978-91-554-8236-7 (ISBN)
Disputation
2012-01-13, Enghoffsalen, Ing 50, Akademiska Sjukhuset, Uppsala, 13:15 (Engelska)
Opponent
Handledare
Tillgänglig från: 2011-12-20 Skapad: 2011-11-26 Senast uppdaterad: 2012-01-03Bibliografiskt granskad

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