Hernia : the journal of hernias and abdominal wall surgery
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Review Meta Analysis
Systematic review and meta-analysis of prophylactic mesh placement for prevention of incisional hernia following midline laparotomy.
Incisional hernia is a common long-term complication after laparotomy. This study investigated whether prophylactic mesh reinforcement of laparotomy reduced the rate of incisional hernia, with emphasis on trial design and quality. ⋯ Mesh reinforcement of laparotomy significantly reduced the rate of incisional hernia in high-risk patients. However, poor assessment of secondary outcomes limits applicability; routine placement in all patients cannot yet be recommended. More evidence regarding the rates of adverse events, cost-benefits and quality of life are needed.
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Randomized Controlled Trial
Randomized clinical trial comparing lightweight mesh with heavyweight mesh for primary inguinal hernia repair.
The aim of the present randomized clinical trial was to compare feeling of a foreign body and the early and late outcomes after inguinal hernia repair with the heavyweight (HW) mesh and lightweight (LW) mesh during a 12-month follow-up at a single specialist center. ⋯ There was no significant difference between our LW mesh and HW mesh groups in terms of chronic pain incidence, recurrence rate, and quality of life following inguinal hernia repair. However, fewer patients in the LW mesh group reported numbness around the groin or down the thigh postsurgery than did those in the HW mesh group and therein may lie in the superiority of LW mesh for inguinal hernia repair. Larger cohort studies with longer follow-up periods are required to elucidate in the future the benefits of the LW mesh.
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The purpose of this study was to establish long-term outcome after elective adult umbilical hernia (AUH) repair. ⋯ AUH repair could be performed with low early and long-term complication rates, with low recurrence rates also after non-mesh repairs. A substantial cohort of patients will unnecessary be implanted with meshes if mesh-reinforced repairs should be used on a routine basis, that is, 16 surplus meshes to prevent one recurrence in the present study. We recommend a tailored approach to AUH repair: suture-based methods with defects smaller than 2 cm and mesh-based repairs considered if larger than that.
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The primary aim of the present study was to investigate risk factors for readmission after elective umbilical and epigastric hernia repair and secondarily to evaluate causes for readmission. ⋯ The risk for 30-day readmission after umbilical or epigastric hernia repairs was mainly because of surgical complications. Open mesh repair reduced the risk for readmission in open repairs; no specific approach was found to reduce readmission after laparoscopic repair.
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Chronic groin pain is defined as pain arising 3-6 months after inguinal hernia repair that can compromise the patient's quality of life. Many articles in the literature report clinical presentation, but there are no well-defined indications and protocols of treatment. ⋯ Choice of the adequate therapy of chronic groin pain after inguinal hernia repair is still controversial. Our surgical approach turned out to be a safe and effective procedure. In this way, an accurate exploration of the whole inguinal region can be performed along with the identification of the nerves involved. Anyway in a certain number of cases, the resolution of pain cannot be achieved; this suggests a possible involvement of differences in the single personality and tolerances of pain in the different patients.