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The time profile of groin hernia recurrences
Örebro University, School of Health and Medical Sciences.
Umeå universitet, Umeå, Sweden; Kirurgkliniken i Östersund, Östersunds sjukhus, Östersund, Sverige.
Kirurgkliniken, Mora lasarett, Mora, Sverige.
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2010 (English)In: Hernia, ISSN 1265-4906, E-ISSN 1248-9204, Vol. 14, no 4, p. 341-344Article in journal (Refereed) Published
Abstract [en]

PURPOSE:

If the pathogeneses of the development of a recurrence varies following the different methods of hernia repair, the time required to develop a recurrence could be expected to vary. The aim of the study was to identify risk factors affecting the time interval between the primary repair and the reoperation.

METHODS:

Data from the Swedish Hernia Register were used. Each year of the 5-year follow-up period was treated as a separate subgroup and merged together into one large group. For each risk factor, we performed a Cox proportional hazard analysis, testing for interactions between the year and the risk factor, with reoperation as the endpoint.

RESULTS:

Altogether, 142,578 repairs were recorded, of which 7.7% were performed on women. The mean age of the cohort was 59 years. The overall recurrence rate in the 5-year period was 4.3%. Multivariate analysis showed that recurrence following surgery for recurrent hernia occurred relatively early (P < 0.05).Recurrence also appeared early if postoperative complications were registered (P < 0.05). Recurrence after suture repair or laparoscopic repair appeared relatively early compared to recurrence following open mesh repair (P < 0.05). In a separate analysis, a relatively higher risk for early recurrence was seen for all sutured repairs compared to all mesh repairs (P < 0.05).

CONCLUSIONS:

The pathogenesis behind the development of recurrence probably differs depending on the technique applied during the hernia repair. The higher proportion of early recurrences following laparoscopic repair, suture repair and recurrent repair may be explained by the high proportion of technical failures.

Place, publisher, year, edition, pages
2010. Vol. 14, no 4, p. 341-344
Keywords [en]
sHernia, Recurrence, Registry, Postoperative complication, Mesh
National Category
Medical and Health Sciences
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-26074DOI: 10.1007/s10029-010-0648-1ISI: 000280232200001OAI: oai:DiVA.org:oru-26074DiVA, id: diva2:557801
Available from: 2012-09-29 Created: 2012-09-29 Last updated: 2018-04-24Bibliographically approved
In thesis
1. Postoperative aspects of inguinal hernia surgery: pain and recurrences
Open this publication in new window or tab >>Postoperative aspects of inguinal hernia surgery: pain and recurrences
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Approximately one in four men will have surgery for ingunial hernia in their lifetime. In Sweden, 16 000 procedures are performed each year. To investigate the possible link between handling of nerves and sensory disturbance, 97 groins in 92 patients were examined one year after inguinal hernia surgery. Sensory disturbances were found to be common after open surgery (29 %), but were not seen after the laparoscopic procedures. No significant relationship between sensory disturbance and handling of nerves or pain was seen. The risk for recurrence has been significantly reduced due to the use of prosthetic meshes, but continued surveillance of this important outcome will always be necessary. In that context, the time frame in which recurrence develops in relation to possible risk factors can help our understanding of the underlying mechanisms. To explore such temporal relationships, 142,578 patients were included in a register study. A relative over-risk for early recurrence was seen after suture repair, laparoscopic repair, after postoperative complications, and after surgery for previous recurrence. Corticosteroids are known to decrease pain and nausea after several surgical procedures. In a randomised trial on open hernia surgery, 398 patients were randomised to treatment with 12 mg of betamethasone or placebo. Decreased levels of pain were seen on the day of surgery, the next day and after one month. No difference was seen on days 2-7 and after one year. Nausea was not common and did not differ between the groups. Reoperation is sometimes performed to correct a presumed structural defect thought to cause the long-term pain. In order to evaluate the result of such treatment, 111 cases were analysed based on register data, questionnaires and medical records. Sixty-two per-cent of the patients reported an improvement compared to before the reoperation, but a high level of pain remaining (42 %), and impaired quality of life was seen. There was no clear advantage for any surgical intervention over the other.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2012. p. 56
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 78
Keywords
Inguinal hernia, surgery, pain, reoperation, recurrence, betamethasone, sensory disturbance, nerve, groin
National Category
Medical and Health Sciences Surgery
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-26054 (URN)978-91-7668-902-8 (ISBN)
Public defence
2012-12-07, Wilandersalen, Universitetssjukhuset, Örebro, (USÖ), Örebro, 13:00 (English)
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Supervisors
Available from: 2012-09-28 Created: 2012-09-28 Last updated: 2017-10-17Bibliographically approved

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Magnusson, Niklas

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