Przepuklina – Rokowania, prognozy i postęp choroby

Przepuklina
Rokowania, prognozy i postęp choroby

Rokowanie w leczeniu przepuklin zależy od wielu czynników, w tym wieku pacjenta, płci, BMI oraz współistniejących chorób takich jak palenie tytoniu, cukrzyca, POChP, stopień ASA III-IV i stosowanie steroidów. Wiek powyżej 80 lat znacząco zwiększa ryzyko powikłań wymagających reoperacji (2,5-krotnie) oraz śmiertelności (12-krotnie) w porównaniu z grupą 70-79 lat. Typ przepukliny ma istotne znaczenie – przepukliny pooperacyjne cechują się wyższym ryzykiem nawrotu (6,7% vs 0,9%) i powikłań niż pierwotne. Wśród czynników śródoperacyjnych istotne są: rodzaj siatki (biologiczna vs syntetyczna), technika naprawy (mostkująca vs pierwotne zamknięcie powięzi), metoda operacji (otwarta vs laparoskopowa) oraz umiejscowienie siatki. Naprawa z użyciem siatki syntetycznej i pierwotne zamknięcie powięzi wykazują lepsze wyniki. W laparoskopowej naprawie przepuklin brzusznych zastosowanie wchłanialnych zszywek i konieczność reinterwencji zwiększają ryzyko nawrotu odpowiednio 2,94 i 2,89 razy.

Przepuklina (Hernia) – Rokowanie (Prognosis)

Czynniki demograficzne wpływające na rokowanie
Choroby współistniejące jako predyktory rokowania
Wpływ typu przepukliny na rokowanie
Czynniki śródoperacyjne wpływające na rokowanie
Czynniki pooperacyjne i początkowe wyniki
Nowoczesne narzędzia predykcyjne
Długoterminowe wyniki i przewidywanie powodzeń rewizji
Znaczenie czasu interwencji
Implikacje dla praktyki klinicznej
Przyszłościowe kierunki badań
Kolejne rozdziały

Przepuklina (Hernia) – Rokowanie (Prognosis)

Rokowanie w przypadku przepuklin zależy od wielu czynników, w tym cech pacjenta, typu przepukliny, wybranej metody operacyjnej oraz czasu interwencji. Współczesne badania dostarczają istotnych danych na temat przewidywania wyników leczenia, co pozwala na bardziej spersonalizowane podejście do pacjentów z przepuklinami.¹ Możliwość dokładnego przewidywania nawrotów ma znaczną użyteczność kliniczną, umożliwiając chirurgom podejmowanie bardziej świadomych decyzji wspólnie z pacjentami, dotyczących tego, kiedy operować, a kiedy powstrzymać się od interwencji.²

Czynniki demograficzne wpływające na rokowanie

Wśród pacjentów z przepuklinami brzusznymi zidentyfikowano trzy główne zmienne demograficzne wpływające na ryzyko nawrotu: płeć żeńska, wiek poniżej 65 lat oraz wskaźnik masy ciała (BMI) przekraczający określone progi (25, 30, 35 lub 40 kg/m²).³ Jednak najistotniejszym czynnikiem ryzyka śmiertelności okazuje się być wiek pacjenta.⁴ Badania wykazały, że pacjenci w wieku 80 lat i starsi mają 2,5 razy wyższe ryzyko powikłań wymagających reoperacji oraz 12-krotnie wyższe ryzyko zgonu w porównaniu z pacjentami w wieku 70-79 lat.⁵

Choroby współistniejące jako predyktory rokowania

Wykazano, że pięć głównych chorób współistniejących istotnie wpływa na rokowanie pacjentów z przepuklinami:⁶

Palenie tytoniu
Cukrzyca
Przewlekła obturacyjna choroba płuc (POChP)
Stopień ASA III-IV
Stosowanie steroidów

⁷

W przypadku przepuklin przełykowo-żołądkowych opracowano model predykcyjny złożony z 4 zmiennych: wiek 80 lat lub więcej, pilność operacji oraz dwie zmienne z indeksu Charlsona (niewydolność serca i choroby płuc), który osiągnął dokładność predykcyjną dla śmiertelności pooperacyjnej na poziomie 88%.⁸ Natomiast 5-zmiennowy model dla poważnych powikłań pooperacyjnych osiągnął predykcję na poziomie 68%.⁹

Wpływ typu przepukliny na rokowanie

Rokowanie różni się znacząco w zależności od typu przepukliny. Przepukliny pooperacyjne (incyzyjne) wiążą się z wyższym ryzykiem nawrotu niż przepukliny pierwotne. Badania wykazują, że ryzyko reoperacji i zgonu jest nieco wyższe po operacji przepukliny pooperacyjnej niż pierwotnej, zarówno w przypadku operacji otwartych, jak i laparoskopowych.¹⁰

W wieloośrodkowym badaniu dotyczącym laparoskopowej naprawy przepuklin brzusznych (LVHR) wykazano, że całkowity wskaźnik nawrotów wyniósł 4,7% przy średnim okresie obserwacji wynoszącym 30,4 miesiąca. Co istotne, grupa pacjentów z przepuklinami pooperacyjnymi charakteryzowała się znacznie wyższym odsetkiem nawrotów niż grupa z przepuklinami pierwotnymi (6,7% vs 0,9%).¹¹

Czynniki śródoperacyjne wpływające na rokowanie

Sześć zmiennych śródoperacyjnych zostało zidentyfikowanych jako istotne czynniki prognostyczne dla nawrotu przepukliny:¹²

Użycie siatki biologicznej (w porównaniu z siatką syntetyczną)
Naprawa mostkująca (bridged repair)
Operacja otwarta vs laparoskopowa
Naprawa szwem vs siatką
Umiejscowienie siatki (onlay/retrorectus)
Umiejscowienie siatki (wewnątrzotrzewnowe/retrorectus)

¹³

Analizy potwierdzają, że naprawa z użyciem siatki daje lepsze wyniki niż naprawa wyłącznie szwami, a pierwotne zamknięcie powięzi skutkuje bardziej niezawodną naprawą niż technika mostkująca.¹⁴ Dane potwierdzają również, że siatki biologiczne są słabsze niż siatki syntetyczne i wiążą się z większą tendencją do nawrotów.¹⁵

W przypadku laparoskopowej naprawy przepuklin brzusznych, analiza wieloczynnikowa wykazała, że zastosowanie wchłanialnych zszywek (tacks) oraz konieczność reinterwencji są głównymi czynnikami ryzyka, zwiększającymi ryzyko nawrotu odpowiednio 2,94 i 2,89 razy.¹⁶

Czynniki pooperacyjne i początkowe wyniki

Zidentyfikowano sześć zmiennych pooperacyjnych jako istotne czynniki prognostyczne nawrotu przepukliny:¹⁷

Jakiekolwiek powikłanie
Zdarzenia w obrębie rany operacyjnej
Zakażenie rany
Seroma
Krwiak
Rozejście się brzegów rany

¹⁸

Początkowa odpowiedź na leczenie może być predyktorem rokowania. Na przykład w przypadku przepuklin przeponowych u niemowląt z wrodzoną przepukliną przeponową (CDH), najwyższy wskaźnik oksygenacji (OI) w pierwszym dniu życia okazał się lepszym predyktorem przeżycia niż wiek ciążowy i ocena w skali Apgar w 5. minucie.¹⁹ Odpowiedź na wziewny tlenek azotu (iNO) była zmienna, ale niemowlęta, które zareagowały na iNO, miały większą szansę na przeżycie.²⁰

Nowoczesne narzędzia predykcyjne

Rozwój algorytmów uczenia maszynowego (ML) pozwala na dokładniejsze przewidywanie wyników leczenia przepuklin. W jednym z badań modele ML wykazały dobrą zdolność dyskryminacyjną w przewidywaniu nawrotu przepukliny (krzywa ROC o powierzchni pod krzywą [AUC] = 0,71), powikłań w obrębie miejsca operowanego (AUC = 0,75) oraz ponownych hospitalizacji w ciągu 30 dni (AUC = 0,74).²¹ Te wyniki wspierają włączenie modeli ML do przedoperacyjnej oceny pacjentów poddawanych rekonstrukcji ściany brzucha, aby zapewnić opartą na danych, spersonalizowaną ocenę ryzyka.²²

W diagnostyce przedoperacyjnej, badanie ultrasonograficzne wykazuje dodatnią wartość predykcyjną (PPV) na poziomie 90,9% w prawidłowej identyfikacji przepukliny pachwinowej wymagającej operacji. Badania wskazują, że BMI jest najprawdopodobniej potencjalnym predyktorem fałszywie dodatnich wyników USG.²³

Długoterminowe wyniki i przewidywanie powodzeń rewizji

Większość przepuklin ostatecznie będzie wymagała naprawy chirurgicznej, ponieważ mają tendencję do pogarszania się z czasem.²⁴ Operacja jest zwykle prostą procedurą ambulatoryjną z krótkim okresem rekonwalescencji. Jest prawie zawsze skuteczna, choć istnieje 10% szans na nawrót przepukliny w późniejszym czasie, szczególnie jeśli warunki, które ją spowodowały, nadal występują.²⁵

W przypadku pacjentów cierpiących na przewlekły ból pooperacyjny po implantacji siatki przy przepuklinie pachwinowej (CPIP), dłuższy czas między umieszczeniem siatki a operacją rewizyjną wiąże się z większymi szansami na poprawę w zakresie bólu, z ilorazem szans (OR) wynoszącym 1,19 na rok. Punkt zwrotny w kwestii szans ryzyka i korzyści wykazano przy 70 miesiącach, z lepszymi wynikami dla pacjentów poddanych operacji rewizyjnej po upływie co najmniej 70 miesięcy (OR = 2,86).²⁶ Oznacza to, że pacjenci z przepukliną pachwinową, u których ból pojawił się później lub którzy cierpieli z powodu bólu przez dłuższy czas, mają większe szanse na pozytywny efekt rewizji siatki.²⁷

Znaczenie czasu interwencji

Pilność operacji ma istotny wpływ na rokowanie. W przypadku olbrzymich przepuklin przełykowo-żołądkowych, operacje nieplanowe wiążą się ze znacznie większą zachorowalnością i śmiertelnością, nawet gdy są wykonywane laparoskopowo. Śmiertelność w przypadku operacji planowych wynosi około 1,1%, podczas gdy w przypadku operacji nieplanowych wzrasta do 8%. Podobnie, poważne powikłania występują u 18% pacjentów poddanych operacjom planowym i u 41% pacjentów poddanych operacjom nieplanowym.²⁸

Przepuklina staje się poważnym problemem, gdy zostaje uwięźnięta w otworze, przez który się wysuwa, i nie może powrócić na swoje miejsce. To może stać się bolesne, a w ciężkich przypadkach tkanka może zostać odcięta od dopływu krwi, powodując martwicę (śmierć tkanki).²⁹

Implikacje dla praktyki klinicznej

Zidentyfikowanie predyktorów nawrotu ma kluczowe znaczenie, ponieważ decyzja o przeprowadzeniu rekonstrukcji zależy od szansy na jej powodzenie.³⁰ Obecne badania wykazują, że procedura laparoskopowej naprawy przepuklin brzusznych (LVHR) z lekką siatką polipropylenową ma niskie wskaźniki powikłań śródoperacyjnych i akceptowalne wskaźniki powikłań pooperacyjnych i późnych dla przepuklin zarówno pooperacyjnych, jak i pierwotnych.³¹

Podczas konsultacji pacjentów w sprawie operacji rewizyjnej siatki w przypadku dokuczliwych objawów, opiekunowie powinni wyjaśnić niemałe ryzyko powikłań i nawrotów, ale nie powinni unikać operacji rewizyjnej z powodu tych czynników, ponieważ (częściowe) usunięcie siatki okazało się skuteczne w łagodzeniu bólu i objawów.³² Opiekunowie nie powinni powstrzymywać się od wskazania operacji ze względu na dłuższy czas trwania objawów, gdy spodziewany jest związek między objawami a lokalizacją siatki.³³

Przyszłościowe kierunki badań

Mimo postępów w technikach rekonstrukcji ściany brzusznej (AWR), nawroty przepuklin, powikłania w miejscu operacyjnym i nieplanowane ponowne hospitalizacje nadal występują.³⁴ Badania prognostyczne dotyczące przepuklin brzusznych powinny być prowadzone prospektywnie, aby wyeliminować stronniczość, z dobrze scharakteryzowanymi uczestnikami, zaślepioną oceną potencjalnych predyktorów i wyników, standardowymi definicjami i metodami wykrywania zarówno predyktorów, jak i wyników.³⁵

Po prospektywnej walidacji, modele predykcyjne mogą zapewnić przewidywanie ryzyka specyficznego dla pacjenta, dostosowane do indywidualnych cech pacjenta, i przyczynić się do podejmowania decyzji dotyczących interwencji chirurgicznej.³⁶

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Materiały źródłowe

#1 Identifying predictors of ventral hernia recurrence: systematic review and meta-analysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC8038271/
This study summarized the current evidence base for predicting ventral hernia recurrence. […] New knowledge is presented regarding patient demographics, hernia characteristics, intraoperative factors and postoperative variables that predispose to recurrence. […] The ability to predict recurrence accurately would have considerable clinical utility, allowing surgeons to make better-informed decisions with their patients as to when, and when not, to operate. […] Identification of predictors of recurrence is pivotal, because the decision whether to perform reconstruction or not pivots on the chance of success. […] The present analysis of intraoperative variables has confirmed the well known protective effect of mesh over suture repair, and also that primary fascial closure results in a more reliable repair than bridged; both of these associations are well established.
#2 Identifying predictors of ventral hernia recurrence: systematic review and meta-analysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC8038271/
This study summarized the current evidence base for predicting ventral hernia recurrence. […] New knowledge is presented regarding patient demographics, hernia characteristics, intraoperative factors and postoperative variables that predispose to recurrence. […] The ability to predict recurrence accurately would have considerable clinical utility, allowing surgeons to make better-informed decisions with their patients as to when, and when not, to operate. […] Identification of predictors of recurrence is pivotal, because the decision whether to perform reconstruction or not pivots on the chance of success. […] The present analysis of intraoperative variables has confirmed the well known protective effect of mesh over suture repair, and also that primary fascial closure results in a more reliable repair than bridged; both of these associations are well established.
#3 Identifying predictors of ventral hernia recurrence: systematic review and meta-analysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC8038271/
Ventra hernias are increasing in prevalence and many recur despite attempted repair. […] This systematic review aimed to identify predictors of ventral hernia recurrence. […] Hernia recurrence was defined in 66 studies (24.1 per cent), using 41 different unstandardized definitions. […] Three patient variables (female sex, age 65 years or less, and BMI greater than 25, 30, 35 or 40 kg/m2), five patient co-morbidities (smoking, diabetes, chronic obstructive pulmonary disease, ASA grade IIIIV, steroid use), two hernia-related variables (incisional/primary, recurrent/primary), six intraoperative variables (biological mesh, bridged repair, open versus laparoscopic surgery, suture versus mesh repair, onlay/retrorectus, intraperitoneal/retrorectus), and six postoperative variables (any complication, surgical-site occurrence, wound infection, seroma, haematoma, wound dehiscence) were identified as significant prognostic factors for hernia recurrence.
#4 Major complications and mortality after ventral hernia repair: an eleven-year Swedish nationwide cohort study | BMC Surgery | Full Text
https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-022-01873-9
Age is the dominant mortality risk factor in ventral hernia repair. […] Patients aged 80 years and older had a 2.5 times higher risk for a complication leading to reoperation, and a 12-fold higher mortality risk than patients aged 70-79 years. […] Forty-three patients died of complications within 30 days of index surgery. […] The risk of death dramatically increases in the group over 80 years after both primary and incisional hernia repair. […] The risk for reoperation and death was somewhat higher after incisional than after primary hernia repair for both open and laparoscopic repairs. […] The findings of the present study indicate that age is the most important risk factor for death.
#5 Major complications and mortality after ventral hernia repair: an eleven-year Swedish nationwide cohort study | BMC Surgery | Full Text
https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-022-01873-9
Age is the dominant mortality risk factor in ventral hernia repair. […] Patients aged 80 years and older had a 2.5 times higher risk for a complication leading to reoperation, and a 12-fold higher mortality risk than patients aged 70-79 years. […] Forty-three patients died of complications within 30 days of index surgery. […] The risk of death dramatically increases in the group over 80 years after both primary and incisional hernia repair. […] The risk for reoperation and death was somewhat higher after incisional than after primary hernia repair for both open and laparoscopic repairs. […] The findings of the present study indicate that age is the most important risk factor for death.
#6 Identifying predictors of ventral hernia recurrence: systematic review and meta-analysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC8038271/
Ventra hernias are increasing in prevalence and many recur despite attempted repair. […] This systematic review aimed to identify predictors of ventral hernia recurrence. […] Hernia recurrence was defined in 66 studies (24.1 per cent), using 41 different unstandardized definitions. […] Three patient variables (female sex, age 65 years or less, and BMI greater than 25, 30, 35 or 40 kg/m2), five patient co-morbidities (smoking, diabetes, chronic obstructive pulmonary disease, ASA grade IIIIV, steroid use), two hernia-related variables (incisional/primary, recurrent/primary), six intraoperative variables (biological mesh, bridged repair, open versus laparoscopic surgery, suture versus mesh repair, onlay/retrorectus, intraperitoneal/retrorectus), and six postoperative variables (any complication, surgical-site occurrence, wound infection, seroma, haematoma, wound dehiscence) were identified as significant prognostic factors for hernia recurrence.
#7 Identifying predictors of ventral hernia recurrence: systematic review and meta-analysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC8038271/
Ventra hernias are increasing in prevalence and many recur despite attempted repair. […] This systematic review aimed to identify predictors of ventral hernia recurrence. […] Hernia recurrence was defined in 66 studies (24.1 per cent), using 41 different unstandardized definitions. […] Three patient variables (female sex, age 65 years or less, and BMI greater than 25, 30, 35 or 40 kg/m2), five patient co-morbidities (smoking, diabetes, chronic obstructive pulmonary disease, ASA grade IIIIV, steroid use), two hernia-related variables (incisional/primary, recurrent/primary), six intraoperative variables (biological mesh, bridged repair, open versus laparoscopic surgery, suture versus mesh repair, onlay/retrorectus, intraperitoneal/retrorectus), and six postoperative variables (any complication, surgical-site occurrence, wound infection, seroma, haematoma, wound dehiscence) were identified as significant prognostic factors for hernia recurrence.
#8 A clinical prediction rule for perioperative mortality and major morbidity after laparoscopic giant paraesophageal hernia repair
https://pmc.ncbi.nlm.nih.gov/articles/PMC3971917/
In the current era, giant paraesophageal hernia repair by experienced minimally-invasive surgeons has excellent perioperative outcomes when performed electively. Nonelective repair, however, is associated with significantly greater morbidity and mortality, even when performed laparoscopically. […] We hypothesized that clinical prediction tools using pretreatment variables could be developed that would predict patient-specific risk of postoperative morbidity and mortality. […] Urgency of operation was a significant predictor of mortality (elective 1.1% versus nonelective 8%) and major morbidity (elective 18% versus nonelective 41%). […] A 4-covariate prediction model consisting of age 80 or greater, urgency of operation and two Charlson comorbidity index variables (congestive heart failure and pulmonary disease) provided discriminatory accuracy for postoperative mortality of 88% while a 5-covariate model for major postoperative morbidity was 68% predictive.
#9 A clinical prediction rule for perioperative mortality and major morbidity after laparoscopic giant paraesophageal hernia repair
https://pmc.ncbi.nlm.nih.gov/articles/PMC3971917/
In the current era, giant paraesophageal hernia repair by experienced minimally-invasive surgeons has excellent perioperative outcomes when performed electively. Nonelective repair, however, is associated with significantly greater morbidity and mortality, even when performed laparoscopically. […] We hypothesized that clinical prediction tools using pretreatment variables could be developed that would predict patient-specific risk of postoperative morbidity and mortality. […] Urgency of operation was a significant predictor of mortality (elective 1.1% versus nonelective 8%) and major morbidity (elective 18% versus nonelective 41%). […] A 4-covariate prediction model consisting of age 80 or greater, urgency of operation and two Charlson comorbidity index variables (congestive heart failure and pulmonary disease) provided discriminatory accuracy for postoperative mortality of 88% while a 5-covariate model for major postoperative morbidity was 68% predictive.
#10 Major complications and mortality after ventral hernia repair: an eleven-year Swedish nationwide cohort study | BMC Surgery | Full Text
https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-022-01873-9
Age is the dominant mortality risk factor in ventral hernia repair. […] Patients aged 80 years and older had a 2.5 times higher risk for a complication leading to reoperation, and a 12-fold higher mortality risk than patients aged 70-79 years. […] Forty-three patients died of complications within 30 days of index surgery. […] The risk of death dramatically increases in the group over 80 years after both primary and incisional hernia repair. […] The risk for reoperation and death was somewhat higher after incisional than after primary hernia repair for both open and laparoscopic repairs. […] The findings of the present study indicate that age is the most important risk factor for death.
#11 Predictive factors of recurrence for laparoscopic repair of primary and incisional ventral hernias with single mesh from a multicenter study | Scientific Reports
https://www.nature.com/articles/s41598-022-08024-3
Laparoscopic ventral hernia repair (LVHR) is a widely practiced treatment for primary (PH) and incisional (IH) hernias, with acceptable outcomes. Prevention of recurrence is crucial and still highly debated. […] IH group presented at major risk of recurrence than PH (6.7% vs 0.9%, p0.001) and application of absorbable tacks resulted a significative predictive factor for recurrence increasing the risk by 2.94 (95% CI 1.187.31). […] The overall recurrence rate for the total cohort of patients was 4.7% (n=47) at a mean follow-up of 30.4 months. […] IH group presented a higher rate of recurrence than PH (6.7% vs 0.9%, p0.001), with almost all cases registered among IH patients (n=44). […] Interestingly, at univariable analysis on 665 IH cases BMI, hernia size and location were not found to be predictive factors of recurrence, as well being primary incisional or recurrent incisional hernia.
#12 Identifying predictors of ventral hernia recurrence: systematic review and meta-analysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC8038271/
Ventra hernias are increasing in prevalence and many recur despite attempted repair. […] This systematic review aimed to identify predictors of ventral hernia recurrence. […] Hernia recurrence was defined in 66 studies (24.1 per cent), using 41 different unstandardized definitions. […] Three patient variables (female sex, age 65 years or less, and BMI greater than 25, 30, 35 or 40 kg/m2), five patient co-morbidities (smoking, diabetes, chronic obstructive pulmonary disease, ASA grade IIIIV, steroid use), two hernia-related variables (incisional/primary, recurrent/primary), six intraoperative variables (biological mesh, bridged repair, open versus laparoscopic surgery, suture versus mesh repair, onlay/retrorectus, intraperitoneal/retrorectus), and six postoperative variables (any complication, surgical-site occurrence, wound infection, seroma, haematoma, wound dehiscence) were identified as significant prognostic factors for hernia recurrence.
#13 Identifying predictors of ventral hernia recurrence: systematic review and meta-analysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC8038271/
Ventra hernias are increasing in prevalence and many recur despite attempted repair. […] This systematic review aimed to identify predictors of ventral hernia recurrence. […] Hernia recurrence was defined in 66 studies (24.1 per cent), using 41 different unstandardized definitions. […] Three patient variables (female sex, age 65 years or less, and BMI greater than 25, 30, 35 or 40 kg/m2), five patient co-morbidities (smoking, diabetes, chronic obstructive pulmonary disease, ASA grade IIIIV, steroid use), two hernia-related variables (incisional/primary, recurrent/primary), six intraoperative variables (biological mesh, bridged repair, open versus laparoscopic surgery, suture versus mesh repair, onlay/retrorectus, intraperitoneal/retrorectus), and six postoperative variables (any complication, surgical-site occurrence, wound infection, seroma, haematoma, wound dehiscence) were identified as significant prognostic factors for hernia recurrence.
#14 Identifying predictors of ventral hernia recurrence: systematic review and meta-analysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC8038271/
This study summarized the current evidence base for predicting ventral hernia recurrence. […] New knowledge is presented regarding patient demographics, hernia characteristics, intraoperative factors and postoperative variables that predispose to recurrence. […] The ability to predict recurrence accurately would have considerable clinical utility, allowing surgeons to make better-informed decisions with their patients as to when, and when not, to operate. […] Identification of predictors of recurrence is pivotal, because the decision whether to perform reconstruction or not pivots on the chance of success. […] The present analysis of intraoperative variables has confirmed the well known protective effect of mesh over suture repair, and also that primary fascial closure results in a more reliable repair than bridged; both of these associations are well established.
#15 Identifying predictors of ventral hernia recurrence: systematic review and meta-analysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC8038271/
Furthermore, the present data are consistent with biological mesh being weaker than synthetic mesh, with greater tendency towards recurrence, an association published previously. […] Moving forwards, prospective ventral hernia prognostic studies should be performed to eliminate bias, with well characterized participants, blinded assessment of potential predictors and outcomes, standard definitions and detection methods for both predictors and outcomes.
#16 Predictive factors of recurrence for laparoscopic repair of primary and incisional ventral hernias with single mesh from a multicenter study | Scientific Reports
https://www.nature.com/articles/s41598-022-08024-3
Multivariate analysis identified the application of absorbable tacks and reintervention as major risk factors, increasing risk of recurrence by 2.94 and 2.89 times, respectively. […] The current study suggests that LVHR procedure with a light-weight polypropylene mesh has low intra-operative complication rates and acceptable post-operative and late complication rates for both IH and PH. IH patients are at a much higher risk of recurrence and surgical strategy should prefer non absorbable or mixed fixation systems.
#17 Identifying predictors of ventral hernia recurrence: systematic review and meta-analysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC8038271/
Ventra hernias are increasing in prevalence and many recur despite attempted repair. […] This systematic review aimed to identify predictors of ventral hernia recurrence. […] Hernia recurrence was defined in 66 studies (24.1 per cent), using 41 different unstandardized definitions. […] Three patient variables (female sex, age 65 years or less, and BMI greater than 25, 30, 35 or 40 kg/m2), five patient co-morbidities (smoking, diabetes, chronic obstructive pulmonary disease, ASA grade IIIIV, steroid use), two hernia-related variables (incisional/primary, recurrent/primary), six intraoperative variables (biological mesh, bridged repair, open versus laparoscopic surgery, suture versus mesh repair, onlay/retrorectus, intraperitoneal/retrorectus), and six postoperative variables (any complication, surgical-site occurrence, wound infection, seroma, haematoma, wound dehiscence) were identified as significant prognostic factors for hernia recurrence.
#18 Identifying predictors of ventral hernia recurrence: systematic review and meta-analysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC8038271/
Ventra hernias are increasing in prevalence and many recur despite attempted repair. […] This systematic review aimed to identify predictors of ventral hernia recurrence. […] Hernia recurrence was defined in 66 studies (24.1 per cent), using 41 different unstandardized definitions. […] Three patient variables (female sex, age 65 years or less, and BMI greater than 25, 30, 35 or 40 kg/m2), five patient co-morbidities (smoking, diabetes, chronic obstructive pulmonary disease, ASA grade IIIIV, steroid use), two hernia-related variables (incisional/primary, recurrent/primary), six intraoperative variables (biological mesh, bridged repair, open versus laparoscopic surgery, suture versus mesh repair, onlay/retrorectus, intraperitoneal/retrorectus), and six postoperative variables (any complication, surgical-site occurrence, wound infection, seroma, haematoma, wound dehiscence) were identified as significant prognostic factors for hernia recurrence.
#19
https://link.springer.com/article/10.1007/s00431-022-04568-8
The highest OI on day 1 predicted survival. […] The percentage change in the PaO2/FiO2 ratio post iNO initiation was higher in infants who survived compared to infants who died. […] We have examined predictors of survival in CDH infants including the response to iNO and demonstrated that the highest oxygenation index on day 1 predicted survival. […] The response to iNO can predict survival in CDH infants. […] Our study showed that the HOI on day 1 was associated with survival after adjusting for gestational age, Apgar score at 5 min and the O/E LHR. […] The response to inhaled nitric oxide was variable in infants with CDH in our study, but infants who responded to iNO were more likely to survive. […] In conclusion, the highest oxygenation index on day 1 of life was a better predictor of survival than gestational age and the Apgar score at 5 min.
#20
https://link.springer.com/article/10.1007/s00431-022-04568-8
The highest OI on day 1 predicted survival. […] The percentage change in the PaO2/FiO2 ratio post iNO initiation was higher in infants who survived compared to infants who died. […] We have examined predictors of survival in CDH infants including the response to iNO and demonstrated that the highest oxygenation index on day 1 predicted survival. […] The response to iNO can predict survival in CDH infants. […] Our study showed that the HOI on day 1 was associated with survival after adjusting for gestational age, Apgar score at 5 min and the O/E LHR. […] The response to inhaled nitric oxide was variable in infants with CDH in our study, but infants who responded to iNO were more likely to survive. […] In conclusion, the highest oxygenation index on day 1 of life was a better predictor of survival than gestational age and the Apgar score at 5 min.
#21
https://journals.lww.com/10.1097/XCS.0000000000000141
Despite advancements in abdominal wall reconstruction (AWR) techniques, hernia recurrences (HRs), surgical site occurrences (SSOs), and unplanned hospital readmissions persist. […] We identified 725 patients (52% women), with a mean age of 6011.5 years, mean body mass index of 317kg/m2, and mean follow-up time of 4229 months. The HR rate was 12.8%, SSO rate was 30%, and 30-day readmission rate was 10.9%. […] ML models demonstrated good discriminatory performance for predicting HR (area under the receiver operating characteristic curve [AUC] 0.71), SSOs (AUC 0.75), and 30-day readmission (AUC 0.74). […] ML algorithms trained on readily available preoperative clinical data accurately predicted complications of AWR. Our findings support incorporating ML models into the preoperative assessment of patients undergoing AWR to provide data-driven, patient-specific risk assessment. […] The machine learning models demonstrated good discriminatory performance for predicting hernia recurrence (area under the receiver operating characteristic curve [AUC] = 0.71).
#22
https://journals.lww.com/10.1097/XCS.0000000000000141
Despite advancements in abdominal wall reconstruction (AWR) techniques, hernia recurrences (HRs), surgical site occurrences (SSOs), and unplanned hospital readmissions persist. […] We identified 725 patients (52% women), with a mean age of 6011.5 years, mean body mass index of 317kg/m2, and mean follow-up time of 4229 months. The HR rate was 12.8%, SSO rate was 30%, and 30-day readmission rate was 10.9%. […] ML models demonstrated good discriminatory performance for predicting HR (area under the receiver operating characteristic curve [AUC] 0.71), SSOs (AUC 0.75), and 30-day readmission (AUC 0.74). […] ML algorithms trained on readily available preoperative clinical data accurately predicted complications of AWR. Our findings support incorporating ML models into the preoperative assessment of patients undergoing AWR to provide data-driven, patient-specific risk assessment. […] The machine learning models demonstrated good discriminatory performance for predicting hernia recurrence (area under the receiver operating characteristic curve [AUC] = 0.71).
#23 Positive predictive value of ultrasound in correctly identifying an inguinal hernia: a single-centered retrospective pilot study | Insights into Imaging | Full Text
https://insightsimaging.springeropen.com/articles/10.1186/s13244-022-01272-x
PPV of ultrasound examinations to identify an inguinal hernia in need of surgery correctly was 90.9% (159/175). […] With a false positive percentage of 9.1%, there is still room for improvement of preoperative diagnostic imaging. […] Preoperative ultrasound had a PPV of 90.9% (159/175) for identifying inguinal hernia in need of surgery. […] BMI was identified as most likely potential predictor of false positive ultrasounds. […] We showed that preoperative ultrasound has a PPV of 90.9%. BMI was identified as most likely potential predictor of FP ultrasound results.
#24 Hernia: What it is, Symptoms, Types, Causes & Treatment
https://my.clevelandclinic.org/health/diseases/15757-hernia
Most hernias eventually will need surgical repair. […] A hernia becomes serious when it gets stuck in the hole that its pushed through and cant go back in. This can become painful, and in severe cases the tissue can become cut off from blood supply, causing necrosis (tissue death). Since hernias tend to worsen over time, most will need surgical repair sooner or later. […] Your healthcare provider will assess how severe it is and how fast its likely to progress. Some hernias may not need urgent repair, but for most, theyll recommend it eventually. The surgery is usually a simple outpatient procedure with a short recovery. Its almost always successful, but there is a 10% chance of the hernia returning sometime later, especially if the conditions that caused it continue.
#25 Hernia: What it is, Symptoms, Types, Causes & Treatment
https://my.clevelandclinic.org/health/diseases/15757-hernia
Most hernias eventually will need surgical repair. […] A hernia becomes serious when it gets stuck in the hole that its pushed through and cant go back in. This can become painful, and in severe cases the tissue can become cut off from blood supply, causing necrosis (tissue death). Since hernias tend to worsen over time, most will need surgical repair sooner or later. […] Your healthcare provider will assess how severe it is and how fast its likely to progress. Some hernias may not need urgent repair, but for most, theyll recommend it eventually. The surgery is usually a simple outpatient procedure with a short recovery. Its almost always successful, but there is a 10% chance of the hernia returning sometime later, especially if the conditions that caused it continue.
#26
https://link.springer.com/article/10.1007/s10029-023-02748-5
With this retrospective case series, we aim to identify predictors for reduction of pain after mesh revision surgery in patients operated for inguinal hernia or pelvic organ prolapse with a polypropylene implant. […] The multivariable logistic regression was performed for each patient group separately. Patients with CPIP had higher chances of improvement of pain when time between mesh placement and mesh revision surgery was longer, with an OR of 1.19 per year. A turning point in chances of risks and benefits was demonstrated at 70 months, with improved outcomes for patients with revision surgery 70 months (OR 2.86). […] A longer duration of at least 70 months between implantation of inguinal mesh and revision surgery seems to give a higher chance on improvement of pain. […] The multivariable analysis for inguinal hernia patients concluded that only the time between insertion of an inguinal implant and the removal of that implant has a positive predictive value for improvement of pain after revision surgery. This signifies that inguinal hernia patients with later onset of pain or patients that have endured pain for a longer period of time, have a higher chance of a positive effect of the mesh revision with an OR of 1.19 per year. A turning point for higher chances on improvement of pain with revision surgery was found at 70 months after initial placement of the mesh using a risk/benefit profile.
#27
https://link.springer.com/article/10.1007/s10029-023-02748-5
With this retrospective case series, we aim to identify predictors for reduction of pain after mesh revision surgery in patients operated for inguinal hernia or pelvic organ prolapse with a polypropylene implant. […] The multivariable logistic regression was performed for each patient group separately. Patients with CPIP had higher chances of improvement of pain when time between mesh placement and mesh revision surgery was longer, with an OR of 1.19 per year. A turning point in chances of risks and benefits was demonstrated at 70 months, with improved outcomes for patients with revision surgery 70 months (OR 2.86). […] A longer duration of at least 70 months between implantation of inguinal mesh and revision surgery seems to give a higher chance on improvement of pain. […] The multivariable analysis for inguinal hernia patients concluded that only the time between insertion of an inguinal implant and the removal of that implant has a positive predictive value for improvement of pain after revision surgery. This signifies that inguinal hernia patients with later onset of pain or patients that have endured pain for a longer period of time, have a higher chance of a positive effect of the mesh revision with an OR of 1.19 per year. A turning point for higher chances on improvement of pain with revision surgery was found at 70 months after initial placement of the mesh using a risk/benefit profile.
#28 A clinical prediction rule for perioperative mortality and major morbidity after laparoscopic giant paraesophageal hernia repair
https://pmc.ncbi.nlm.nih.gov/articles/PMC3971917/
In the current era, giant paraesophageal hernia repair by experienced minimally-invasive surgeons has excellent perioperative outcomes when performed electively. Nonelective repair, however, is associated with significantly greater morbidity and mortality, even when performed laparoscopically. […] We hypothesized that clinical prediction tools using pretreatment variables could be developed that would predict patient-specific risk of postoperative morbidity and mortality. […] Urgency of operation was a significant predictor of mortality (elective 1.1% versus nonelective 8%) and major morbidity (elective 18% versus nonelective 41%). […] A 4-covariate prediction model consisting of age 80 or greater, urgency of operation and two Charlson comorbidity index variables (congestive heart failure and pulmonary disease) provided discriminatory accuracy for postoperative mortality of 88% while a 5-covariate model for major postoperative morbidity was 68% predictive.
#29 Hernia: What it is, Symptoms, Types, Causes & Treatment
https://my.clevelandclinic.org/health/diseases/15757-hernia
Most hernias eventually will need surgical repair. […] A hernia becomes serious when it gets stuck in the hole that its pushed through and cant go back in. This can become painful, and in severe cases the tissue can become cut off from blood supply, causing necrosis (tissue death). Since hernias tend to worsen over time, most will need surgical repair sooner or later. […] Your healthcare provider will assess how severe it is and how fast its likely to progress. Some hernias may not need urgent repair, but for most, theyll recommend it eventually. The surgery is usually a simple outpatient procedure with a short recovery. Its almost always successful, but there is a 10% chance of the hernia returning sometime later, especially if the conditions that caused it continue.
#30 Identifying predictors of ventral hernia recurrence: systematic review and meta-analysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC8038271/
This study summarized the current evidence base for predicting ventral hernia recurrence. […] New knowledge is presented regarding patient demographics, hernia characteristics, intraoperative factors and postoperative variables that predispose to recurrence. […] The ability to predict recurrence accurately would have considerable clinical utility, allowing surgeons to make better-informed decisions with their patients as to when, and when not, to operate. […] Identification of predictors of recurrence is pivotal, because the decision whether to perform reconstruction or not pivots on the chance of success. […] The present analysis of intraoperative variables has confirmed the well known protective effect of mesh over suture repair, and also that primary fascial closure results in a more reliable repair than bridged; both of these associations are well established.
#31 Predictive factors of recurrence for laparoscopic repair of primary and incisional ventral hernias with single mesh from a multicenter study | Scientific Reports
https://www.nature.com/articles/s41598-022-08024-3
Multivariate analysis identified the application of absorbable tacks and reintervention as major risk factors, increasing risk of recurrence by 2.94 and 2.89 times, respectively. […] The current study suggests that LVHR procedure with a light-weight polypropylene mesh has low intra-operative complication rates and acceptable post-operative and late complication rates for both IH and PH. IH patients are at a much higher risk of recurrence and surgical strategy should prefer non absorbable or mixed fixation systems.
#32
https://link.springer.com/article/10.1007/s10029-023-02748-5
When counseling patients for mesh revision surgery in case of bothersome symptoms, caregivers should explain the non-negligible complication risks and recurrence rates, but should not avoid revision surgery based on these factors, since (partial) removal of mesh has proven to be successful in pain and symptom relief. […] Current case series shows that a longer duration between implantation of inguinal mesh and revision surgery of at least 70 months has a higher chance on improvement of pain, meaning caregivers should not refrain from indicating surgery based on a longer duration of symptoms when an association between symptoms and the location of the mesh is expected.
#33
https://link.springer.com/article/10.1007/s10029-023-02748-5
When counseling patients for mesh revision surgery in case of bothersome symptoms, caregivers should explain the non-negligible complication risks and recurrence rates, but should not avoid revision surgery based on these factors, since (partial) removal of mesh has proven to be successful in pain and symptom relief. […] Current case series shows that a longer duration between implantation of inguinal mesh and revision surgery of at least 70 months has a higher chance on improvement of pain, meaning caregivers should not refrain from indicating surgery based on a longer duration of symptoms when an association between symptoms and the location of the mesh is expected.
#34
https://journals.lww.com/10.1097/XCS.0000000000000141
Despite advancements in abdominal wall reconstruction (AWR) techniques, hernia recurrences (HRs), surgical site occurrences (SSOs), and unplanned hospital readmissions persist. […] We identified 725 patients (52% women), with a mean age of 6011.5 years, mean body mass index of 317kg/m2, and mean follow-up time of 4229 months. The HR rate was 12.8%, SSO rate was 30%, and 30-day readmission rate was 10.9%. […] ML models demonstrated good discriminatory performance for predicting HR (area under the receiver operating characteristic curve [AUC] 0.71), SSOs (AUC 0.75), and 30-day readmission (AUC 0.74). […] ML algorithms trained on readily available preoperative clinical data accurately predicted complications of AWR. Our findings support incorporating ML models into the preoperative assessment of patients undergoing AWR to provide data-driven, patient-specific risk assessment. […] The machine learning models demonstrated good discriminatory performance for predicting hernia recurrence (area under the receiver operating characteristic curve [AUC] = 0.71).
#35 Identifying predictors of ventral hernia recurrence: systematic review and meta-analysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC8038271/
Furthermore, the present data are consistent with biological mesh being weaker than synthetic mesh, with greater tendency towards recurrence, an association published previously. […] Moving forwards, prospective ventral hernia prognostic studies should be performed to eliminate bias, with well characterized participants, blinded assessment of potential predictors and outcomes, standard definitions and detection methods for both predictors and outcomes.
#36 A clinical prediction rule for perioperative mortality and major morbidity after laparoscopic giant paraesophageal hernia repair
https://pmc.ncbi.nlm.nih.gov/articles/PMC3971917/
Predictive models using pretreatment patient characteristics can accurately predict mortality and major morbidity after giant paraesophageal hernia repair. […] After prospective validation, these models could provide patient-specific risk prediction, tailored for individual patient characteristics, and contribute to decision-making regarding surgical intervention.