Search

Incisionalhernier og parastomalhernier er hernier, der er udviklet i en cikatrice efter abdominal kirurgi eller omkring en stomi. Incisionalhernier er med en incidens på 11-30% en af de hyppigste langtidskomplikationer efter abdominal kirurgi. Parastomalhernier udvikles hos op til 50% af patienter med stomi. Der foretages knap 500 incisional- og parastomalhernieoperationer i Danmark om året

Aim Patients with inflammatory bowel disease (IBD) may undergo several abdominal surgeries with a risk of incisional hernia repair (IHR). The objectives of this study were to establish the risk of IHR and to analyse predictors of IHR after a first-time abdominal surgery for IBD. Method This Danish nationwide register-based cohort study (1996–2018) followed IBD patients from index operation until the date of IHR. The absolute risk was calculated as the cumulative incidence proportion treating death as a competing risk. Cox proportional hazard regression was used to compare the risk of IHR among different subtypes of IBD and to explore predictors of IHR. IBD subtypes were classified as ulcerative colitis (UC), Crohn's disease (CD) or unclassified IBD (IBD-U). Results In total, 10 130 patients with IBD (UC 3911 [39%]; CD 4210 [41%]; IBD-U 2009 [20%]) underwent either an open or a laparoscopic index operation. The 10-year cumulative incidence of IHR varied between 5.0% and 6.3%, with a significantly higher risk in patients with UC and IBD-U. Patients with UC (75.9%) and IBD-U (91.9%) had more (two or more) abdominal surgeries in the follow-up period compared with CD (51.9%). The risk of IHR increased dramatically with the number of surgeries, although not as markedly if a laparoscopic approach was used. Male sex, age, comorbidity, fascial dehiscence, wound infection and presence of stoma were predictors of IHR for patients with IBD. Conclusion The long-term risk of IHR was roughly 5%–6%, with a higher risk in patients with UC and IBD-U. Open surgical approach and number of previous surgeries were, among other things, important predictors of IHR., Aim: Patients with inflammatory bowel disease (IBD) may undergo several abdominal surgeries with a risk of incisional hernia repair (IHR). The objectives of this study were to establish the risk of IHR and to analyse predictors of IHR after a first-time abdominal surgery for IBD. Method: This Danish nationwide register-based cohort study (1996–2018) followed IBD patients from index operation until the date of IHR. The absolute risk was calculated as the cumulative incidence proportion treating death as a competing risk. Cox proportional hazard regression was used to compare the risk of IHR among different subtypes of IBD and to explore predictors of IHR. IBD subtypes were classified as ulcerative colitis (UC), Crohn's disease (CD) or unclassified IBD (IBD-U). Results: In total, 10 130 patients with IBD (UC 3911 [39%]; CD 4210 [41%]; IBD-U 2009 [20%]) underwent either an open or a laparoscopic index operation. The 10-year cumulative incidence of IHR varied between 5.0% and 6.3%, with a significantly higher risk in patients with UC and IBD-U. Patients with UC (75.9%) and IBD-U (91.9%) had more (two or more) abdominal surgeries in the follow-up period compared with CD (51.9%). The risk of IHR increased dramatically with the number of surgeries, although not as markedly if a laparoscopic approach was used. Male sex, age, comorbidity, fascial dehiscence, wound infection and presence of stoma were predictors of IHR for patients with IBD. Conclusion: The long-term risk of IHR was roughly 5%–6%, with a higher risk in patients with UC and IBD-U. Open surgical approach and number of previous surgeries were, among other things, important predictors of IHR.

Background: Mesh is recommended for umbilical hernias with defects > 1 cm to reduce recurrence. For umbilical hernias with defect width ≤ 1 cm, the literature is sparse. The aim of this nationwide cohort study was to assess outcomes after suture and mesh repair of umbilical hernias with defect width ≤ 1 cm and to evaluate outcomes after onlay mesh repair specifically. Methods: By merging data from the Danish Hernia Database and the National Patients Registry from 2007 to 2018, patients undergoing elective open repair of an umbilical hernia with defect width ≤ 1 cm were identified. Available data included details about comorbidity, surgical technique, 90-day readmission, 90-day reoperation and operation for recurrence. Results: A total of 7849 patients were included, of whom 25.7% (2013/7849) underwent mesh repair. Reoperation for recurrence was significantly decreased after mesh repair 3.1% (95% C.I. 2.1–4.1) compared with suture repair 6.7% (95% C.I. 6.0–7.4), P < 0.001. Readmission and reoperation rates were significantly higher for mesh repair 7.9% (159/2013) and 2.6% (52/2013) than for suture repair 6.5% (381/5836) and 1.5% (89/5836), P = 0.036 and P = 0.002, respectively. Onlay mesh repairs had the lowest risk of recurrence 2.0% (95% C.I. 0.6–3.5), and readmission [7.9% (65/826)] and reoperation [3.9% (32/826)] rates within 90 days were comparable to suture repairs [6.5% (381/5836)] and [3.3% (192/5836)], P = 0.149 and P = 0.382, respectively. Conclusions: Even for the smallest umbilical hernias, mesh repair significantly decreased the recurrence rate. Onlay mesh repair was associated with lowest risk of recurrence without increasing early complications.

The National Danish Inguinal Hernia Database (1997) and Ventral Hernia Database (2007), together the Danish Hernia Database, was launched to monitor and optimize surgical quality and outcomes after hernia repairs. The purpose of the present qualitative review was to present five "highlight" publications from the 123 published/in press (October 2020) original publications from the Danish Hernia Database. Two international hernia experts independently nominated 10 publications from the Database publication list published between 2010 and 2020. Each of the 10 members of the database steering group ranked the 10 publications according to the following three categories: (I) originality, (II) methodology, and (III) clinical impact. The publications were ranked as 1= good, 2= very good, 3= outstanding. The five publications with the highest score were depicted as highlights. The publications dealt with: (I) long-term mesh-related complications after incisional hernia repair, (II) outcomes after parastomal hernia repairs, (III) mesh or suture repair of ventral hernias in women having subsequent pregnancy, (IV) reoperation for recurrence versus clinical recurrence rates, and (V) recurrence rates after resorbable versus non-resorbable tackers for laparoscopic ventral hernia repair. Data from the Danish Hernia Database is internationally acknowledged. The nationwide Danish data supplements the higher-ranking evidence by randomized controlled trials (RCTs) by adding evidence-based answers to scientifically clinically relevant questions. The Danish Hernia Database is still active after more than 20 years.

Traditionally, the quality of ventral hernia repair has been measured by hard outcomes such as morbidity and recurrence, but patient-reported outcome measures (PROMs) have become increasingly popular. In this review we suggest, that only a minor subset of PROMs has improved in patients undergoing elective large-sized incisional hernia repair. For umbilical and smaller incisional hernia repairs, no significant evidence for improved PROMs was found. The vast majority of data were of questionable scientific methodology.

There is an increasing focus on patient-reported outcome measures (PROMs) to document bariatric surgical quality. In this review, the literature has been scrutinised, and 19 clinical studies (including 14 validated bariatric procedure/disease-specific and generic questionnaires) have been analysed. Long-term PROMs are significantly improved after bariatric surgery, and we recommend to use a combination of the disease-specific IWQOL Lite questionnaire and the generic EQ-5D-5L questionnaire for future research and for the monitoring of bariatric surgical quality.

Traditionally, the quality of ventral hernia repair has been measured by hard outcomes such as morbidity and recurrence, but patient-reported outcome measures (PROMs) have become increasingly popular. In this review we suggest, that only a minor subset of PROMs has improved in patients undergoing elective large-sized incisional hernia repair. For umbilical and smaller incisional hernia repairs, no significant evidence for improved PROMs was found. The vast majority of data were of questionable scientific methodology.