JOURNAL READING

RISK FACTORS FOR PERIOPERATIVE COMPLICATIONS IN

INGUINAL HERNIA REPAIR

Dirk Weyhe, Navid Tabriz, Bianca Sahlmann,Verena-Nicole Uslar

KEPANITERAAN KLINIK ILMU BEDAH

FK UMS – RSUD Dr. Harjono S. Ponorogo
2017
JOURNAL IDENTITY

• Risk Factors For Perioperative

Title Complications in Inguinal Hernia Repair

• Dirk Weyhe, Navid Tabriz, Bianca

Authors Sahlmann,Verena-Nicole Uslar

Date of • February 25, 2017

Published

Published • Innovative Surgical Sciences

by
ABSTRACT …
The current literature suggests that perioperative complications occur in 8%–10%
of all inguinal hernia repairs.

Risk factors that potentially cause complications such as: Patient age, ASA
score, DM, smoking, emergency level (emergency surgery vs. elective
surgery), low operative preparation, type of anesthesia, and bilateral
hernia and sliding hernia in men.

The most commonly reported complications are bleeding (0.9%), wound infection
(0.5%), and pulmonary and cardiovascular complications (0.2%).

Several studies use the Clavien-Dindo classification system to

determine the level of perioperative complications

Of the 3.9% of publications use the Clavien-Dindo classification.

22% (Clavien-Dindo class ≥ IIIa).
78% (Clavien-Dindo class <III).
Introduction …

For men, there is a lifelong risk of contracting an

inguinal or femoral hernia of 27%–43%. For women,
there is a risk of 3%–6%

Throughout the world, about 20 million inguinal

hernia repairs are performed every year. Thus, inguinal
hernia repair is one of the most frequently performed
surgeries worldwide.

Since the introduction of mesh augmentation in hernia

repair, a multitude of techniques have developed,
each with respective inherent risk factors.
Continued…

In this context, complications are

defined as an uncommon course of The severity of the complications may be
disease accompanied by particular classified using the seven-point Clavien-

symptoms. Dindo classification scale.

PURPOSE
To know the description and estimation of risk factors
that potentially cause complications due to improvement
of inguinal hernia based on Clavien-Dindo classification.
Materials and methods

Research • SYSTEMATIC REVIEW

design

• Intrinsic Criteria:
• Risk factors such as emergency and elective inguinal hernia

Restrictio repair

n Criteria • Exclusion Criteria:

• Case reports and studies of laparoscopic hernia surgery
• Complications of chronic thigh pain
Results
Risk Factor Analysis and Total Number of Complications

Of the 39 studies, 571,445 hernia improvements were

evaluated. The following risk factors are a complication of
identified inguinal hernia such as:
1. Patient Age
2. ASA Score (American Society of Anesthesia)
3. Diabetes
4. Smoke
5. Level of emergency surgery (emergency operation VS.
elective surgery)
6. Low operation preparation
7. Types of anesthesia
8. In men experiencing bilateral hernia and sliding hernia
Continued…
Distribution of 7,985 incidence reports with this type of
complication
Continued…

Grade of Complications by Clavien-Dindo Classification

16,482 complications, 651

(3.9%) were included in the
Clavien-Dindo classification
The most incidence reports
are, Grade I and II (75%),
Grade III: 21.5% and Grade IV:
0.2%
DISCUSSION

The risk of death is the Patients> 60 years with

most severe emergency surgery
significantly showed risk
complication of inguinal factors for cardiovascular
hernia repair with an complications 30 days after
incidence of 0.004%. surgery. (0.21%)

It is also influenced by Wound infection rate in low-risk

environments are reported to be
the administration of less than 5%. For patients with
perioperative high comorbidity, the risk may
prophylactic antibiotics rise to 8.7%.
Continued…
Transabdominal Total Extra
Complications Preperitoneal Peritoneal (TEP)
(TAPP)
From all cases the
complications 5,4% 2,9%
Cases of visceral
injury 0,3% (29 from 0,1% (7 from
(Bowel, VU) 10.887) 6700)
Bleeding cases
0,4% 0,28%
CONCLUSION

Risk factors present in the patient can potentially lead to

perioperative complications in the improvement of inguinal
hernia. From the results of this study found that the most
frequent complications are bleeding (0.85%), wound infections
(0.46%), and cardiovascular and pulmonary complications
(0.21%). While according to Clavien-Dindo classification, grade I-
II (75%), grade III: 21.5%, grade IV (0.2%).

The Grade of complications in patients with inguinal hernia repair

can be analyzed using the Clavien-Dindo classification system,
where the objective is to evaluate the type of perioperative
complications, to estimate potential outcomes in the direction of
therapeutic complications in the patient, and to identify risk
factors associated with complications.
Thank You