Long-term follow-up after meshectomy with acellular human dermis repair for postherniorrhaphy inguinodynia

Matthew Koopman, Brett H. Yamane, James R. Starling

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Hypothesis: Direct inguinal hernia repair with acellular human dermis (AHD) may offer greater symptom improvement and lower risk of hernia recurrence than anatomical repair without mesh (AWM) after mesh removal (with or without neurectomy) for postherniorrhaphy inguinodynia. Design: Retrospective cohort study with long-term follow-up. Setting: Tertiary referral center for mesh inguinodynia. Patients: Patients undergoing meshectomy (with or without neurectomy) for postherniorrhaphy inguinodynia were identified. Medical records were reviewed, and patients were contacted to evaluate outcomes. Patients whose postmeshectomy hernias were repaired using AHD vs AWM were compared. Main Outcome Measures: Patient satisfaction and recurrence. Results: Sixty-seven patients (35 in the AHD group and 32 in the AWM group) completed the follow-up. Patient demographics, duration and severity of symptoms, and time to meshectomy were similar between groups. The mean length of follow-up was 31.9 months for the AHD group and 80.2 months for the AWM group (P7gt;.001). Fewer neurectomies were performed in the AHD group than in the AWM group (43% [15 of 35] vs 72% [23 of 32], P=.03). Eighty-three percent (29 of 35) of patients in the AHD group reported good or excellent groin pain improvement compared with 72% (23 of 32) of patients in theAWMgroup (P=.38). Eighty-three percent (29 of 35) of patients in the AHD group were satisfied with results compared with 81% (26 of 32) of patients in the AWM group (P=<..99). The AHD vs AWM procedures were associated with similar recovery, time to hernia recurrence, complication rates (11% [4 of 35] vs 3% [1 of 32], P=.36), and hernia recurrence rates (9% [3 of 35] vs 12% [4 of 32], P=.80). Predictors of patient dissatisfaction with meshectomy included patient smoking (odds ratio, 9.1; P=.01) and filing of workers' compensation claims (odds ratio, 12.8; P=.02). Conclusions: Meshectomy (with or without neurectomy) for postherniorrhaphy inguinodynia leads to significant symptom improvement and patient satisfaction, with acceptable morbidity and recurrence rates. The use of AHD vs AWM does not improve iatrogenic hernia recurrence.

Original languageEnglish (US)
Pages (from-to)427-431
Number of pages5
JournalArchives of Surgery
Volume146
Issue number4
DOIs
StatePublished - Apr 1 2011
Externally publishedYes

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Acellular Dermis
Hernia
Recurrence
Patient Satisfaction
Odds Ratio
Workers' Compensation
Groin
Inguinal Hernia
Herniorrhaphy
Tertiary Care Centers
Medical Records

ASJC Scopus subject areas

  • Surgery

Cite this

Long-term follow-up after meshectomy with acellular human dermis repair for postherniorrhaphy inguinodynia. / Koopman, Matthew; Yamane, Brett H.; Starling, James R.

In: Archives of Surgery, Vol. 146, No. 4, 01.04.2011, p. 427-431.

Research output: Contribution to journalArticle

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title = "Long-term follow-up after meshectomy with acellular human dermis repair for postherniorrhaphy inguinodynia",
abstract = "Hypothesis: Direct inguinal hernia repair with acellular human dermis (AHD) may offer greater symptom improvement and lower risk of hernia recurrence than anatomical repair without mesh (AWM) after mesh removal (with or without neurectomy) for postherniorrhaphy inguinodynia. Design: Retrospective cohort study with long-term follow-up. Setting: Tertiary referral center for mesh inguinodynia. Patients: Patients undergoing meshectomy (with or without neurectomy) for postherniorrhaphy inguinodynia were identified. Medical records were reviewed, and patients were contacted to evaluate outcomes. Patients whose postmeshectomy hernias were repaired using AHD vs AWM were compared. Main Outcome Measures: Patient satisfaction and recurrence. Results: Sixty-seven patients (35 in the AHD group and 32 in the AWM group) completed the follow-up. Patient demographics, duration and severity of symptoms, and time to meshectomy were similar between groups. The mean length of follow-up was 31.9 months for the AHD group and 80.2 months for the AWM group (P7gt;.001). Fewer neurectomies were performed in the AHD group than in the AWM group (43{\%} [15 of 35] vs 72{\%} [23 of 32], P=.03). Eighty-three percent (29 of 35) of patients in the AHD group reported good or excellent groin pain improvement compared with 72{\%} (23 of 32) of patients in theAWMgroup (P=.38). Eighty-three percent (29 of 35) of patients in the AHD group were satisfied with results compared with 81{\%} (26 of 32) of patients in the AWM group (P=<..99). The AHD vs AWM procedures were associated with similar recovery, time to hernia recurrence, complication rates (11{\%} [4 of 35] vs 3{\%} [1 of 32], P=.36), and hernia recurrence rates (9{\%} [3 of 35] vs 12{\%} [4 of 32], P=.80). Predictors of patient dissatisfaction with meshectomy included patient smoking (odds ratio, 9.1; P=.01) and filing of workers' compensation claims (odds ratio, 12.8; P=.02). Conclusions: Meshectomy (with or without neurectomy) for postherniorrhaphy inguinodynia leads to significant symptom improvement and patient satisfaction, with acceptable morbidity and recurrence rates. The use of AHD vs AWM does not improve iatrogenic hernia recurrence.",
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N2 - Hypothesis: Direct inguinal hernia repair with acellular human dermis (AHD) may offer greater symptom improvement and lower risk of hernia recurrence than anatomical repair without mesh (AWM) after mesh removal (with or without neurectomy) for postherniorrhaphy inguinodynia. Design: Retrospective cohort study with long-term follow-up. Setting: Tertiary referral center for mesh inguinodynia. Patients: Patients undergoing meshectomy (with or without neurectomy) for postherniorrhaphy inguinodynia were identified. Medical records were reviewed, and patients were contacted to evaluate outcomes. Patients whose postmeshectomy hernias were repaired using AHD vs AWM were compared. Main Outcome Measures: Patient satisfaction and recurrence. Results: Sixty-seven patients (35 in the AHD group and 32 in the AWM group) completed the follow-up. Patient demographics, duration and severity of symptoms, and time to meshectomy were similar between groups. The mean length of follow-up was 31.9 months for the AHD group and 80.2 months for the AWM group (P7gt;.001). Fewer neurectomies were performed in the AHD group than in the AWM group (43% [15 of 35] vs 72% [23 of 32], P=.03). Eighty-three percent (29 of 35) of patients in the AHD group reported good or excellent groin pain improvement compared with 72% (23 of 32) of patients in theAWMgroup (P=.38). Eighty-three percent (29 of 35) of patients in the AHD group were satisfied with results compared with 81% (26 of 32) of patients in the AWM group (P=<..99). The AHD vs AWM procedures were associated with similar recovery, time to hernia recurrence, complication rates (11% [4 of 35] vs 3% [1 of 32], P=.36), and hernia recurrence rates (9% [3 of 35] vs 12% [4 of 32], P=.80). Predictors of patient dissatisfaction with meshectomy included patient smoking (odds ratio, 9.1; P=.01) and filing of workers' compensation claims (odds ratio, 12.8; P=.02). Conclusions: Meshectomy (with or without neurectomy) for postherniorrhaphy inguinodynia leads to significant symptom improvement and patient satisfaction, with acceptable morbidity and recurrence rates. The use of AHD vs AWM does not improve iatrogenic hernia recurrence.

AB - Hypothesis: Direct inguinal hernia repair with acellular human dermis (AHD) may offer greater symptom improvement and lower risk of hernia recurrence than anatomical repair without mesh (AWM) after mesh removal (with or without neurectomy) for postherniorrhaphy inguinodynia. Design: Retrospective cohort study with long-term follow-up. Setting: Tertiary referral center for mesh inguinodynia. Patients: Patients undergoing meshectomy (with or without neurectomy) for postherniorrhaphy inguinodynia were identified. Medical records were reviewed, and patients were contacted to evaluate outcomes. Patients whose postmeshectomy hernias were repaired using AHD vs AWM were compared. Main Outcome Measures: Patient satisfaction and recurrence. Results: Sixty-seven patients (35 in the AHD group and 32 in the AWM group) completed the follow-up. Patient demographics, duration and severity of symptoms, and time to meshectomy were similar between groups. The mean length of follow-up was 31.9 months for the AHD group and 80.2 months for the AWM group (P7gt;.001). Fewer neurectomies were performed in the AHD group than in the AWM group (43% [15 of 35] vs 72% [23 of 32], P=.03). Eighty-three percent (29 of 35) of patients in the AHD group reported good or excellent groin pain improvement compared with 72% (23 of 32) of patients in theAWMgroup (P=.38). Eighty-three percent (29 of 35) of patients in the AHD group were satisfied with results compared with 81% (26 of 32) of patients in the AWM group (P=<..99). The AHD vs AWM procedures were associated with similar recovery, time to hernia recurrence, complication rates (11% [4 of 35] vs 3% [1 of 32], P=.36), and hernia recurrence rates (9% [3 of 35] vs 12% [4 of 32], P=.80). Predictors of patient dissatisfaction with meshectomy included patient smoking (odds ratio, 9.1; P=.01) and filing of workers' compensation claims (odds ratio, 12.8; P=.02). Conclusions: Meshectomy (with or without neurectomy) for postherniorrhaphy inguinodynia leads to significant symptom improvement and patient satisfaction, with acceptable morbidity and recurrence rates. The use of AHD vs AWM does not improve iatrogenic hernia recurrence.

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