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Are immunosuppressive conditions and preoperative corticosteroid treatment risk factors in inguinal hernia repair?

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Abstract

Introduction

Immunosuppressive conditions and/or preoperative corticosteroid treatment have a negative influence on wound healing and can, therefore, lead to higher rates of surgical site infections (SSIs) and seromas. For inguinal hernia, no such studies have been carried out to date.

Methods

In an analysis of data from the Herniamed Registry, 2312 of 142,488 (1.6%) patients with primary unilateral inguinal hernia repair had an anamnestic history of an immunosuppressive condition and/or preoperative corticosteroid treatment. Using propensity score matching, 2297 (99.4%) pairs with comparative patient characteristics were formed. These were then compared using the following primary outcome criteria: intra- and postoperative complications, complication-related reoperations, recurrence at one-year follow-up, pain on exertion, pain at rest, and chronic pain requiring treatment at one-year follow-up. Of the 2297 matched pairs with primary unilateral inguinal hernia repair, 82.76% were male patients. 1010 (44.0%) were operated in laparo-endoscopic techniques (TEP, TAPP), 1225 (53.3%) in open techniques (Bassini, Shouldice, Lichtenstein, Plug, TIP, Gilbert, Desarda), and 62 (2.7%) in other techniques.

Results

The matched pair analysis results did not identify any disadvantage in terms of the outcome criteria for patients with an anamnestic history of immunosuppressive condition and/or preoperative corticosteroid treatment (yes vs no). In particular, no disadvantage was noted in the rate of surgical site infections (0.65% vs 0.70%; ns) or seromas (1.22% vs 1.57%; ns). The overall rates of postoperative complications were 3.40% vs 4.31% (p = ns) (plus 0.22% concordant events in five matched pairs).

Conclusion

In primary unilateral inguinal hernia surgery, an immunosuppressive condition and/or preoperative corticosteroid treatment does not appear to have a negative influence on wound complications.

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References

  1. Kingsnorth A, LeBlanc K (2003) Hernias: inguinal and incisional. Lancet 362(9395):1561–1571

    Article  PubMed  Google Scholar 

  2. The HerniaSurge Group (2018) International guidelines for groin hernia management. Hernia 22:1–165. https://doi.org/10.1007/s10029-017-16668-x

    Article  Google Scholar 

  3. Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M (2009) European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13:343–403. https://doi.org/10.1007/s10029-009-0529-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Bittner R, Arregui ME, Bisgaard T, Dudai M, Ferzli GS, Fitzgibbons RJ, Fortelny RH, Klinge U, Köckerling F, Kuhry E, Kukleta J, Lomanto D, Misra MC, Montgomery A, Morales-Conde RW, Rosenberg J, Sauerland S, Schug-Pass C, Singh K et al (2011) Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)]. Surg Endosc 25:2773–2843. https://doi.org/10.1007/s00464-011-1799-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Bittner R, Montgomery MA, Arregui E, Bansal V, Bingener J, Bisgaard T, Buhck H, Dudai M, Ferzli GS, Fitzgibbons RJ, Fortelny RH, Grimes KL, Klinge U, Köckerling F, Kumar S, Kukleta J, Lomanto D, Misra MC, Morales-Conde S, Reinpold W, Rosenberg J, Singh K, Timoney M, Weyhe D, Chowbey P (2015) Update of guidelines on laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia (International Endohernia Society). Surg Endosc 29:289–321. https://doi.org/10.1007/s00464-014-3917-8

    Article  CAS  PubMed  Google Scholar 

  6. Miserez M, Peeters E, Aufenacker T, Bouillot JL, Campanelli G, Conze J, Fortelny R, Heikkinen T, Jorgensen LN, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Simons MP (2014) Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 18:151–163. https://doi.org/10.1007/s10029-014-1236-6

    Article  CAS  PubMed  Google Scholar 

  7. Weyhe D, Navid T, Sahlmann B, Uslar VN (2017) Risk factors for perioperative complications in inguinal hernia repair: a systematic review. Innov Surg Sci 2:47–52. https://doi.org/10.1515/iss-2017-0008

    Article  PubMed  PubMed Central  Google Scholar 

  8. Köckerling F et al (2019) Comparing routine administrative data with registry data for assessing quality of hospital care in patients with inguinal hernia. Hernia. https://doi.org/10.1007/s10029-019-02009-4

    Article  PubMed  PubMed Central  Google Scholar 

  9. Esposito S (2001) Immune system and surgical site infection. J Chemother 13(1):12–16. https://doi.org/10.1179/joc.2001.13.Supplement-2.12

    Article  PubMed  Google Scholar 

  10. Avishai E, Yeghiazaryan K, Golubnitschaja O (2017) Impaired wound healing: facts and hypotheses for multi-professional considerations in predictive, preventive and personalized medicine. EPMA J 8:23–33. https://doi.org/10.1007/s13167-017-0081-y

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ranson WA, White SJW, Cheung ZB, Mihail C, YeI KJS, Cho SK (2018) The effects of chronic preoperative streroid therapy on perioperative complications following elective posterior lumbar fusion. Glob Spine J 8:834–841. https://doi.org/10.1177/2192568218775960

    Article  Google Scholar 

  12. Arbid SA, El-Khoury H, Faek J, Tamim H, Chami H (2019) Association of preoperative systematic corticosteroid therapy with surgical outcomes in chronic obstructive pulmonary disease patients. Ann Thorac Med 14:141–147. https://doi.org/10.4103/atm.ATM_245_18:10.4103/atm.ATM_245_18

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Ismael H, Horst M, Farooq M, Jordon J, Patton JH, Rubinfeld IS (2011) Adverse effects of preoperative steroid use on surgical outcomes. Am J Surg 201(305–8):308–309. https://doi.org/10.1016/j.amjsurg.2010.09.018

    Article  CAS  Google Scholar 

  14. Wang AS, Armstrong EJ, Armstrong AW (2013) Corticosteroids and wound healing: clinical considerations in the perioperative period. Am J Surg 206:410–417. https://doi.org/10.1016/j.amjsurg.2012.11.018

    Article  CAS  PubMed  Google Scholar 

  15. Mazzei M, Zhao H, Edwards MA (2019) Perioperative outcomes of bariatric surgery in the setting of chronic steroid use: an MBSAQIP database analysis. Surg Obes Relat Dis 15:926–934. https://doi.org/10.1016/j.soard.2019.02.007

    Article  PubMed  Google Scholar 

  16. Bootun R (2013) Effects of immunosuppressive therapy on wound healing. Int Wound J 10:98–104. https://doi.org/10.1111/j.1742-481X.2012.00950.x

    Article  PubMed  Google Scholar 

  17. Nguyen GC, Elnahas A, Jackson TD (2014) The impact of preoperative steroid use on short-term outcomes following surgery for inflammatory bowel disease. J Crohn’s Colit 8:1661–1667. https://doi.org/10.1016/j.crohns.2014.07.007

    Article  Google Scholar 

  18. Haskins IN, Krpata DM, Prabu AS, Tastaldi L, Perez AJ, Tu C, Rosenblatt S, Poulose BK (2018) Immunosuppression is not a risk factor for 30-day wound events or additional 30-day morbidity or mortality after open ventral hernia repair: An analysis of the Americas Hernia Society Quality Collaborative. Surgery 164:594–600. https://doi.org/10.1016/j.surg.2018.05.023

    Article  PubMed  Google Scholar 

  19. Stechemesser B, Jacob DA, Schug-Pass C, Köckerling F (2012) Herniamed: an internet-based registry for outcome research in hernia surgery. Hernia 16:269–276. https://doi.org/10.1007/s10029-012-0908.3

    Article  CAS  PubMed  Google Scholar 

  20. Kyle-Leinhase I, Köckerling F, Jorgensen LN, Montgomery A, Gillion JF, Rodriguez JAP, Hope W, Muysoms F (2018) Comparison of hernia registries: the CORE project. Hernia 22:561–575. https://doi.org/10.1007/s10029-017-1724-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Köckerling F, Bittner R, Kofler M, Mayer F, Adolf D, Kuthe A, Weyhe D (2019) Lichtenstein versus total extraperitoneal patch plasty versus transabdominal patch plasty technique for primary unilateral inguinal hernia repair. Ann Surg 269:351–357

    Article  PubMed  Google Scholar 

  22. Haapaniemi S, Nilsson E (2002) Recurrence and pain three years after groin hernia repair. Validation of postal questionnaire and selective physical examination as a method of follow-up. Eur J Surg 168:22–28. https://doi.org/10.1080/110241502317307535

    Article  PubMed  Google Scholar 

  23. Miserez M, Alexandre JH, Campanelli G, Corcione F, Cuccurullo D, Pascual MH, Hoeferlin A, Kongsnorth AN, Mandala V, Palot JP, Schumpelick V, Simmermacher RK, Stoppa R, Flament JB (2007) The European hernia society groin hernia classification: simple and easy to remember. Hernia 11:113–116

    Article  CAS  PubMed  Google Scholar 

  24. Harpaz R, Dahl RM, Dooling KL (2016) Prevalence of immunosuppression among US Adults, 2013. JAMA 316:23

    Article  Google Scholar 

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Acknowledgments

Ferdinand Köckerling—Grants to fund the Herniamed Registry from Johnson & Johnson, Norderstedt; Karl Storz, Tuttlingen; pfm medical, Cologne; Dahlhausen, Cologne; B Braun, Tuttlingen; MenkeMed, Munich; and Bard, Karlsruhe.

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Correspondence to F. Köckerling.

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M. Varga, F. Köckerling, F. Mayer, M. Lechner, R. Fortelny, R. Bittner, K. Borhanian, D. Adolf, R. Bittner, and K. Emmanuel1 have no conflicts of interest or financial ties to disclose.

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Varga, M., Köckerling, F., Mayer, F. et al. Are immunosuppressive conditions and preoperative corticosteroid treatment risk factors in inguinal hernia repair?. Surg Endosc 35, 2953–2964 (2021). https://doi.org/10.1007/s00464-020-07736-9

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  • DOI: https://doi.org/10.1007/s00464-020-07736-9

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