Page 50 - herina surgery and possible lawsuits

Urinary retention m post herniorrhaphy related to type of anesthesia. Meta analysis had

shown the incidence of urinary retention was lower with local anesthesia (LA) 0.37%,
with regional anesthesia (RA) 2.42%, and general anesthesia (GA) 3.00%. The low
incidence of retention with LA is in accordance with the inhibitory effects of RA and

GA on bladder function.[93]
Emergency hernia surgery incidence was 5.1% for inguinal hernia where as 36.5% for
femoral hernia, as studied from Swedish Henna Register (n=l,07,838).[35] Bowel

resection performed in 22.7% of emergent femoral repairs and 5.4% of emergent
inguinal repairs. Femoral hernia operations compnsed 1.1% of groin henna
operations on men and 22.4% of operations on women. [94]
Mortality after hernia surgery defined as standardized mortality ratio (SMR) within 30 days.

Mortality risk was not raised above that of the background population for elective
groin henna repair, but it was mcreased 7-fold after emergency operations and 20-fold

if bowel resection was undertaken.[35]

Complications related to the use of prosthetics.
Most of the complications already descnbed. The complications specific to mesh are depend
f
upon choosing a mesh. The surgeon must decide which properties are the most important for
the specific situation.

• Polypropylene meshes are durable and have a low infection nsk but they have little

flexibility and a high adhesion risk. The use of heavyweight meshes is associated with
increased complications and adverse events, such as fistula and adhesion formation
and pain.[85] Although these complications are mamly observed during intra-

pentoneal application, they have also been observed as a result of Extra-peritoneal
placement. [95]
• Heavyweight meshes have an increased surface area and, therefore, produce a more
intense foreign body reaction. They also tend to shrink more than lightweight meshes

and are stiffer, which can make normal abdominal movements difficult or
unnatural. [84]

• Lightweight typically refers more to meshes with a larger pore size, resulting in a
smaller surface area. The lower amount of material present m lightweight meshes
should lead to decreased foreign body reaction and fibrosis. [96]
The main factors to consider in relation to complications outlined below.

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