Thursday, 31 October 2013

Obesity and Inguinal Hernia

A. Obesity is defined as a medical condition of excess body fat has accumulated overtime, while overweight is a condition of excess body weight relatively to the height. According to the Body Mass Index(BMI), a BMI between 25 to 29.9 is considered over weight, while a BMI of over 30 is an indication of obesity. According to the statistic, 68% of American population are either overweight or obese.

B. How do calculate your BMI index
BMI= weight (kg)/ height (m2)

C. Inguinal hernia is defined as a condition of forming of a sac by the lining of the abdominal cavity (peritoneum) as a result of protrusion of abdominal-cavity contents through the inguinal canal. According to the statistics, the risk of Inguinal Hernia is higher in male, accounted for 27% and lower in female accounted for only 3% of the disease. If left untreated, it may be fatal to the host if the disease progress rapidly.

D. How Obesity associates with Inguinal Hernia
1, In the study of "Effect of body mass index on groin hernia surgery" by Rosemar A, Angerås U, Rosengren A, Nordin P., posted in PubMed, researchers filed the result that Of the 49,094 patients, 3.5% had a BMI <20 kg/m2 and 5.2% were obese. Altogether, women constituted only 7.7% of the studied group, but among patients with BMI <20 kg/m2 that had surgical procedures for femoral hernia, 81.4% were women. The relation between BMI and postoperative complications was U-shaped and after adjustment for age, gender, and emergency procedure, patients with BMI <20 and >25 had a significant increased risk when compared with patients with BMI from 20 to 25. Reoperation for recurrence of groin hernia has an increased hazard ratio of 1.20 (95% confidence interval, 1.00-1.40) in overweight, which was particularly evident after open suture and preperitoneal mesh techniques.

2. According to the abstract of the study of "Risk factors for inguinal hernia among adults in the US population" by Ruhl CE, Everhart JE., posted in PubMed, researchers stated that among men in multivariate analysis, a higher incidence (p < 0.05) of inguinal hernia was associated with an age of 40-59 years (hazard ratio (HR) = 2.2, 95% confidence interval (CI): 1.7, 2.8), an age of 60-74 years (HR = 2.8, 95% CI: 2.2, 3.6), and hiatal hernia (HR = 1.8, 95% CI: 1.2, 2.7), while Black race (HR = 0.58, 95% CI: 0.42, 0.79), being overweight (HR = 0.79, 95% CI: 0.66, 0.95), and obesity (HR = 0.51, 95% CI: 0.36, 0.71) were associated with a lower incidence. Among women, older age, rural residence, greater height, chronic cough, and umbilical hernia were associated with inguinal hernia.

3. In abstract of the study of "Risk factors for inguinal hernia in women: a case-control study. The Coala Trial Group" by Liem MS, van der Graaf Y, Zwart RC, Geurts I, van Vroonhoven TJ., posted in PubMed, researchers indicated in a hospital-based case-control study of 89 female patients with an incident inguinal hernia and 176 age-matched female controls. Activity since birth with two validated questionnaires was measured and smoking habits, medical and operation history, Quetelet index (kg/m2), and history of pregnancies and deliveries were recorded. Response for cases was 81% and for controls 73%. Total physical activity was not associated with inguinal hernia (univariate odds ratio (OR) = 0.8, 95% confidence interval (CI) 0.6-1.1), but high present sports activities was associated with less inguinal hernia (multivariate OR = 0.2, 95% CI 0.1-0.7). Obesity (Quetelet index > 30) was also protective for inguinal hernia (OR = 0.2, 95% CI 0.04-1.0). Independent risk factors were positive family history (OR = 4.3, 95% CI 1.9-9.7) and obstipation (OR = 2.5, 95% CI 1.0-6.7).

4. In a study of "The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery" by Lindström D, Sadr Azodi O, Bellocco R, Wladis A, Linder S, Adami J., posted in PubMed, researchers found that smoking increases the risk of postoperative complications even in minor surgery such as inguinal hernia procedures. Obesity increases hospitalization after inguinal hernia surgery. The Swedish version of oral moist tobacco, snus, does not seem to affect the complication rate after hernia surgery at all.

5. According to the study of "Inguinal hernia recurrence: classification and approach" by Campanelli G, Pettinari D, Nicolosi FM, Cavalli M, Avesani EC., posted in PubMed, researchers found that following a simple anatomo-clinical classification into three types that could be used to orient surgical strategy, were: type R1--first recurrence of "high" oblique external reducible hernia with small (<2 cm) defect in non-obese patients after pure tissue or mesh repair; type R2--first recurrence of "low" direct reducible hernia with small (<2 cm) defect in non-obese patients after pure tissue or mesh repair; and type R3--all other recurrences, including femoral recurrences, recurrent groin hernia with large defect (inguinal eventration), multi-recurrent hernias, non-reducible contralateral primary or recurrent hernia, and situations compromised by aggravating factors (e.g. obesity) or otherwise not easily included in R1 or R2 after pure tissue or mesh repair.

6. Etc.

E. Treatments of Obesity and Inguinal Hernia
1. According to the study of "Local anesthetic hernia repair in overweight and obese patients" by Reid TD, Sanjay P, Woodward A, posted in PubMed, researchers found that Local anesthetic inguinal hernia repair in the obese is safe and well tolerated. Use of a large volume local anesthetic mixture is recommended in overweight and obese patients.

2.In the study of "Factors determining the doses of local anesthetic agents in unilateral inguinal hernia repair" by Kulacoglu H, Ozyaylali I, Yazicioglu D., popsted in PubMed, researchers indicated that again, the feasibility of local anesthesia in elective inguinal hernia repair in all patient groups with different characteristics. The mean and maximum doses of local anesthetic agents were well within safety limits, even in recurrent and large hernias. Younger age, large hernias, recurrent hernias, omental mass in the hernia sac, high BMI, and duration of operation might be the factors affecting local anesthetic doses. The significant independent parameters in the multivariate analysis were duration of operation, sac content, and BMI for lidocaine dose, whereas the duration of operation and sac content were determinative for the sum volume of lidocaine and bupivacaine.

3. Etc.

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