Comparison of laparoscopic and open inguinal–hernia repair in elderly patients: the experience of two comprehensive medical centers over 10 years - Scorecard - MDSpire
Advertisement
Comparison of laparoscopic and open inguinal–hernia repair in elderly patients: the experience of two comprehensive medical centers over 10 years
Clinical Scorecard: Evaluation of Laparoscopic Versus Open Inguinal Hernia Repair in Geriatric Patients: Insights from Two Comprehensive Medical Centers Over a Decade
At a Glance
Category
Detail
Condition
Inguinal hernia in elderly patients
Key Mechanisms
Progressive loss of tissue strength and increased intra-abdominal pressure with age leading to hernia development
Target Population
Patients aged 65 years or older undergoing inguinal hernia repair
Care Setting
Two medical centers in China with traditional care and surgical-medical co-management (SMC) models
Key Highlights
Laparoscopic repair is associated with less postoperative pain and faster recovery but requires general anesthesia.
Elderly patients have higher perioperative risks due to comorbidities and frailty.
SMC model provides comprehensive perioperative care improving outcomes and reducing complications.
Guideline-Based Recommendations
Diagnosis
Confirm inguinal hernia diagnosis via operative notes and clinical evaluation.
Assess frailty using Frailty Assessment Scale for Elderly Inguinal Hernia Patients.
Preoperative evaluation by multidisciplinary team including internists, surgeons, anesthetists, and specialists.
Management
Select surgical approach (open or laparoscopic) based on patient’s physical condition and multidisciplinary discussion.
Use laparoscopic repair cautiously in elderly patients with ASA classes I–II.
Implement SMC model for perioperative management to optimize outcomes.
Provide adequate pain management, nutrition support, and early mobilization postoperatively.
Monitoring & Follow-up
Monitor for major complications: deep incisional or organ space infections, intestinal injury, mechanical obstruction.
Monitor for minor complications: seroma, bleeding, hematoma, fever, surgical site infection, urine retention, urinary infection.
Observe for other adverse events: delirium, venous thromboembolism, anemia, pneumonia.
Risks
Higher perioperative mortality and complications in elderly due to comorbidities and frailty.
Laparoscopic approach may increase postoperative urine retention and seroma incidence.
General anesthesia required for laparoscopic repair may pose risks in frail elderly.
Patient & Prescribing Data
Elderly patients aged 65 years or older undergoing inguinal hernia repair in Chinese medical centers
Laparoscopic repair under SMC is as safe as open repair with potential benefits in recovery; traditional care associated with longer hospital stays and higher postoperative pain.
Clinical Best Practices
Conduct comprehensive preoperative multidisciplinary evaluation and optimize modifiable risk factors.
Choose surgical approach based on patient’s ASA class, frailty, and preferences.
Employ SMC perioperative care model to reduce complications and improve recovery.
Ensure vigilant postoperative monitoring for complications and early intervention.
Promote early mobilization and rehabilitation exercises to enhance recovery.
Patients with preoperative vitamin D deficiency had higher postoperative pain scores and opioid use after mastectomy, including more than triple the odds of moderate to severe pain within 24 hours of surgery.
