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We also write in response to the article by Wu J. regarding inguinal hernia repair in the elderly [1]. We are in agreement with Li J. pertaining the comments on this manuscript [2]. Wu et al. have conducted a good study and one of the strengths of their analysis stems for the large cohort of octogenarians (1,963). In a previous study, we also found that mortality for an inguinal hernia repair in octogenarians was 13% if it was an emergent operation compared to zero in the elective setting even with a similar ASA in both cohorts [3]. Thus, we are in strong agreement that inguinal hernias should be electively repaired in octogenarians. In addition, we have the following comments to add to this important discussion.
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(1)
Of 1082 inguinal hernias that I have performed in veteran patients since 2005, 66 (6.1%) have been on octogenarians and 3 (0.3%) nonagenarians. We have reviewed outcomes in patients ≥80-year-old (group I) vs. all others (group II). Comparing group I vs. group II the rate of inguinodynia was 0 vs. 1.9% (p = 0.27), recurrence rate was 1.7 vs. 0.8% (p = 0.47). Minor complications were more common in group I 20.3 vs. 9.38% (p = 0.006). Length of stay (LOS) = 1.23 ± 5.99 vs. 0.28 ± 2.01 days (p = 0.23), LOS >2days = 8.47 vs. 2.4% (p = 0.006). Multivariate analysis did not identify and independent predictors of major or minor complications [4].
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(2)
With a follow up of 5.27 ± 3.27 years, 74% of patients were still alive. Twenty-six percent have died of natural causes and the average number of years alive after repair was 2.9 years (range 0.1–9.3 years).
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(3)
The number of patients undergoing IH in the octogenarian cohort continues to increase. In my practice it has been 8, 9 and 15% in the past 3 years.
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(4)
Inguinodynia should not be a factor to consider as an adverse event as in our cohort of veteran patients this is low (n = 1082, age = 60.4 ± 1.4 years old, rate of inguinodynia = 1.5%) [5]. We attribute the low rate of inguinodynia, in part, to the relatively older age of our cohort of patients [6].
References
Wu JJ, Baldwin BC, Goldwater E et al (2017) Should we perform elective inguinal hernia repair in the elderly? Hernia 21:51. doi:10.1007/s10029-016-1517-3
Li J, Zhang W (2017) Hernia. doi:10.1007/s10029-017-1574-2
Huerta S, Pham T, Foster S et al (2014) Outcomes of emergent inguinal hernia repair in veteran octogenarians. Am Surg 80:479–483
Jain VSM, Madni TD, Huerta S (2017) Inguinal hernia repair in octogenarians and beyond. J Surg Res (In Press)
Huerta S, Patel PM, Mokdad AA, Chang J (2016) Predictors of inguinodynia, recurrence, and metachronous hernias after inguinal herniorrhaphy in veteran patients. Am J Surg 212:391–398
Huerta S (2009) Atypical location of the ilioinguinal nerve during herniorrhaphy. Am J Surg 197:427–428
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All of the authors had significant contribution for the content of this work. They all read and approved the final version of this article. Dr. Huerta is primarily responsible for all the content.
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This study was approved by the Institutional Review Board (IRB) at the VA North Texas Health Care System.
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Jain, V., Sultany, M. & Huerta, S. Comment to: Should we perform elective inguinal hernia repair in the elderly? Wu J. J. et al.. Hernia 21, 823–824 (2017). https://doi.org/10.1007/s10029-017-1612-0
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DOI: https://doi.org/10.1007/s10029-017-1612-0