Systemic Inflammatory Response After Hernia Repair: a Systematic Review

Overview

Journal Langenbecks Arch Surg

Specialty General Surgery

Date 2017 Aug 24

PMID 28831565

Citations 9

Authors

Dunja Kokotovic

Jakob Burcharth

Frederik Helgstrand

Ismail Gogenur

Affiliations

Soon will be listed here.

Abstract

Purpose: All surgical procedures elicit a complex systemic inflammatory response effectuated and modulated by cytokines. The purpose of this systematic review was to present an overview of the inflammatory response and the serum markers associated with hernia repair and to compare the response between patients treated with and without mesh.

Methods: The review was conducted in line with PRISMA guidelines. The outcomes of interest were serum concentration of leukocytes, cytokines, and acute phase proteins before and after hernia repair with or without mesh reinforcement. The risk of bias was assessed using the Cochrane ROBINS-I tool for non-randomized studies of intervention.

Results: A total of 31 studies were included in the systematic review including 1326 patients with a mean age ranging from 33 to 67 years. The studies predominantly included males (95.0% males, 5.0% female) with inguinal hernias (98.5% inguinal hernias, 1.5% incisional hernias). The inflammatory response after hernia repair was characterized by an increase in CRP, IL-6, leukocytes, neutrophils, IL-1, IL-10, fibrinogen, and α1-antitrypsin and a decrease in lymphocytes and albumin within the first 24 postoperative hours. The systemic inflammatory response was normalized before or on the seventh postoperative day. A higher CRP and IL-6 serum concentration was found in patients treated with mesh compared with sutured repairs.

Conclusions: Hernia repair elicits a systemic inflammatory response characterized by an increase in CRP, IL-6, leukocytes, neutrophils, IL-1, IL-10, fibrinogen, and α1-antitrypsin and a decrease in lymphocytes and albumin. A higher inflammatory response was found after mesh repair compared with non-mesh repair and after open mesh repair compared with laparoscopic mesh repair.

Citing Articles

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References

Jakeways M, Mitchell V, Hashim I, Chadwick S, Shenkin A, Green C . Metabolic and inflammatory responses after open or laparoscopic cholecystectomy. Br J Surg. 1994; 81(1):127-31. DOI: 10.1002/bjs.1800810146. View

Rosch R, Junge K, Schachtrupp A, Klinge U, Klosterhalfen B, Schumpelick V . Mesh implants in hernia repair. Inflammatory cell response in a rat model. Eur Surg Res. 2003; 35(3):161-6. DOI: 10.1159/000070045. View

Papaziogas B, Koutelidakis I, Giamarellos-Bourboulis E, Lazaridis C, Koussoulas V, Galanis I . Lipid peroxidation and inguinal hernia repair. Tension-free vs. Andrews technique. Prostaglandins Leukot Essent Fatty Acids. 2004; 71(4):221-5. DOI: 10.1016/j.plefa.2004.03.016. View

Esser N, Legrand-Poels S, Piette J, Scheen A, Paquot N . Inflammation as a link between obesity, metabolic syndrome and type 2 diabetes. Diabetes Res Clin Pract. 2014; 105(2):141-50. DOI: 10.1016/j.diabres.2014.04.006. View

Sterne J, Hernan M, Reeves B, Savovic J, Berkman N, Viswanathan M . ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016; 355:i4919. PMC: 5062054. DOI: 10.1136/bmj.i4919. View

Di Vita G, Patti R, DAgostino P, Arcoleo F, Caruso G, Arcara M . Serum VEGF and b-FGF profiles after tension-free or conventional hernioplasty. Langenbecks Arch Surg. 2005; 390(6):528-33. DOI: 10.1007/s00423-005-0578-z. View

DeVon H, Piano M, Rosenfeld A, Hoppensteadt D . The association of pain with protein inflammatory biomarkers: a review of the literature. Nurs Res. 2013; 63(1):51-62. DOI: 10.1097/NNR.0000000000000013. View

Welsch T, Muller S, Ulrich A, Kischlat A, Hinz U, Kienle P . C-reactive protein as early predictor for infectious postoperative complications in rectal surgery. Int J Colorectal Dis. 2007; 22(12):1499-507. DOI: 10.1007/s00384-007-0354-3. View

Burger J, Luijendijk R, Hop W, Halm J, Verdaasdonk E, Jeekel J . Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg. 2004; 240(4):578-83. PMC: 1356459. DOI: 10.1097/01.sla.0000141193.08524.e7. View

10.

Suter M, Martinet O, Spertini F . Reduced acute phase response after laparoscopic total extraperitoneal bilateral hernia repair compared to open repair with the Stoppa procedure. Surg Endosc. 2002; 16(8):1214-9. DOI: 10.1007/s00464-001-9164-9. View

11.

ODwyer M, Owen H, Torrance H . The perioperative immune response. Curr Opin Crit Care. 2015; 21(4):336-42. DOI: 10.1097/MCC.0000000000000213. View

12.

Parry-Billings M, Baigrie R, Lamont P, Morris P, Newsholme E . Effects of major and minor surgery on plasma glutamine and cytokine levels. Arch Surg. 1992; 127(10):1237-40. DOI: 10.1001/archsurg.1992.01420100099017. View

13.

Tsai Y, Ho C, Tai H, Chung S, Chueh S . Laparoendoscopic single-site versus conventional laparoscopic total extraperitoneal hernia repair: a prospective randomized clinical trial. Surg Endosc. 2013; 27(12):4684-92. DOI: 10.1007/s00464-013-3116-z. View

14.

Pinato D, Bains J, Irkulla S, Pomroy J, Ujam B, Gaze D . Advanced age influences the dynamic changes in circulating C-reactive protein following injury. J Clin Pathol. 2013; 66(8):695-9. DOI: 10.1136/jclinpath-2012-201374. View

15.

Uzunkoy A, Coskun A, Akinci O, Kocyigit A . Systemic stress responses after laparoscopic or open hernia repair. Eur J Surg. 2000; 166(6):467-71. DOI: 10.1080/110241500750008781. View

16.

Hill A, Banwell P, Darzi A, Menzies-Gow N, Monson J, Guillou P . Inflammatory markers following laparoscopic and open hernia repair. Surg Endosc. 1995; 9(6):695-8. DOI: 10.1007/BF00187942. View

17.

Di Vita G, Milano S, Frazzetta M, Patti R, Palazzolo V, Barbera C . Tension-free hernia repair is associated with an increase in inflammatory response markers against the mesh. Am J Surg. 2000; 180(3):203-7. DOI: 10.1016/s0002-9610(00)00445-1. View

18.

Di Vita G, Milano S, Patti R, Raimondo D, Di Bella G, DAgostino P . Cytokine modifications after tension-free hernioplasty or open conventional inguinal hernia repair. Am J Surg. 2001; 181(6):487-91. DOI: 10.1016/s0002-9610(01)00637-7. View

19.

Di Vita G, Patti R, Barrera T, Arcoleo F, Ferlazzo V, Cillari E . Impact of heavy polypropylene mesh and composite light polypropylene and polyglactin 910 on the inflammatory response. Surg Innov. 2010; 17(3):229-35. DOI: 10.1177/1553350610371334. View

20.

Kulacoglu H, Ozdogan M, Gurer A, Ersoy E, Onder Devay A, Duygulu Devay S . Prospective comparison of local, spinal, and general types of anaesthesia regarding oxidative stress following Lichtenstein hernia repair. Bratisl Lek Listy. 2008; 108(8):335-9. View