The University of North Carolina at Chapel Hill School of Medicine, Department of Surgery, Chapel Hill, NC, USA.
The University of North Carolina at Chapel Hill School of Medicine, Department of Surgery, Chapel Hill, NC, USA.
J Am Med Dir Assoc. 2022 Apr;23(4):563-567. doi: 10.1016/j.jamda.2022.02.008. Epub 2022 Mar 5.
Groin hernia repair is one of the most common surgeries performed in the United States, with more than 700,000 performed every year. These repairs are commonly performed in an elective setting to alleviate symptoms and prevent obstruction and/or strangulation. Prior studies have demonstrated that watchful waiting is a reasonable option compared with surgery, because of the low risk of life-threatening complications from groin hernias. However, other studies have demonstrated that there is increased risk of mortality after surgery in older persons (age ≥65 years). Therefore, the question is if and when older patients should pursue groin hernia repair. In this article, we provide an evidence-based overview on the management and treatment of inguinal hernia repair in older persons. Focusing on which patients should be repaired, the optimal timing of surgery, what is the best anesthesia, how the repair should be performed, and the importance of understanding frailty should help surgeons and primary care physicians determine the best management of inguinal hernias in older adults.
腹股沟疝修补术是美国最常见的手术之一，每年有超过 70 万例手术。这些修复通常在选择性环境中进行，以缓解症状并预防阻塞和/或绞窄。先前的研究表明，与手术相比，密切观察等待是一种合理的选择，因为腹股沟疝导致危及生命的并发症的风险较低。然而，其他研究表明，老年人（年龄≥65 岁）手术后的死亡率增加。因此，问题是老年患者是否应该进行腹股沟疝修补术。在本文中，我们提供了老年人腹股沟疝治疗的循证概述。重点介绍哪些患者应该接受修复、手术的最佳时机、最佳麻醉方法、修复的方法以及了解脆弱性的重要性，这些都有助于外科医生和初级保健医生确定老年人腹股沟疝的最佳治疗方法。
