Complications and recurrence rates of patients with Ehlers-Danlos syndrome undergoing ventral hernioplasty: a case series

Abstract

PurposeVentral hernia repair is one of the most frequently performed surgical procedures, though recurrences are common. Recurrence can be caused by impaired collagen formation or maturation; hence, patients with Ehlers-Danlos syndrome (EDS) are potentially at increased risk for hernia recurrence. EDS causes altered collagen metabolism, though little is known about the influence of EDS on ventral hernioplasty outcomes. This study aims to analyze these patients to report complication rates, recurrence rates, and, if possible, to give recommendations for surgical intervention.MethodsA retrospective analysis between January 2000 and January 2017 was performed in a university hospital Belgium (UZ Ghent). Data on baseline characteristics, primary surgery, and hernias were extracted from patients’ medical charts. Noted endpoints were postoperative complications and recurrences.ResultsFourteen patients (50% males) were included. Ten (71%) had an incisional hernia and four (29%) had a primary ventral hernia. Median age was 45 years (IQR 37.75–52.75), median BMI was 24.82 (IQR 22.43–26.87). Four patients (29%) smoked, one patient (7.1%) had diabetes mellitus, and five patients (36%) had an aneurysm of the abdominal aorta. All patients underwent elective open hernioplasty with mesh reinforcement. Three patients (21%) had a postoperative complication (two infections, one seroma). Recurrence rate was 7.1% (one patient).ConclusionsThis series describes 14 patients with a median follow-up of 50 months and a recurrence rate of 7.1%. The low recurrence rate could be explained by the use of large meshes that reinforce the entire midline to compensate for the reduced collagen strength in EDS patients.

Prevention of incisional hernia using different suture materials for closing the abdominal wall: a comparison of PDS, Vicryl and Prolene in a rat model

“…In high-risk patients, the incidence increases to up to 30% [5,6]. The identified patient-related risk factors are obesity (BMI > 25 kg/m 2 ), the presence of an abdominal aortic aneurysm and congenital connective tissue disorders [7][8][9][10][11][12]. Furthermore, postoperative wound complications are an independent risk factor for the development of an incisional hernia [9].…”

Year-Over-Year Ventral Hernia Recurrence Rates and Risk Factors

“…Furthermore, we demonstrated that greater mesh width was associated with lower recurrence rates. This may be attributed to increased coverage and support of the hernia defect, enhanced tissue ingrowth and incorporation, and improved tension distribution across the abdominal wall . Limited studies have analyzed effects of mesh overlap as well as mesh area-to-defect ratio on recurrence; however, few if any have specifically examined the impact of exact mesh size on recurrence rates.…”