Effect of hernia size on operative repair and post-operative outcomes after open ventral hernia repair

Abstract

Hernia defect size affects operative time and surgical technique for repair of a ventral hernia. Larger defect size is associated with increased post-operative morbidity and length of stay but not readmission, recurrence, or mortality. Hernia size greater than 400 cm should not be a limitation to operative repair.

Increasing hernia size requires higher GRIP values for a biomechanically stable ventral hernia repair

“…Most randomized controlled studies quote hernia dimensions as an inclusion criteria but fail to report the mesh sizes used in relation to the hernia size [ 1 ]. Hernia overlap not tailored to the diameter of the hernia orifice is recognized as a key determinant of hernia recurrence [ 14 , 15 ]. Calculating the grip can take into account the mesh-defect area ratio and might give a unifying view on the various types of repair [ 8 , 9 ].…”

A systematic methodological review of reported perioperative variables, postoperative outcomes and hernia recurrence from randomised controlled trials of elective ventral hernia repair: clear definitions and standardised datasets are needed

“…Loss of domain was not reported by any trial. Because current evidence is contradictory, with some studies suggesting that hernia width does correlate with recurrence [64] whereas others do not [65,66], future trials need to report apparently important predictors to facilitate subsequent analysis. Investigators should also grade hernias using appropriate scales, for example the VHWG scale [17] and the CDC wound classification scale [27] as these scales themselves may prove to be outcome predictors.…”

Proposal for a national triage system for the management of ventral hernias

“…18 Indeed, two recently published and internally validated risk stratification scores include an ASA grade of greater than or equal to 3 as a major predictor for surgical site infection and recurrence following ventral hernia repair surgery. 8,9 Our pathway recognises ASA grade 3 or above as a risk factor and, in the presence of other patient factors, may result in patients being referred to and treated in a specialist hernia centre. In addition, patients are stratified preoperatively based on risk and a multidisciplinary team approach is taken to optimise medical comorbidities before surgery.…”

“…6 Creation of a formal hernia subspecialisation pathway (including referral, where appropriate, to specialist hernia centres) is reliant upon an accurate, widely accepted and relevant grading system to establish the severity of the ventral hernia and the need for specialist input. In recent years, several grading scales have been proposed 7,8,9 but few have been externally validated and with limited success. 10 In addition, these scales are not practical for clinical use and do not allow for ventral hernia triage as many evidencebased predictor variables are not used.…”