Incidence and risk factors for incisional hernia and recurrence: Retrospective analysis of the French national database

Gignoux, B; Bayon, Yves; Martin, D. F.; Phan, Raksmey; Augusto, Vincent; Darnis, Benjamin; Sarazin, Marianne

doi:10.1111/codi.15581

Cited by 33 publications

(22 citation statements)

References 31 publications

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“…Interestingly, we found older patients and patients with higher BMI to have significantly lower risk of hernia recurrence during the study period. Particularly with regard to BMI, these findings run counter to existing population-level literature, which suggests that patients with higher BMI have significantly greater risk of recurrence after hernia repair 29–31. It is possible that our findings reflect differences in the subjective experiences of these patients based on the PROs we collected.…”

Section: Discussioncontrasting

confidence: 99%

“…Particularly with regard to BMI, these findings run counter to existing population-level literature, which suggests that patients with higher BMI have significantly greater risk of recurrence after hernia repair. [29][30][31] It is possible that our findings reflect differences in the subjective experiences of these patients based on the PROs we collected. For reasons unknown, patients in these categories may have been less likely to perceive or report a bulge on PROs and therefore been less likely to have been counted as a recurrence.…”

Section: Discussionmentioning

confidence: 92%

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Long-term Clinical and Patient-Reported Outcomes After Transversus Abdominis Release With Permanent Synthetic Mesh: A Single Center Analysis of 1203 Patients

et al. 2022

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Objective: We aimed to report long-term clinical and patient-reported outcomes of transversus abdominis release (TAR) with permanent synthetic mesh performed in a high-volume abdominal wall reconstruction practice. Summary Background Data: Despite increasing utilization of TAR in abdominal wall reconstruction, long-term clinical and patient-reported outcomes remain uncertain. Methods: Prospectively collected registry data from the Cleveland Clinic Center for Abdominal Core Health were analyzed retrospectively. Patients undergoing elective, open VHR with TAR and permanent synthetic mesh implantation between August 2014 and March 2020 with 30-day clinical and ≥1 year clinical or patient-reported outcome follow-up were included. Outcomes included composite hernia recurrence, characterized by patient-reported bulges and recurrent hernias noted on physical exam or imaging, as well as hernia-specific quality of life and pain. Results: A total of 1203 patients were included. Median age was 60 years [interquartile range (IQR): 52–67], median body mass index was 32 kg/m2 (IQR: 28–36), median hernia width was 15 cm (IQR: 12–19), and 57% of hernias were recurrent. Fascial reapproximation was achieved in 92%. At a median follow-up of 2 years (IQR: 1–4), the overall composite hernia recurrence rate was 26%, with sensitivity analysis yielding best-case and worst-case estimates of 5% and 28%, respectively. Patients experienced improved hernia-specific quality of life and pain regardless of recurrence outcome; however, those who did not recur experienced more substantial improvement. Conclusions: TAR with permanent synthetic mesh remains a valuable, versatile technique; however, surgeon and patient expectations should be tempered regarding long-term durability. Despite a high rate of recurrence, patients experience measurable improvements in quality of life.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 92%

Long-term Clinical and Patient-Reported Outcomes After Transversus Abdominis Release With Permanent Synthetic Mesh: A Single Center Analysis of 1203 Patients

et al. 2022

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“…The patient and technical factors are important causes in its development. Age, obesity, malnutrition, connective tissue disorders, improper fascial closure, and certain surgeries like bariatric surgery contribute to improper wound healing and leave the patient at a higher risk of developing a hernia [2,3].…”

Section: Introductionmentioning

confidence: 99%

Effect of Suture Length on the Incidence of Incisional Hernia and Surgical Site Infection in Patients Undergoing Midline Laparotomy: A Systematic Review and Meta-Analysis

Sekhar¹,

Ekka²,

Nair³

et al. 2023

Cureus

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The development of an incisional hernia is a common complication of midline laparotomy. Improper fascial closure techniques have a significant role in its development. It can also lead to poor wound healing and increase the risk of developing surgical site infections (SSI). Upon conducting a thorough literature review, various studies have been conducted on closing abdominal wounds. However, there is a dearth of studies portraying the role of suture length in the prevention of incisional hernia and SSI. The effect of using a greater suture-to-wound length ratio on postoperative outcomes was not clearly analyzed or described. The objective of this study is to assess the effectiveness of using a suture length to wound length ratio ≥4:1 versus a ratio <4:1 in preventing postoperative complications such as incisional hernia and SSI.This study is a systematic review of randomized controlled trials on abdominal wound closure using a suture length to wound length ratio of ≥4:1 and <4:1. published in PubMed, Google Scholar, and Cochrane library. The inclusion and exclusion criteria were defined. The relevant studies identified from 1991 to 2017, were included in the analysis. The primary endpoint was the incidence of incisional hernia, and the secondary outcome was the incidence of SSI.This meta-analysis considered five randomized controlled trials that compared the effects of using different suture length to wound length ratios during abdominal closure on incisional hernia and SSI. Participants ranged in size from 100 to 363. The trial follow-up period ranged from a minimum of 10 months to five years. The outcomes studied in the two groups were incisional hernia and SSI. The relative risk of the occurrence of incisional hernia if the suture length to wound length ratio was ≥4:1 was 0.42 with a p-value of <0.001 which was considered significant. This implied that using a suture length of more than four times that of the wound i.e., 4:1, significantly decreases the risk of developing an incisional hernia by more than half. The relative risk of developing a SSI was 0.98 with a p-value of 0.966. Thus, this method of abdominal closure uing a longer suture length to wound length ratio does not contribute to an increased incidence or significant change in the risk of developing SSI.

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“…The incidence of incisional hernia (IH) after laparotomy varies from 5% to 17%; depending upon the time lapsed and the type of initial surgery. 1,2 Giant incisional hernias (IH larger than 10 cm, GIHs) are a special entity and are commonly repaired with a non-absorbable mesh placed in the retromuscular plane, with the hernia sac (HS) as a barrier between the mesh and abdominal contents. 3 A common problem in long-standing GIHs is a combination of wide separation of recti, inability to close the anterior rectus sheath primarily, and a thin, poorly vascularised, stretched overlying skin.…”

Section: Introductionmentioning

confidence: 99%

‘Flip-flap’ hernia sac sandwich mesh hernioplasty for giant incisional hernia

et al. 2023

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Purpose: The treatment of giant ventral hernia (GVH) with domain loss is a challenge for surgeons. This modified and simplified form of sandwich technique in a form of flip-flap repair was done to assess the outcomes of GVH repair by using the hernia sac taking into account the late complications in terms of recurrence, mesh explantation and early: SSO (surgical site occurrence). Material and method: A total of 21 patients of GVH were treated with flip-flap repair technique in the department of surgery in a teaching hospital in the central India between December 16 to June 21. In flip-flap technique the hernia sac is tailored in the best possible way, by making multiple layered flaps encasing the Polypropylene mesh in between, separating it from intraperitoneal contents and subcutaneous tissue. Results: In this prospective and interventional study, the collected data revealed the mean follow up period of 22.3 months (7months to 48months). Mean age was 44.2years (27-65 years). SSO was seen in 38% of cases mainly in the form of SSI. No explantation of mesh and recurrence was seen in any patient. Conclusion: The flip-flap repair technique is safe and effective surgical technique that can be used for the treatment of GVH regardless of the size, BMI or position of hernia.

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Incidence and risk factors for incisional hernia and recurrence: Retrospective analysis of the French national database

Cited by 33 publications

References 31 publications

Long-term Clinical and Patient-Reported Outcomes After Transversus Abdominis Release With Permanent Synthetic Mesh: A Single Center Analysis of 1203 Patients

Long-term Clinical and Patient-Reported Outcomes After Transversus Abdominis Release With Permanent Synthetic Mesh: A Single Center Analysis of 1203 Patients

Effect of Suture Length on the Incidence of Incisional Hernia and Surgical Site Infection in Patients Undergoing Midline Laparotomy: A Systematic Review and Meta-Analysis

‘Flip-flap’ hernia sac sandwich mesh hernioplasty for giant incisional hernia

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