Incisional hernia recurrence after open elective repair: expertise in abdominal wall surgery matters

Pereira, José António; Bravo-Salvá, Alejandro; Montcusí, Blanca; Pérez-Farre, S.; Prado, Laura Fresno de; López-Cano, Manuel

doi:10.1186/s12893-019-0569-6

Cited by 17 publications

(15 citation statements)

References 28 publications

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“…When the operations were performed in an AWU, there were fewer complications (66.7% vs. 28.6%; P = 0.04). These data confirm the risks of urgent IH surgery [24] and support the hypothesis that these techniques should be performed, if possible, by specialized surgeons [13] or should be avoided, particularly in higher risk situations, such as emergencies.…”

Section: Discussionsupporting

confidence: 83%

Early outcomes of component separation techniques: an analysis of the Spanish registry of incisional Hernia (EVEREG)

Rodríguez

Bravo-Salvá

Montcusí-Ventura

et al. 2021

Hernia

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Aim To analyze the outcomes of component separation techniques (CST) to treat incisional hernias (IH) in a large multicenter cohort of patients. Methods All IH repair using CST, registered in EVEREG from July 2012 to December 2019, were included. Data on the pre-operative patient characteristics and comorbidities, IH characteristics, surgical technique, complications, and recurrence were collected. Outcomes between anterior (ACS) and posterior component separation (PCS) techniques were compared. Risk factors for complications and recurrences were analyzed. Results During the study period, 1536 patients underwent CST (45.5% females) with a median age of 64.0 years and median body mass index (BMI) of 29.7 kg/m2. ACS was the most common technique (77.7%). Overall complications were frequent in both ACS and PCS techniques (36.5%), with a higher frequency of wound infection (10.6% vs. 7.0%; P = 0.05) and skin necrosis (4.4% vs. 0.1%; P < 0.0001) with the ACS technique. Main factors leading to major complications were mesh explant (OR 1.72; P = 0.001), previous repair (OR 0.75; P = 0.038), morbid obesity (OR 0.67; P = 0.015), ASA grade (OR 0.62; P < 0.0001), COPD (OR 0.52; P < 0.0001), and longitudinal diameter larger than 10 cm (OR 0.58; P = 0.001). After a minimum follow-up of 6 months (median 15 months; N = 590), 59 (10.0%) recurrences were diagnosed. Operations performed in a non-specialized unit were significantly associated with recurrences (HR 4.903, CI 1.64–14.65; P = 0.004). Conclusion CST is a complex procedure with a high rate of complications. Both ACS and PCS techniques have similar complication and recurrence rates. Operations performed in a specialized unit have better outcomes.

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Section: Discussionsupporting

confidence: 83%

Early outcomes of component separation techniques: an analysis of the Spanish registry of incisional Hernia (EVEREG)

Rodríguez

Bravo-Salvá

Montcusí-Ventura

et al. 2021

Hernia

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“…The second biggest influence is the prices of the mesh (β = −0.500, p < 0.001). This fits in with the increased complexity of these hernias and their care as described in the literature, as well as the increased complication rate compared to primary ventral hernias [ 4 , 33 , 34 , 35 , 40 , 41 ]. The epidemiological factor BMI (β = −0.590, p < 0.001), as well as non-modifiable epidemiological factors such as gender (β = −0.113, p = 0.055) and age (β = −0.026) also have a major influence ( p < 0.050).…”

Section: Discussionsupporting

confidence: 55%

“…The complication rate for primary ventral hernia care is displayed as 3–23% [ 29 , 30 , 31 , 32 ]. The rate of complications in incisional hernia care is presented as 12.7–29.1% [ 33 , 34 , 35 ]. These data show that ventral hernia repair is an important surgical issue.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Factors Relevant to Revenue Improvement in Ventral Hernia Repair, Their Influence on Surgical Training, and Development of Predictive Models: An Economic Evaluation

et al. 2021

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Background: Ventral hernia repairs (VHR) are frequent but loss- making. This study aims to identify epidemiological and procedure related factors in VHR and their influence on surgical training. Methods: Data from 86 consecutive patients who underwent VHR in 2019 was collected. Moreover, 66 primary ventral hernias and 20 incisional hernias were repaired in open procedures. Linear regression models were made. Results: Primary VHR procedures showed a mean deficit of −378.17 CHF per case. Incisional hernia repair procedures resulted in a deficit of −1442.50 CHF per case. The two hernia groups were heterogeneous. For the primary VHR procedures, the surgery time (β = 0.564, p < 0.001) had the greatest influence, followed by the costs of the mesh (β = −0.215, p < 0.001). The epidemiological factors gender (β = 0.143, p < 0.01) and body mass index (BMI) (β = −0.087, p = 0.074) were also influential. For incisional hernia procedures a surgeon’s experience had the most significant influence (β = 0.942, p < 0.001), and the second largest influence was the price of the mesh (β = -.500, p < 0.001). The epidemiological factor BMI (β = −0.590, p < 0.001), gender (β = −0.113, p = 0.055) and age (β = −0.026, p < 0.050) also had a significant influence. Conclusion: Our analysis shows a way of improving financial results in the field of ventral hernia repair. Costs can be visualized and reduced to optimize revenue enhancement in surgical departments. In our analysis primary ventral hernias are an appropriate training operation, in which the experience of the surgeon has no significant impact on costs. In primary VHR procedures, revenue enhancement is limited when using an expensive mesh. However, the treatment of incisional hernias is recommended by specialists. The financial burden is significantly higher with less experience. Therefore, these operations are not suitable for surgical training. The re-operation rate decreases with increasing experience of the surgeon. This directly affects the Patient Related Outcome (PROM) and quality of treatment. Therefore, high-quality training must be enforced. Since financial pressure on hospitals is increasing further, it is crucial to investigate cost influencing factors. The majority of Swiss public hospitals will no longer be able to operate ventral hernias profitably without new concepts. In addition to purchasing management, new construction projects, and mergers, improving the results of individual departments is a key factor in maintaining the profitability of hospitals in the future regarding hernia repair without losing the scope of teaching procedures.

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“…Previous studies have reported that patients treated by surgeons who have specialized training and clinical practice focused on abdominal wall reconstruction [ 14 ], or those who perform high volumes of incisional hernia surgery [ 15 ], have better outcomes compared to other patients. These improved results may be due to more appropriate choice of procedures and/or mesh materials, better surgical technique or a combination of both.…”

Section: Discussionmentioning

confidence: 99%

Wide variation in surgical techniques to repair incisional hernias: a survey of practice patterns among general surgeons

MacDonald

Johnson

2021

BMC Surg

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Background The purpose of this research was to examine the self-reported practice patterns of Canadian general surgeons regarding the elective repair of incisional hernias. Methods A mail survey was sent to all general surgeons in Canada. Data were collected regarding surgeon training, years in practice, practice setting and management of incisional hernias. Surgeons were asked to describe their usual surgical approach for a patient with a midline incisional hernia and a 10 × 6 cm fascial defect. Results Of the 1876 surveys mailed out 555 (30%) were returned and 483 surgeons indicated that they perform incisional hernia repair. The majority (62%) have been in practice > 10 years and 73% regularly repair incisional hernias. In response to the clinical scenario of a patient with an incisional hernia, 74% indicated that they would perform an open repair and 18% would perform a laparoscopic repair. Ninety eight percent of surgeons would use mesh, 73% would perform primary fascial closure and 47% would perform a component separation. The most common locations for mesh placement were intraperitoneal (46%) and retrorectus/preperitoneal (48%). The most common repair, which was reported by 37% of surgeons, was an open operation, with mesh, with primary fascial closure and a component separation. Conclusions While almost all surgeons who perform incisional hernia repairs would use permanent mesh, there was substantial variation reported in surgical approach, mesh location, fascial closure and use of component separation techniques. It is unclear how this variability may impact healthcare resources and patient outcomes.

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Incisional hernia recurrence after open elective repair: expertise in abdominal wall surgery matters

Cited by 17 publications

References 28 publications

Early outcomes of component separation techniques: an analysis of the Spanish registry of incisional Hernia (EVEREG)

Early outcomes of component separation techniques: an analysis of the Spanish registry of incisional Hernia (EVEREG)

Analysis of Factors Relevant to Revenue Improvement in Ventral Hernia Repair, Their Influence on Surgical Training, and Development of Predictive Models: An Economic Evaluation

Wide variation in surgical techniques to repair incisional hernias: a survey of practice patterns among general surgeons

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