Is Pooled Data Analysis of Ventral and Incisional Hernia Repair Acceptable?

Abstract

PurposeIn meta-analyses and systematic reviews comparing laparoscopic with open repair of ventral hernias, data on umbilical, epigastric, and incisional hernias are pooled. Based on data from the Herniamed Hernia Registry, we aimed to investigate whether the differences in the therapy and treatment results justified such an approach.MethodsBetween 1st September 2009 and 31st August 2013, 31,664 patients with a ventral hernia were enrolled in the Herniamed Hernia Registry. The implicated hernias included 16,206 umbilical hernias, 3,757 epigastric hernias, and 11,701 incisional hernias. Data on the surgical techniques, postoperative complication rates, and 1-year follow-up results were subjected to statistical analysis to identify any significant differences between the various hernia types.ResultsThe laparoscopic IPOM technique was used significantly more often for incisional hernia than for epigastric hernia, 31.3 vs. 24.0%, respectively, and was used for 12.9% of umbilical hernias (p < 0.0001). Likewise, the open technique with suturing of defect was used significantly more often for umbilical hernia than for epigastric hernia, 56.1 vs. 35.4%, respectively, and was used for 12.5% of incisional hernias (p < 0.0001). The postoperative complication rates of 3.2% for umbilical hernia and 3.5% for epigastric hernia were significantly lower than for incisional hernia, at 9.2% (p < 0.0001). That was also true for the reoperation rates due to postoperative complications, of 1.0 vs. 1.2 vs. 4.2% (p < 0.0001). The 1-year follow-up revealed significantly higher recurrence rates as well as rates of chronic pain needing treatment of 6.3 and 7.9%, respectively, for incisional hernia, compared with 4.1 and 4.3%, respectively, for epigastric hernia, and 2 and 1.9%, respectively, for umbilical hernia (p < 0.0001).ConclusionSince significant differences were identified in the therapy and treatment results between umbilical hernia, epigastric hernia, and incisional hernia, scientific studies should be conducted comparing the various surgical techniques only for a single hernia type.

Laparoscopic ventral hernia repair: outcomes in primary versus incisional hernias: no effect of defect closure

“…Most studies pool PH and IH in LVHR and repeatedly report a recurrence rate close to 5% in these pooled analyses [30,86,150]. That epigastric and umbilical hernia have different outcome has been elucidated by a registry study [151], and may have diverse etiologies [152]. In synopsis, the results from the PH cohort treated with LVHR in our study do not differ from published reports and seem to add to the pool of evidence that favors this methodology.…”

External Validation of the European Hernia Society Classification for Postoperative Complications after Incisional Hernia Repair: A Cohort Study of 2,191 Patients

“…Several studies have addressed the issue of postoperative complications after incisional hernia repair, [9][10][11] but these studies did not correct for any risk factors and did not use any size classification, such as the EHS classification.…”

Accreditation and certification requirements for hernia centers and surgeons: the ACCESS project

“…The national risk in Denmark of 30-day readmission following umbilical and epigastric hernia repair mainly due to the occurrence of a wound infection, hematoma, seroma, and pain is 5% with a complication-related re-operation rate of 0.3% [ 78 ]. In the Herniamed Registry, the 30-day postoperative surgical complication rates in 16,206 umbilical hernias was found to be 3.2% and in 3,757 epigastric hernias 3.5% [ 79 ]. The corresponding complication-related re-operation rates for umbilical and epigastric hernias were 1.0% and 1.2%, respectively [ 79 ].…”

“…In the Herniamed Registry, the 30-day postoperative surgical complication rates in 16,206 umbilical hernias was found to be 3.2% and in 3,757 epigastric hernias 3.5% [ 79 ]. The corresponding complication-related re-operation rates for umbilical and epigastric hernias were 1.0% and 1.2%, respectively [ 79 ].…”