Law of Diminishing Returns in Ventral Hernia Repair: Fact or Fiction?

Abstract

Background: Repeated ventral hernia repair is associated with increased risk of complications and recurrence. The authors present the first study looking at how repeated ventral hernia repair affects quality of life, and whether there is a relationship between the number of prior repairs and quality-of-life improvement after surgery. Methods: A retrospective chart review was conducted of patients undergoing ventral hernia repair between August of 2017 and August of 2019, who completed at least one preoperative and postoperative Abdominal Hernia-Q. Patients were split into four cohorts based on number of prior repairs (zero, one, two, or three or more). Categorical data were compared using chi-square and Fisher’s exact tests, and continuous data were analyzed using Kruskal-Wallis tests. Results: Ninety-three patients met inclusion criteria, with 19 (20 percent), 45 (48 percent), 15 (16 percent), and 14 patients (15 percent) in each cohort, ranging from zero to three or more prior repairs. Patients with more prior repairs were significantly more likely to be readmitted and undergo reoperation (p = 0.04 and p = 0.01, respectively), in addition to significantly higher cost of care (p = 0.004). Patients with three or more prior repairs had significantly lower preoperative quality of life when compared to patients with two or fewer prior repairs (p = 0.04). However, all patients reported a similar absolute level of quality of life postoperatively, irrespective of prior repairs (p = 0.34). Conclusions: Treatment of recurrent hernia remains a challenge because of poor clinical outcomes and higher risk of recurrence. This study shows that patients with multiple prior ventral hernia repairs report similar postoperative quality of life as patients undergoing primary repair. This information is valuable in determining appropriate surgical candidates and improving preoperative counseling. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Contemporary Abdominal Wall Reconstruction: Emerging Techniques and Trends

“…Multiple methods have emerged to maximize fascial reapproximation, and mesh has proven a rich substrate for innovation. Implicated in the repair of hernias is preventing hernia complications such as bowel incarceration or strangulation, as well as optimizing the aesthetic restoration of the abdomen [6]. In addition to the surgical emergencies that hernias can precipitate, they have been shown to significantly impact patients' quality of life and body image [6].…”

“…Implicated in the repair of hernias is preventing hernia complications such as bowel incarceration or strangulation, as well as optimizing the aesthetic restoration of the abdomen [6]. In addition to the surgical emergencies that hernias can precipitate, they have been shown to significantly impact patients' quality of life and body image [6]. Interestingly, data demonstrates that patients undergoing abdominal wall reconstruction report significant increases in quality of life after repair regardless of the number of prior repairs [7].…”

Discussion: Law of Diminishing Returns in Ventral Hernia Repair: Fact or Fiction?

“…P atel et al should be congratulated for a wellwritten article on an important outcome of ventral hernia repair. 1 Studies of outcomes following abdominal wall reconstruction have mainly focused on surgical-site complications and hernia recurrence. Given the desire to improve quality of care for patients, patient-reported outcome measures are gaining importance.…”