Long-term Recurrence and Complications Associated With Elective Incisional Hernia Repair

Kokotovic, Dunja; Bisgaard, Thue; Helgstrand, Frederik

doi:10.1001/jama.2016.15217

Cited by 315 publications

(214 citation statements)

References 36 publications

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“…Given the well-established collagen impairment in EDS patients, a high recurrence rate in this population was anticipated. However, the 7% recurrence rate after open mesh repair in this study is lower than the 12% found in literature in the general patient population after elective open ventral hernioplasty with mesh reinforcement, after a median follow-up of 59 months [15]. The low recurrence rate can potentially be explained by the large mesh size.…”

Section: Discussioncontrasting

confidence: 55%

Complications and recurrence rates of patients with Ehlers-Danlos syndrome undergoing ventral hernioplasty: a case series

Kroese

Mommers

Robbens

et al. 2018

Hernia

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PurposeVentral hernia repair is one of the most frequently performed surgical procedures, though recurrences are common. Recurrence can be caused by impaired collagen formation or maturation; hence, patients with Ehlers-Danlos syndrome (EDS) are potentially at increased risk for hernia recurrence. EDS causes altered collagen metabolism, though little is known about the influence of EDS on ventral hernioplasty outcomes. This study aims to analyze these patients to report complication rates, recurrence rates, and, if possible, to give recommendations for surgical intervention.MethodsA retrospective analysis between January 2000 and January 2017 was performed in a university hospital Belgium (UZ Ghent). Data on baseline characteristics, primary surgery, and hernias were extracted from patients’ medical charts. Noted endpoints were postoperative complications and recurrences.ResultsFourteen patients (50% males) were included. Ten (71%) had an incisional hernia and four (29%) had a primary ventral hernia. Median age was 45 years (IQR 37.75–52.75), median BMI was 24.82 (IQR 22.43–26.87). Four patients (29%) smoked, one patient (7.1%) had diabetes mellitus, and five patients (36%) had an aneurysm of the abdominal aorta. All patients underwent elective open hernioplasty with mesh reinforcement. Three patients (21%) had a postoperative complication (two infections, one seroma). Recurrence rate was 7.1% (one patient).ConclusionsThis series describes 14 patients with a median follow-up of 50 months and a recurrence rate of 7.1%. The low recurrence rate could be explained by the use of large meshes that reinforce the entire midline to compensate for the reduced collagen strength in EDS patients.

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Section: Discussioncontrasting

confidence: 55%

Complications and recurrence rates of patients with Ehlers-Danlos syndrome undergoing ventral hernioplasty: a case series

Kroese

Mommers

Robbens

et al. 2018

Hernia

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“…The size of the abdominal wall defect is an independent factor for the incidence of postoperative complications and recurrences. The risk of mesh-related complications is directly proportional to the size of the mesh placed (13)(14)(15). With regard to gain in quality of life, perioperative morbidity and likelihood of recurrence, there is evidence to support an early indication for surgery (also with smaller lesions).…”

Section: European Registry Of Abdominal Wall Hernias (Eurahs) (Etable)mentioning

confidence: 99%

“…With the publication of that study at the latest, the use of permanent, non-absorbable mesh to reinforce incisional hernia repair became the standard of care. Current long-term data from the Danish Hernia Register show that the recurrence rate is significantly lower after mesh repair (15). At present, meshes made of polypropylene (PP), polyester (PES), polyvinylidene fluoride (PVDF), and polytetrafluoroethylene (PTFE) are commercially available.…”

Section: Surgical Techniquesmentioning

confidence: 99%

The Treatment of Incisional Hernia

Dietz

Menzel

Lock

et al. 2018

Deutsches Ärzteblatt International

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SummaryBackground: A meta-analysis of studies from multiple countries has shown that the incidence of incisional hernia varies from 4% to 10% depending on the type of operation. No epidemiological surveys have been conducted so far. The worst possible complication of an incisional hernia if it is not treated surgically is incarceration. In this article, we present the main surgical methods of treating this condition. We also evaluate the available randomized and controlled trials (RCTs) in which open and laparoscopic techniques were compared and analyze the patients' quality of life.

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“…The outcome of suture repair of incisional hernias, which is similar to mesh repair in this series, should be interpreted with caution as the type of hernias were different. However, suture repair (without mesh) of incisional hernia remains a controversial subject and the debate has been intensified by the report by Kokotovic and co-workers [14]. In a registry-based nationwide (Denmark) cohort study including 3242 patients (1119 open mesh (34.5%); 366 open non-mesh (11.3%); and 1757 laparoscopic mesh (54.2%)), mesh repair was associated with a lower risk of recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…The cumulative incidence of mesh-related complications was 5.6% for open mesh repair and 3.7% laparoscopic mesh repair whereas longterm repair-related complication rate for patients with non-mesh repair was 0.8%. Kokotovic and co-workers [14] concluded that with long-term follow-up, the benefits attributable to mesh are offset in part by mesh-re-Furthermore, the number of surgeons performing few procedures might have diluted the outcome measures. This study also highlights the difficulties of comparison of results due to the large diversity of heterogeneity of incisional hernias managed by different surgeons even in a single centre who do not use an accepted or validated classification system.…”

Section: Discussionmentioning

confidence: 99%

Management of Incisional Hernias at a Tertiary Centre

A¹

2017

Int J Surg Res Pract

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with more elderly people undergoing surgery [1,2] and the increasing application of more complex procedures serve to maintain the prevalence of incisional hernias. About 10 to 30% of all patients undergoing laparotomy develop an incisional hernia [3][4][5][6]. Despite results of a prospective, controlled, randomised blind study showing the computed likelihood of incisional hernia at one year of 1.5% in the prophylactic mesh group compared to 35.9% in the group without mesh closure [7]; only few surgeons take prophylactic measures such as use of mesh for closure of wounds at high risk in order to prevent incisional hernias. The direct hospital costs and indirect costs to society of using mesh relative to primary suture closure after elective laparotomy showed mesh to be more effective, less costly and overall more cost-effective [8]. Incisional hernias therefore remain a major issue for patients undergoing abdominal surgery. It is not surprising therefore that there is ongoing debate about whether repair of incisional hernias should remain in the purview of general surgeons or be handed over to specialist hernia surgeons.The aim of this study was to review the experience of incisional hernias at a tertiary institution to determine what factors might improve the outcome of care. MethodsAll patients with incisional hernias operated at Derriford Hospital, Plymouth between January 2009 and December 2011 were included in the study. A retrospective review was performed to include elective and emergency cases; operative details of the index procedure and hernia repair; and postoperative events including wound events; surgical site infections (SSI) and outcome. To achieve this, a comprehensive review of Abstract Background and aims: About 10-30% of patients undergoing laparotomy develop an incisional hernia. The aim of this study was to review the experience of incisional hernias at a tertiary institution to determine what factors might improve the outcome of care.

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Long-term Recurrence and Complications Associated With Elective Incisional Hernia Repair

Cited by 315 publications

References 36 publications

Complications and recurrence rates of patients with Ehlers-Danlos syndrome undergoing ventral hernioplasty: a case series

Complications and recurrence rates of patients with Ehlers-Danlos syndrome undergoing ventral hernioplasty: a case series

The Treatment of Incisional Hernia

Management of Incisional Hernias at a Tertiary Centre

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