Lower Reoperation Rate for Recurrence after Mesh versus Sutured Elective Repair in Small Umbilical and Epigastric Hernias. A Nationwide Register Study

Christoffersen, Mette; Helgstrand, Frederik; Rosenberg, Jacob; Kehlet, Henrik; Bisgaard, Thue

doi:10.1007/s00268-013-2160-0

Cited by 93 publications

(70 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Suture repair or the Mayo technique for umbilical hernia closure are both associated with a recurrence rate of 10%–30% 12,13. The use of a prosthetic mesh, even for small defects, significantly reduces hernia recurrence 2,3,14. This 1-year interim analysis of the PANACEA trial shows a low 12-month recurrence rate of 2.8% (3/106).…”

Section: Discussionmentioning

confidence: 91%

A multicenter prospective study of patients undergoing open ventral hernia repair with intraperitoneal positioning using the<br />monofilament polyester composite ventral patch: interim results of the PANACEA study

Berrevoet¹,

Doerhoff²,

Muysoms³

et al. 2017

MDER

View full text Add to dashboard Cite

PurposeThis study assessed the recurrence rate and other safety and efficacy parameters following ventral hernia repair with a polyester composite prosthesis (Parietex™ Composite Ventral Patch [PCO-VP]).Patients and methodsA single-arm, multicenter prospective study of 126 patients undergoing open ventral hernia repair with the PCO-VP was performed. Patient outcomes were assessed at discharge and at 10 days, 1, 6, 12, and 24 months postoperative.ResultsAll patients had hernioplasty for umbilical (n = 110, 87.3%) or epigastric hernia (n = 16, 12.7%). Mean hernia diameter was 1.8 ± 0.8 cm. Mean operative time was 36.2 ±15.6 minutes, with a mean mesh positioning time of 8.1 ± 3.4 minutes. Surgeons reported satisfaction with mesh ease of use in 95% of surgeries. The cumulative hernia recurrence rate at 1 year was 2.8% (3/106). Numeric Rating Scale (NRS) pain scores showed improvement from 2.1 ± 2.0 at preoperative baseline to 0.5 ± 0.7 at 1 month postoperative (P < 0.001), and this low pain level was maintained at 12 months postsurgery (P < 0.001). The mean global Carolina’s Comfort Scale® (CCS) score improved postoperatively from 3.8 ± 6.2 at 1 month to 1.6 ± 3.5 at 6 months (P < 0.001). One patient was unsatisfied with the procedure.ConclusionThis 1-year interim analysis using PCO-VP for primary umbilical and epigastric defects shows promising results in terms of mesh ease of use, postoperative pain, and patient satisfaction. Recurrence rate is low, but, as laparoscopic evaluation shows a need for patch repositioning in some cases, an accurate surgical technique remains of utmost importance.

show abstract

Section: Discussionmentioning

confidence: 91%

A multicenter prospective study of patients undergoing open ventral hernia repair with intraperitoneal positioning using the<br />monofilament polyester composite ventral patch: interim results of the PANACEA study

Berrevoet¹,

Doerhoff²,

Muysoms³

et al. 2017

MDER

View full text Add to dashboard Cite

show abstract

“…Combining data from the DVHD with data from patient files, patient questionnaires, and clinical examinations revealed that mesh repairs reduce the risk for recurrence significantly,7 even in small repairs and without increased risk of pain 10,11. Additionally, large-size data from DVHD have shown that laparoscopic intraperitoneal mesh fixation with absorbable as compared with titanium tacks is associated with an increased risk of hernia recurrence.…”

Section: Examples Of Researchmentioning

confidence: 99%

“…The nationwide studies have pointed out several areas for surgical improvement for the different types of ventral hernias to reduce risk for early and late complications and recurrence. These include the advantageous application of a sublay mesh during open repair of an incisional hernia7 and use of a mesh for open umbilical or epigastric hernia repair to reduce recurrence 10…”

Section: Examples Of Researchmentioning

confidence: 99%

The Danish Ventral Hernia Database – a valuable tool for quality assessment and research

Helgstrand¹,

Jørgensen²

2016

CLEP

View full text Add to dashboard Cite

AimThe Danish Ventral Hernia Database (DVHD) provides national surveillance of current surgical practice and clinical postoperative outcomes. The intention is to reduce postoperative morbidity and hernia recurrence, evaluate new treatment strategies, and facilitate nationwide implementation of evidence-based treatment strategies. This paper describes the design and purpose of DVHD.Study populationAdult (≥18 years) patients with a Danish Civil Registration Number and undergoing surgery under elective or emergency conditions for ventral hernia in a Danish surgical department from 2007 and beyond. A total of 80% of all ventral hernia repairs performed in Denmark were reported to the DVHD.Main variablesDemographic data (age, sex, and center), detailed hernia description (eg, type, size, surgical priority), and technical aspects (open/laparoscopic and mesh related factors) related to the surgical repair are recorded. Data registration is mandatory. Data may be merged with other Danish health registries and information from patient questionnaires or clinical examinations.Descriptive dataMore than 37,000 operations have been registered. Data have demonstrated high agreement with patient files. The data allow technical proposals for surgical improvement with special emphasis on reduced incidences of postoperative complications, hernia recurrence, and chronic pain.ConclusionDVHD is a prospective and mandatory registration system for Danish surgeons. It has collected a high number of operations and is an excellent tool for observing changes over time, including adjustment of several confounders. This national database registry has impacted on clinical practice in Denmark and led to a high number of scientific publications in recent years.

show abstract

“…The evidence that umbilical and epigastric hernias must be repaired using a mesh, in analogy with other hernias, is accumulating [1-7]. The use of a mesh in large hernias reduces the risk of recurrence from approximately 15-40% to 1-10% [1,4-6,8-10].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, the results of the Hernia Umbilicalis Mesh versus Primair suture (HUMP) trial that focuses on hernias smaller than 2 centimetres will have great added value for umbilical hernias in particular [11]. Other retrospective studies suggest that for the reoperation rate due to recurrence mesh is superior in umbilical and epigastric hernias [7]. In contrast to the HUMP trial, which places the mesh in this pre-peritoneal plane, a mesh can also be placed intraperitoneally.…”

Section: Introductionmentioning

confidence: 99%

Mesh Or Patch for Hernia on Epigastric and Umbilical Sites (MORPHEUS trial): study protocol for a multi-centre patient blinded randomized controlled trial

et al. 2014

View full text Add to dashboard Cite

BackgroundEvidence is accumulating that, similar to other ventral hernias, umbilical and epigastric hernias must be mesh repaired. The difficulties involved in mesh placement and in mesh-related complications could be the reason many small abdominal hernias are still primary closed. In laparoscopic repair, a mesh is placed intraperitoneally, while the most common procedure is open surgery is pre-peritoneal mesh placement. A recently developed alternative method is the so-called patch repair, in this approach a mesh can be placed intraperitoneally through open surgery. In theory, such patches are particularly suitable for small hernias due to a reduction in the required dissection. This simple procedure is described in several studies. It is still unclear whether this new approach is associated with an equal risk of recurrence and complications compared with pre-peritoneal meshes. The material of the patch is in direct contact with intra-abdominal organs, it is unknown if this leads to more complications. On the other hand, the smaller dissection in the pre-peritoneal plane may lead to a reduction in wound complications.Methods/Design346 patients suffering from an umbilical or epigastric hernia will be included in a multi-centre patient-blinded trial, comparing mesh repair with patch repair. Randomisation will take place for the two operation techniques. The two devices investigated are a flat pre-peritoneal mesh and a Proceed Ventral Patch®. Stratification will occur per centre. Post-operative evaluation will take place after 1, 3, 12 and 24 months. The number of complications requiring treatment is the primary endpoint. Secondary endpoints are Verbal Descriptor Scale (VDS) pain score and VDS cosmetic score, operation duration, recurrence and costs. An intention to treat analysis will be performed.DiscussionThis trial is one of the first in its kind, to compare different mesh devices in a randomized controlled setting. The results will help to evaluate mesh repair for epigastric an umbilical hernia, and find a surgical method that minimizes the complication rate.Trial registrationNetherlands Trail Registration (NTR) www.trialregister.nl 2010 NTR2514 NL33995.060.10

show abstract

Lower Reoperation Rate for Recurrence after Mesh versus Sutured Elective Repair in Small Umbilical and Epigastric Hernias. A Nationwide Register Study

Cited by 93 publications

References 28 publications

A multicenter prospective study of patients undergoing open ventral hernia repair with intraperitoneal positioning using the<br />monofilament polyester composite ventral patch: interim results of the PANACEA study

A multicenter prospective study of patients undergoing open ventral hernia repair with intraperitoneal positioning using the<br />monofilament polyester composite ventral patch: interim results of the PANACEA study

The Danish Ventral Hernia Database – a valuable tool for quality assessment and research

Mesh Or Patch for Hernia on Epigastric and Umbilical Sites (MORPHEUS trial): study protocol for a multi-centre patient blinded randomized controlled trial

Contact Info

Product

Resources

About

Lower Reoperation Rate for Recurrence after Mesh versus Sutured Elective Repair in Small Umbilical and Epigastric Hernias. A Nationwide Register Study

Cited by 93 publications

References 28 publications

A multicenter prospective study of patients undergoing open ventral hernia repair with intraperitoneal positioning using the<br />monofilament polyester composite ventral patch: interim results of the PANACEA study

A multicenter prospective study of patients undergoing open ventral hernia repair with intraperitoneal positioning using the<br />monofilament polyester composite ventral patch: interim results of the PANACEA study

The Danish Ventral Hernia Database &ndash; a valuable tool for quality assessment and research

Mesh Or Patch for Hernia on Epigastric and Umbilical Sites (MORPHEUS trial): study protocol for a multi-centre patient blinded randomized controlled trial

Contact Info

Product

Resources

About

The Danish Ventral Hernia Database – a valuable tool for quality assessment and research