Outcomes After Emergency Versus Elective Ventral Hernia Repair: A Prospective Nationwide Study

Abstract

Emergency umbilical/epigastric or incisional hernia repair was beset with up to 15-fold higher mortality, reoperation, and readmission rates than elective repair. Older age, female gender, and umbilical hernia defects between 2 and 7 cm or incisional hernia defects up to 7 cm were important risk factors for emergency repair.

Watchful waiting in incisional hernia: Is it safe?

“…Although the absolute numbers are small, the risks for poor early outcomes after emergency operative intervention, such as postoperative mortality, recurrence, and readmissions, have been described previously. [21][22][23] In contrast, 70 patients (67%) in the WW group never needed operative repair during a median follow-up of 66 months of WW (IQR, 46-86) and therefore have not been at risk for any postoperative complication. The asymptomatic patients in the WW group nearly have the same crossover rates as the whole WW group, 31% versus 33%, respectively; in contrast, the emergency repair rates appear to be less---8% in the OT group versus 24% in the WW group.…”

“…In total, 151 patients were planned for elective OT of whom 140 patients underwent the surgical procedure after a median of 14 weeks (IQR, [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. The remaining 11 patients (7%) crossed over to WW; 6 patients (55%) crossed over to WW, because their IH became of less importance with regard to their comorbidities, 4 (36%) decided to not undergo OT, and 1 was cancelled because of increased operation risk owing to obesity.…”

“…A large, nationwide, prospective cohort comparing emergency and elective incisional hernia repair showed a 30-day mortality of 6.4%. 21 An explanation for the greater 30-day mortality in our group may be that a number of these patients were assigned to WW owing to comorbidity (23%) and obesity (22%). Furthermore, patients who presented with incarcerated IH were excluded from our study.…”

Ventral hernia: Patient selection, treatment, and management

“…17 Outcomes of emergency surgery are dismal with increased risk of all complications including reoperation (RR 2.72, 95% CI 1.5-4.94), 30-day readmission (RR 1.61, 95% CI 1.23-2.11), and mortality (RR 13.1, 95% CI 6.39-26.86). 18 Alternatively, elective repair in high-risk patients is associated with substantially increased risk for complications. These patients enter a vicious cycle of high-risk ventral hernia repair (elective or emergent), complications, followed by reoperation and repeat ventral hernia repair, starting the cycle over.…”

Hernioplastía Ventral Laparoscópica

“…Recientemente Helgstrand et al, han descrito una serie de 935 pacientes con hernias ventrales complicadas de los cuales aproximadamente 10% de ellos fue resuelto por vía laparoscópica. Sin embargo, no se describen resultados quirúrgicos ni postoperatorios de este subgrupo en especial 21 . En nuestra serie, todos los casos sometidos a exploración laparoscópica no requirieron resecciones intestinales de ningún tipo, pese a que 3 pacientes presentaban asas de intestino delgado en el saco herniario.…”