Risk Factors for Surgical Complications in Ventral Hernia Repair

Abstract

BackgroundThe aim of this study was to identify risk factors for an adverse event, i.e. early surgical complication, need for ICU care and readmission, following ventral hernia repair. Our hypothesis was that there is an association between an increased complication rate following ventral hernia repair and specific factors, including hernia size, BMI > 35, concomitant bowel surgery, ASA-class, age, gender and method of hernia repair.MethodsData from a hernia database with prospectively entered data on 408 patients operated for ventral hernia between 2007 and 2014 at two Swedish university hospitals were analysed. A 3-month follow-up of complications, need for intensive care and readmission, was performed by reviewing the medical records.ResultsEighty-one of 408 patients (20%) had a registered complication. Fifty-eight (14%) of these were classed as Clavien I–IIIa, and in 19 cases a Clavien IIIb–IV complication was reported. Large hernia size was associated with increased risk for early complication. A Kendall Tau test analysis revealed a proportional relationship between hernia size and modified Clavien outcome class (p < 0.001). Morbid obesity, ASA-class, method, hernia recurrence, age and concomitant bowel surgery were not statistically significant predictors of adverse events.ConclusionsAssessment of hernia aperture size is of great importance in the preoperative evaluation of ventral hernia patients to consider risk for post-operative complications. These results suggest a careful attitude when applying watchful waiting concepts and when postponing hernia surgery to achieve weight loss. A delaying attitude may result in increased risk of complications caused by increasing hernia size.

One-year outcome after repair of giant incisional hernia using synthetic mesh or full-thickness skin graft: a randomised controlled trial

“…Repair using synthetic mesh material for reinforcement, as used for less complex hernia repairs with low recurrence rates, is unsatisfactory in giant incisional hernia repair where recurrence rates can exceed 30% and complications are more common and more serious [ 2 , 5 , 7 – 9 ]. Furthermore, infection related to the use of synthetic material, as well as long-term complaints such as chronic pain, dysfunction of the abdominal wall, enterocutaneous fistulae and discomfort, is seen [ 5 , 10 ].…”

Modified Dick Procedure in Giant Incisional Hernia, a Single Center Experience

“…In open ventral hernia repair, the average length of stay is reported to be 5-9 days (8-10). Giant incisional hernias are observed to have unsatisfactory recurrence rate, prolonged operative time, length of stay and have a higher rate of wound site complications, due to the extent of dissection (11)(12)(13). Although Modified Dick repair group had wider fascia defect (mean 9.3 cm) in our study, the operation time did not increase due to the surgical technique used.…”

The reality of general surgery training and increased complexity of abdominal wall hernia surgery

“…Large defect sizes have a recognized negative influence on the perioperative complication rates and consequently the long-term outcomes [42,43]. Increased hernia size leads to an increased risk of complications [44].…”

“…Other potential risk factors for an unfavorable outcome in hernia surgery are chronic obstructive pulmonary disease, diabetes, aortic aneurysm, immunosuppression, corticosteroid treatment, smoking, coagulopathy, antiplatelet medication and anticoagulation therapy [44,46,[51][52][53].…”