Substantial variation among hernia experts in the decision for treatment of patients with incisional hernia: a descriptive study on agreement

Kokotovic, Dunja; Gögenur, Ismail; Helgstrand, Frederik

doi:10.1007/s10029-016-1562-y

Cited by 30 publications

(15 citation statements)

References 33 publications

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“…For colostomies, highly varying incidences of primary repair of parastomal bulges or hernias (0-54%) have been reported in single-centre studies with 2-10 years of follow-up [35,36]. Consistent with the present study, these differences are likely to reflect variation in treatment decisions among experts [37], perhaps because of the absence of high-quality evidence to support such decisions [13].…”

Section: Discussionsupporting

confidence: 75%

Surgical repair of parastomal bulging: a retrospective register‐based study on prospectively collected data

et al. 2020

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Aim The aim of this work was to examine (1) the incidence of primary repair, (2) the incidence of recurrent repair and (3) the types of repair performed in patients with parastomal bulging. Method Prospectively collected data on parastomal bulging from the Danish Stoma Database were linked to surgical data on repair of parastomal bulging from the Danish National Patient Register. Survival statistics provided cumulative incidences and time until primary and recurrent repair. Results In the study sample of 1016 patients with a permanent stoma and a parastomal bulge, 180 (18%) underwent surgical repair. The cumulative incidence of a primary repair was 9% [95% CI (8%; 11%)] within 1 year and 19% [95% CI (17%; 22%)] within 5 years after the occurrence of a parastomal bulge. We found a similar probability of undergoing primary repair in patients with ileostomy and colostomy. For recurrent repair, the 5-year cumulative incidence was 5% [95% CI (3%; 7%)]. In patients undergoing repair, the probability was 33% [95% CI (21%; 46%)] of having a recurrence requiring repair within 5 years. The main primary repair was open or laparoscopic repair with mesh (43%) followed by stoma revision (39%). Stoma revision and repair with mesh could precede or follow one another as primary and recurrent repair. Stoma reversal was performed in 17% of patients. Conclusion Five years after the occurrence of a parastomal bulge the estimated probability of undergoing a repair was 19%. Having undergone a primary repair, the probability of recurrent repair was high. Stoma reversal was more common than expected.

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Section: Discussionsupporting

confidence: 75%

Surgical repair of parastomal bulging: a retrospective register‐based study on prospectively collected data

et al. 2020

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“…In the literature, several studies compare mesh and suture repair techniques, open and laparoscopic repair techniques, and mesh type as well as the plane in which the mesh should be placed. Currently, there is no consensus regarding the abdominal plane in which the mesh should be placed (13).…”

Section: Introductionmentioning

confidence: 99%

Randomized prospective comparison of long-term results of onlay and sublay mesh repair techniques for incisional hernia

Sevinç

Okuş

et al. 2018

Turk J Surg

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Objective: Incisional hernia is a significant problem after laparotomy, and there is still no consensus on an ideal treatment method. The aim of this study was to compare the results of onlay and sublay mesh repair techniques. Material and Methods:In this randomized prospective trial, 100 patients were divided into two groups: onlay and sublay groups. Recurrences were evaluated by performing a physical examination. Results:The median follow-up was 37.1 (26.6 to 46.5) months. In the onlay group, the mean operation time was significantly shorter. However, in terms of postoperative pain and wound complications, the sublay group had significantly better results. The recurrence rates were found to be similar in both groups (6% in the onlay group and 2% in the sublay group). Conclusion:In the treatment of incisional hernia, sublay mesh repair is superior to onlay mesh repair in terms of postoperative pain and wound complications. Both techniques have similar recurrence rates. Keywords:Incisional hernia, mesh repair, onlay, sublay INTRODUCTIONIncisional hernia is a significant complication after laparotomy; its incidence ranges between 10% and 20% (1-4). This common problem can result in bowel strangulation, pain, and enterocutaneous fistula, and it affects the quality of life. The results of repair techniques vary widely. High recurrence rates have been reported for suture techniques, whereas mesh placement can reduce recurrence (5-10). In mesh repair, one of the most important problems is the placement of the mesh. Some techniques are reported to be associated with particularly high rates of some complications, such as recurrence, wound infection, and fistula (11,12). In the literature, several studies compare mesh and suture repair techniques, open and laparoscopic repair techniques, and mesh type as well as the plane in which the mesh should be placed. Currently, there is no consensus regarding the abdominal plane in which the mesh should be placed (13).The aim of this study was to compare the early and late results of onlay and sublay mesh repair techniques. , an American Society of Anesthesiologists score (ASA) of 4, or severe pulmonary or cardiac disease were not included. The remaining patients who agreed to be involved and signed the informed consent form were randomized into two groups: onlay group and sublay group. After the initial evaluation, 100 patients were included and were randomized to each group by the closed envelope method. The patients' demographic data, BMI, diameter of fascial defects, operation time (from first incision to dressing), visual analog scale (VAS) scores at the second and 24 th hours, length of hospital stay, drain takeoff time, postoperative complications, and recurrences were recorded. The fascial defect diameter was measured intraoperatively and is presented in cm 2 . All operations were performed according to the elective standard. There were no emergency operations. MATERIAL AND METHODS Operative TechniqueAll operations were performed under general anesthesia, and no antibioti...

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“…Numerous guidelines, meta-analyses and systematic reviews explore the best possible surgical treatment for ventral and incisional hernias ( 1 – 26 ). Nonetheless, there is very little agreement among experts on the precise treatment strategy ( 27 ). The reasons for that are no doubt manifold.…”

Section: Introductionmentioning

confidence: 99%

What Is the Current Knowledge About Sublay/Retro-Rectus Repair of Incisional Hernias?

Köckerling

Schug-Paß

Scheuerlein³

2018

Front. Surg.

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Introduction: There continues to be very little agreement among experts on the precise treatment strategy for incisional hernias. That is the conclusion drawn from the very limited scientific evidence available on the repair of incisional hernias. The present review now aims to critically assess the data available on the sublay/retro-rectus technique for repair of incisional hernia. Materials and Methods:A systematic search of the literature was performed in May 2018 using Medline, PubMed, and the Cochrane Library. This article is based on 77 publications.Results: The number of available RCTs that permit evaluation of the role of the sublay/retro-rectus technique in the repair of only incisional hernia is very small. The existing data suggest that the sublay/retro-rectus technique has disadvantages compared with the laparoscopic IPOM technique for repair of incisional hernia, but in that respect has advantages over all other open techniques. However, the few existing studies provide only a limited level of evidence for assessment purposes. Conclusion:Further RCTs based on a standardized technique are urgently needed for evaluation of the role of the sublay/retro-rectus incisional hernia repair technique.

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Substantial variation among hernia experts in the decision for treatment of patients with incisional hernia: a descriptive study on agreement

Abstract: In a standardized setting, agreement in choice of treatment strategy for patients with incisional hernias was very low among experienced surgeons. A standardization of surgical decision making is desirable to develop new interventions and improve clinical outcomes.

Cited by 30 publications

References 33 publications

Surgical repair of parastomal bulging: a retrospective register‐based study on prospectively collected data

Surgical repair of parastomal bulging: a retrospective register‐based study on prospectively collected data

Randomized prospective comparison of long-term results of onlay and sublay mesh repair techniques for incisional hernia

What Is the Current Knowledge About Sublay/Retro-Rectus Repair of Incisional Hernias?

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