Analysis of 4,015 recurrent incisional hernia repairs from the Herniamed registry: risk factors and outcomes

Abstract

IntroductionThe proportion of recurrences in the total collective of all incisional hernias has been reported to be around 25%. In the European Hernia Society (EHS) classification, recurrent incisional hernias are assigned to a unique prognostic group and considered as complex abdominal wall hernias. Surgical repairs are characterized by dense adhesions, flawed anatomical planes caused by previous dissection or mesh use, and device-related complications. To date, only relatively small case series have been published focusing on outcomes following recurrent incisional hernia repair. This cohort study now analyzes the outcome of recurrent incisional hernia repair assessing potential risk factors based on data from the Herniamed registry. Special attention is paid to the technique used during the primary incisional hernia repair, since laparoscopic IPOM was recently deemed to cause more complications during subsequent repairs. Methods In the multicenter Internet-based Herniamed registry, patients with recurrent incisional hernia repair between September 2009 and January 2018 were enrolled. In a confirmatory multivariable analysis, factors potentially associated with the outcome parameters (intraoperative, postoperative and general complications, complication-related reoperations, re-recurrences, pain at rest and on exertion, and chronic pain requiring treatment at one-year follow-up) were evaluated. Results In total, 4015 patients from 712 participating hospitals were included. Postoperative complications and complicationrelated reoperations were significantly associated with larger recurrent hernia defect size, open recurrent incisional hernia repair and the use of larger meshes. General complications were more frequent in female sex patients and when larger meshes were used. Higher re-recurrence rate was observed with lateral defect localization, present risk factors, and time interval ≤ 1 year between primary and recurrent incisional hernia repair. Pain rates at 1-year follow-up were unfavorably related with pre-existing preoperative pain, female sex, lateral defect localization, larger mesh, presence of risk factors, and postoperative complications. As regards the primary incisional hernia repair technique, laparoscopic IPOM was found to show no effect versus open mesh techniques on the subsequent recurrence repair, despite a trend toward higher rates of complication-related reoperations. Conclusion The outcomes of recurrent incisional hernia repair were significantly associated with potential influencing factors, which are very similar to the factors seen in primary incisional hernia repair. The impact of the primary incisional hernia repair technique, namely laparoscopic IPOM versus open mesh techniques, on the outcome of recurrent incisional hernia repair seems less pronounced than anticipated.

Clinical observation of extraction-site incisional hernia after laparoscopic colorectal surgery

“…A multifactorial analysis identified factors such as age, obesity, sex, combined anemia, and concurrent respiratory disease as independent risk factors for IH. This finding aligns with prior research on IH following abdominal surgery[ 4 , 11 , 12 ]. Patients presenting these conditions exhibit delayed wound healing and are prone to wound infection or suboptimal wound healing, thereby amplifying the risk of IH[ 13 ].…”

Tratamento Da Dor No Pós-Operatório De Hérnias Incisionais Com Perda De Domicílio

“…Uma analgesia eficaz seguindo o reparo da hérnia pode interferir positivamente no desfecho do paciente. 10,11,12 Há a possibilidade de redução de intensidade ou até desaparecimento da dor nas semanas e meses seguintes, desta forma uma abordagem conservadora é aconselhável. No período inicial da sintomatologia adotar uma conduta expectante é algo a se considerar associada a realização de analgesia básica.…”

Construction and properties of the silk fibroin and polypropylene composite biological mesh for abdominal incisional hernia repair

“…Surgical mesh repair is still the main clinical treatment for incisional hernia of the abdominal wall ( Yang et al, 2020a ; Hoffmann et al, 2021 ). The general treatment strategy for incisional hernia is as follows: small incisional hernias (hernia ring diameter<5 cm) can be repaired with suture alone.…”