Pooled data analysis of primary ventral (PVH) and incisional hernia (IH) repair is no more acceptable: results of a systematic review and metanalysis of current literature

Stabilini, Cesare; Cavallaro, Giuseppe; Dolce, Pasquale; Giovannini, Sara Capoccia; Corcione, Francesco; Frascio, Marco; Sodo, Maurizio; Merola, Giovanni; Bracale, Umberto

doi:10.1007/s10029-019-02033-4

Cited by 39 publications

(29 citation statements)

References 38 publications

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“…To this day, data on PH and IH is often pooled, even though several studies suggest that these hernias are different entities [6][7][8][9]. The present analysis of 9159 patients of the prospective French Hernia Club database validates previous research stating that PH and IH are significantly different in terms of most baseline, surgical and hernia characteristics, and postoperative outcomes.…”

Section: Discussionsupporting

confidence: 78%

“…A meta-analysis by Stabilini et al [9] found that IH has a higher recurrence rate than PH. However, the question remains whether this is still the case after correcting for hernia width.…”

Section: Discussionmentioning

confidence: 99%

“…Hernia recurrence is not reported in the present study due to insufficient data on PH recurrence in the Hernia Club database. A probable explanation for this is the fact that PH has a smaller average width, less frequently having concomitant defects at the surgery and a shorter operative time, resulting in a simpler procedure and, subsequently, a shorter post-operative follow-up period compared to patients with IH, resulting in less available data on PH recurrence [9]. As both the formation of IH and hernia recurrence are the result of failed wound healing, it seems logical that hernia recurrence is more common in IH.…”

Section: Discussionmentioning

confidence: 99%

“…However, in hernia research, data on PH and IH is still often pooled [2][3][4][5]. In the last decade, several articles have been published comparing PH and IH, which concluded that these hernias are significantly different entities in terms of baseline characteristics, surgical and hernia characteristics and outcomes [6][7][8][9]. Köckerling et al [6] and Stirler et al [8] concluded that patients with IH had significantly worse outcomes with higher postoperative complication rates and higher recurrence rates.…”

Section: Introductionmentioning

confidence: 99%

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Hernia width explains differences in outcomes between primary and incisional hernias: a prospective cohort study of 9159 patients

Verstoep

Smet²,

Sneiders

et al. 2020

Hernia

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Purpose Data on primary (PH) and incisional hernias (IH) are often pooled, even though several studies have illustrated that these are different entities with worse outcomes for IHs. The aim of this study is to validate previous research comparing PHs and IHs and to examine whether hernia width is an important contributor to the differences between these hernia types. Methods A registry-based, prospective cohort study was performed, utilizing the French Hernia Club database. All patients undergoing PH or IH repair between September 8th 2011 and May 22nd 2019 were included. Baseline, hernia and surgical characteristics, and postoperative outcomes were collected. Outcomes were analyzed per width category (≤ 2 cm, 3–4 cm, 5–10 cm and > 10 cm). Results A total of 9159 patients were included, of whom 4965 (54%) had PH and 4194 (46%) had IH. PHs and IHs differed significantly in 12/15 baseline characteristics, 9/10 hernia and surgical characteristics, and all outcomes. Overall, complications and re-interventions were more common in patients with IH. After correcting for width, the differences between PH and IH were no longer significant, except for medical complications, which were more common after IH repair compared to PH. Conclusion After correcting for hernia width, most outcomes do not significantly differ between PH and IH, indicating that not hernia type, but hernia width is an important factor contributing to the differences between PH and IH.

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Section: Discussionsupporting

confidence: 78%

“…A meta-analysis by Stabilini et al [9] found that IH has a higher recurrence rate than PH. However, the question remains whether this is still the case after correcting for hernia width.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Hernia width explains differences in outcomes between primary and incisional hernias: a prospective cohort study of 9159 patients

Verstoep

Smet²,

Sneiders

et al. 2020

Hernia

View full text Add to dashboard Cite

show abstract

“…We systematically treated patients with hernia defect closure and 5 cm mesh overlapping in order to minimize seroma, bulging and recurrence, following the recommendations of the International Endo Hernia Society (IEHS) [ 23 ]. Furthermore, we decided to include only patients with incisional hernias, as treatment and outcomes in case of congenital defect may vary and represent a source of bias [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Robotic assisted treatment of flank hernias: case series

et al. 2020

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Background: Flank hernias are uncommon, surgical treatment is challenging and the minimally-invasive approach not always feasible. The aim of this study was to report the safety and feasibility of the robotic-assisted repair. Methods: The study was approved by the local ethic committee (2019-01132 CE3495). A retrospective search on a prospectively collected dataset including demographic and clinical records on robotic surgery at our institution was performed to identify patients treated for a flank hernia. Patients were followed-up 6 months. Results: From January 2018 to December 2019, out of 190 patients who underwent robotic-assisted hernia surgery, seven with incisional flank hernia were included. Median age was 69.0 years (IQR 63.2-78.0), BMI was 27.3 kg/m 2 (IQR 25.8-32.3) and two patients were male (29%). All patients were referred to surgery because of pain, whereas one of them described recurrent episodes of small bowel obstruction. The median hernia defect measured 25 mm ((IQR 21-40), median mesh diameter was 10 cm (IQR 10-12.5) and median operative time was 137 min (IQR 133-174). No intraoperative complication occurred. Postoperatively, one patient developed a pneumonia, which required antibiotics. Length of hospital stay was 4.0 days (IQR 3.0-7.7). Six months after surgery, neither recurrence nor chronic pain were recorded. Conclusions: Robotics in abdominal wall hernia surgery remains a matter of debate, despite a growing interest from the surgical community. In our reported experience with flank hernias, we found the robotic-assisted approach to be safe and feasible for the treatment of this uncommon clinical entity.

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Closure of the fascial defect during laparoscopic umbilical hernia repair: a randomized clinical trial

Christoffersen

Westen

Rosenberg

et al. 2020

British Journal of Surgery

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Background The objective of the study was to analyse patient-reported outcome measures (PROMs), seroma formation, long-term recurrence and chronic pain after closure of the fascial defect in patients undergoing laparoscopic umbilical hernia mesh repair. Methods This was a randomized double-blinded trial in patients undergoing elective laparoscopic umbilical hernia repair comparing sutured closure of the fascial defect before intraperitoneal onlay mesh (IPOM) repair with a no-closure IPOM repair. Postoperative pain, movement limitations, discomfort and fatigue were registered before surgery and on postoperative days 1–3, 7 and 30. Seroma formation, quality of life and cosmesis were assessed at day 30, and at 2 years of follow-up. Recurrence (clinical and reoperation) and chronic pain were assessed after 2 years. Results Eighty patients were randomized. Median defect sizes in closure and no-closure groups were 2·5 (range 1·5–4·0) and 2·5 (2·0–5·5) cm respectively (P = 0·895). There were no significant differences in early and late postoperative pain or in any other early or late PROMs, except for early fatigue which was higher in the closure group (P = 0·011). Seroma formation after 30 days was significantly reduced after closure (14 of 40; 35 (95 per cent c.i. 22 to 51) per cent) compared with no closure (22 of 38; 58 (42 to 72) per cent) (P = 0·043). Cumulative recurrence after 2 years was lower in the closure group: 5 of 36 (7 (3 to 17) per cent) versus 12 of 37 (19 (10 to 33) per cent) for no closure (P = 0·047). Conclusion Closure of the fascial defect in laparoscopic umbilical hernia IPOM repair significantly reduced early seroma formation and long-term recurrence without inducing side-effects such as pain, or other early or late PROMs. Registration number: NCT01962480 (https://www.clinicaltrials.gov).

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Pooled data analysis of primary ventral (PVH) and incisional hernia (IH) repair is no more acceptable: results of a systematic review and metanalysis of current literature

Cited by 39 publications

References 38 publications

Hernia width explains differences in outcomes between primary and incisional hernias: a prospective cohort study of 9159 patients

Hernia width explains differences in outcomes between primary and incisional hernias: a prospective cohort study of 9159 patients

Robotic assisted treatment of flank hernias: case series

Closure of the fascial defect during laparoscopic umbilical hernia repair: a randomized clinical trial

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