Potential influencing factors on the outcome in incisional hernia repair: a registry-based multivariable analysis of 22,895 patients

Köckerling, F.; Hoffmann, Henry; Adolf, Daniela; Reinpold, Wolfgang; Kirchhoff, Philipp; Mayer, F; Weyhe, Dirk; Lammers, B. J.; Emmanuel, Klaus

doi:10.1007/s10029-020-02184-9

Cited by 26 publications

(25 citation statements)

References 35 publications

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“…The intraoperative complication rate during recurrent incisional hernia repair was significantly increased in male patients and with the use of larger meshes. This contradicts findings of a recent study investigating factors influencing the outcome of primary incisional hernia repair [38]. Here, female patients had a higher risk for intraoperative complications.…”

Section: Discussioncontrasting

confidence: 90%

“…Drains alone do not cause intraoperative complications, but they serve as surrogate markers for a complicated intraoperative course, such as extensive bleeding or damaging bowel, where surgeons may be prone to inserting drains. Regarding postoperative complications and complication-related reoperations following recurrent incisional hernia repair, our study could also demonstrate that the potential influencing factors associated with more unfavorable outcomes are predominantly identical compared to those of primary incisional hernia repair [20,38,[41][42][43]. In detail, larger mesh size and larger EHS defect size were associated with increased risks for both outcomes.…”

Section: Discussionmentioning

confidence: 52%

“…With this study, we contribute to the ongoing debate on improving surgical care in complex abdominal wall hernias. We could demonstrate that risk factors for unfavorable outcomes for recurrent incisional hernia repair are almost identical to the risk factors for primary incisional hernia repair [38]. Also, the increasingly criticized laparoscopic IPOM was again associated with significantly less postoperative complications and complication-related reoperation in recurrent incisional hernia repair.…”

Section: Discussionmentioning

confidence: 76%

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

Hoffmann

Köckerling

Adolf

et al. 2020

Hernia

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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.

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Section: Discussioncontrasting

confidence: 90%

Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 76%

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

Hoffmann

Köckerling

Adolf

et al. 2020

Hernia

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“…Other possible causes are the higher incidence of comorbidities in IH patients or differences in hernia width [7]. Larger IHs are more prone to unfavorable outcomes than smaller IHs [10]. On average, IHs are significantly larger than PHs, and the difference in postoperative outcomes between PH and IH may be due to the difference in hernia width.…”

Section: Electronic Supplementary Materialsmentioning

confidence: 99%

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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“…The risk of complete mesh excision may be significant, often requiring extensive lysis of adhesions with a risk of intestinal damage. In addition, if the mesh is well embedded, there is a risk of destruction of the natural components of the abdominal wall, which makes subsequent reconstruction difficult [8,9] Purpose The purpose of the study was to analyze early and late postoperative complications when using allo-and autografts in the surgery of incisional ventral hernias.…”

Section: Introductionmentioning

confidence: 99%

Analysis of Postoperative Complications in Repair Ofincisional Ventral Hernias Using Allo- And Autografts

Protasov¹,

Topchiev²,

Parshin³

et al. 2020

AREM

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The article provides a multicenter retrospective analysis of postoperative complications in patients after ventral hernias repair. The study went on for 10 years and included 628 patients divided into 2 groups. The first group included 510 patients operated on using polypropylene implants (mesh density 60g/m2 ). In the second group (118 patients) a de-epithelized autodermal graft prepared according to the authors' technology was applied. Clavien-Dindo classification was used to describe postoperative complications. The total number of complications in the first group was 22.2%, in the second group — 2.5% (p < 0.01). In the analysis of complications in all patients operated on using both allo- and autograft, the most frequent complications in the form of seroma were noted when implants using the one lay technique — 22.3% (p < 0.05) were installed. The autodermal de-epithelized graft used in ventral hernia plastics, regardless of their localization and size, especially in relapses after alloplasty, may be a good alternative to synthetic grafts.

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Potential influencing factors on the outcome in incisional hernia repair: a registry-based multivariable analysis of 22,895 patients

Cited by 26 publications

References 35 publications

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

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

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

Analysis of Postoperative Complications in Repair Ofincisional Ventral Hernias Using Allo- And Autografts

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