Watchful Waiting for Ventral Hernias: A Longitudinal Study

Abstract

Ventral hernias are a common clinical problem. Immediate repair is recommended for most ventral hernias despite significant recurrence rates. This practice may be related to a lack of understanding of the natural history of ventral hernias. The purpose of this study was to determine the natural history of ventral hernias and to determine if watchful waiting is an acceptable and safe option. Forty-one patients with ventral hernias were enrolled in a longitudinal cohort study of watchful waiting. Primary outcomes were functional impairment resulting from hernia disease as measured by the Activities Assessment Scale (AAS) and changes from baseline to two years in the physical and mental component score of the SF-36 Health Survey. Secondary outcomes included complications such as incarceration. Mixed-effects model for repeated measures and Student's t tests were used to evaluate scale performance. The mean age of enrollees was 64 years, and the mean hernia size was 239 cm2. Eleven patients were lost to follow-up, and seven patients died of other causes. All remaining patients were followed for two years. There was one incarceration during the follow-up period. There was no deterioration in the AAS score (baseline vs 24 months = 28 vs 25, P = 0.60). There was deterioration of the physical functioning dimension of the SF-36 (baseline vs 24 months = 40 vs 32, P < 0.01), but the mental functioning dimension was improved (45 vs 51; P = 0.01). Watchful waiting was a safe option for patients in this study with ventral hernias.

Costs Associated With Modifiable Risk Factors in Ventral and Incisional Hernia Repair

“…7,31,32 While the risk of emergency surgical procedures is relatively low, it is not 0. 9 Moreover, nonoperative management results in poor quality of life and functional status. 10,33 In a 2016 prospective, case-matched study 10 of operative vs nonoperative management of ventral hernia, operative management improved overall function and quality of life.…”

“…Forgoing operative VIHR in high-risk patients avoids postoperative complications, but it is associated with decreased functional status and poor quality of life and exposes patients to the risk of emergency VIHR. 9,10 Consequently, there is increasing interest in preoperatively addressing modifiable patient comorbidity as a strategy to improve postoperative outcomes and reduce cost. Preoperative optimization can result in a quicker return to baseline functional capacity and has the potential to reduce postoperative complications.…”

Use of Computed Tomography in Diagnosing Ventral Hernia Recurrence

“…[24][25][26] Given that the risk for incarceration or strangulation of clinically detectable hernias is low (estimated 1%-2% per year; range, 0%-20%), one might postulate that the risk for complications from radiologically detected hernias would also be low. [27][28][29][30][31][32] Repair of hernias only detectable on radiologic imaging may result in the unnecessary use of resources, increased risk for complications, and increased stress on patients. 33 In addition, without the correlation of intraoperative findings, it is unclear whether these hernias only seen on imaging are actually present.…”

Utility of Draining Fluid Collections Following Mesh Ventral Hernia Repair

“…Each year, more than 350,000 VHRs are performed in the United States [2]. While usually considered a relatively low-risk procedure, VHR is associated with a morbidity rate of up to 60% with complications including wound infection, seroma formation, reoperation, hospital readmission, and cardiovascular abnormalities [3].…”