Skip to main content
Top
Published in: Hernia 4/2018

Open Access 01-08-2018 | Original Article

Complications and recurrence rates of patients with Ehlers-Danlos syndrome undergoing ventral hernioplasty: a case series

Authors: L. F. Kroese, E. H. Mommers, C. Robbens, N. D. Bouvy, J. F. Lange, F. Berrevoet

Published in: Hernia | Issue 4/2018

Login to get access

Abstract

Purpose

Ventral hernia repair is one of the most frequently performed surgical procedures, though recurrences are common. Recurrence can be caused by impaired collagen formation or maturation; hence, patients with Ehlers-Danlos syndrome (EDS) are potentially at increased risk for hernia recurrence. EDS causes altered collagen metabolism, though little is known about the influence of EDS on ventral hernioplasty outcomes. This study aims to analyze these patients to report complication rates, recurrence rates, and, if possible, to give recommendations for surgical intervention.

Methods

A retrospective analysis between January 2000 and January 2017 was performed in a university hospital Belgium (UZ Ghent). Data on baseline characteristics, primary surgery, and hernias were extracted from patients’ medical charts. Noted endpoints were postoperative complications and recurrences.

Results

Fourteen patients (50% males) were included. Ten (71%) had an incisional hernia and four (29%) had a primary ventral hernia. Median age was 45 years (IQR 37.75–52.75), median BMI was 24.82 (IQR 22.43–26.87). Four patients (29%) smoked, one patient (7.1%) had diabetes mellitus, and five patients (36%) had an aneurysm of the abdominal aorta. All patients underwent elective open hernioplasty with mesh reinforcement. Three patients (21%) had a postoperative complication (two infections, one seroma). Recurrence rate was 7.1% (one patient).

Conclusions

This series describes 14 patients with a median follow-up of 50 months and a recurrence rate of 7.1%. The low recurrence rate could be explained by the use of large meshes that reinforce the entire midline to compensate for the reduced collagen strength in EDS patients.
Literature
1.
go back to reference Deerenberg EB, Harlaar JJ, Steyerberg EW, Lont HE, van Doorn HC, Heisterkamp J, Wijnhoven BP, Schouten WR, Cense HA, Stockmann HB, Berends FJ, Dijkhuizen FP, Dwarkasing RS, Jairam AP, van Ramshorst GH, Kleinrensink GJ, Jeekel J, Lange JF (2015) Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. Lancet 386(10000):1254–1260. https://doi.org/10.1016/s0140-6736(15)60459-7 CrossRefPubMed Deerenberg EB, Harlaar JJ, Steyerberg EW, Lont HE, van Doorn HC, Heisterkamp J, Wijnhoven BP, Schouten WR, Cense HA, Stockmann HB, Berends FJ, Dijkhuizen FP, Dwarkasing RS, Jairam AP, van Ramshorst GH, Kleinrensink GJ, Jeekel J, Lange JF (2015) Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. Lancet 386(10000):1254–1260. https://​doi.​org/​10.​1016/​s0140-6736(15)60459-7 CrossRefPubMed
2.
4.
go back to reference Radu P, Bratucu M, Garofil D, Goleanu V, Popa F, Strambu V (2015) The role of collagen metabolism in the formation and relapse of incisional hernia. Chirurgia (Bucur) 110(3):224–230 Radu P, Bratucu M, Garofil D, Goleanu V, Popa F, Strambu V (2015) The role of collagen metabolism in the formation and relapse of incisional hernia. Chirurgia (Bucur) 110(3):224–230
6.
go back to reference Henriksen NA (2016) Systemic and local collagen turnover in hernia patients. Dan Med J 63(7):7 Henriksen NA (2016) Systemic and local collagen turnover in hernia patients. Dan Med J 63(7):7
10.
go back to reference Malfait F, Francomano C, Byers P, Belmont J, Berglund B, Black J, Bloom L, Bowen JM, Brady AF, Burrows NP, Castori M, Cohen H, Colombi M, Demirdas S, De Backer J, De Paepe A, Fournel-Gigleux S, Frank M, Ghali N, Giunta C, Grahame R, Hakim A, Jeunemaitre X, Johnson D, Juul-Kristensen B, Kapferer-Seebacher I, Kazkaz H, Kosho T, Lavallee ME, Levy H, Mendoza-Londono R, Pepin M, Pope FM, Reinstein E, Robert L, Rohrbach M, Sanders L, Sobey GJ, Van Damme T, Vandersteen A, van Mourik C, Voermans N, Wheeldon N, Zschocke J, Tinkle B (2017) The 2017 international classification of the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet 175(1):8–26. https://doi.org/10.1002/ajmg.c.31552 CrossRefPubMed Malfait F, Francomano C, Byers P, Belmont J, Berglund B, Black J, Bloom L, Bowen JM, Brady AF, Burrows NP, Castori M, Cohen H, Colombi M, Demirdas S, De Backer J, De Paepe A, Fournel-Gigleux S, Frank M, Ghali N, Giunta C, Grahame R, Hakim A, Jeunemaitre X, Johnson D, Juul-Kristensen B, Kapferer-Seebacher I, Kazkaz H, Kosho T, Lavallee ME, Levy H, Mendoza-Londono R, Pepin M, Pope FM, Reinstein E, Robert L, Rohrbach M, Sanders L, Sobey GJ, Van Damme T, Vandersteen A, van Mourik C, Voermans N, Wheeldon N, Zschocke J, Tinkle B (2017) The 2017 international classification of the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet 175(1):8–26. https://​doi.​org/​10.​1002/​ajmg.​c.​31552 CrossRefPubMed
11.
go back to reference Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, Dietz UA, Eker HH, El Nakadi I, Hauters P, Hidalgo Pascual M, Hoeferlin A, Klinge U, Montgomery A, Simmermacher RK, Simons MP, Smietanski M, Sommeling C, Tollens T, Vierendeels T, Kingsnorth A (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13(4):407–414. https://doi.org/10.1007/s10029-009-0518-x CrossRefPubMedPubMedCentral Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, Dietz UA, Eker HH, El Nakadi I, Hauters P, Hidalgo Pascual M, Hoeferlin A, Klinge U, Montgomery A, Simmermacher RK, Simons MP, Smietanski M, Sommeling C, Tollens T, Vierendeels T, Kingsnorth A (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13(4):407–414. https://​doi.​org/​10.​1007/​s10029-009-0518-x CrossRefPubMedPubMedCentral
12.
go back to reference Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral
13.
go back to reference Girotto JA, Malaisrie SC, Bulkely G, Manson PN (2000) Recurrent ventral herniation in Ehlers-Danlos syndrome. Plast Reconstr Surg 106(7):1520–1526CrossRefPubMed Girotto JA, Malaisrie SC, Bulkely G, Manson PN (2000) Recurrent ventral herniation in Ehlers-Danlos syndrome. Plast Reconstr Surg 106(7):1520–1526CrossRefPubMed
Metadata
Title
Complications and recurrence rates of patients with Ehlers-Danlos syndrome undergoing ventral hernioplasty: a case series
Authors
L. F. Kroese
E. H. Mommers
C. Robbens
N. D. Bouvy
J. F. Lange
F. Berrevoet
Publication date
01-08-2018
Publisher
Springer Paris
Published in
Hernia / Issue 4/2018
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-018-1739-7

Other articles of this Issue 4/2018

Hernia 4/2018 Go to the issue