Top

Hernia

Published in:

01-02-2021 | Incisional Hernia | Original Article

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

Authors: H. Hoffmann, F. Köckerling, D. Adolf, F. Mayer, D. Weyhe, W. Reinpold, R. Fortelny, P. Kirchhoff

Published in: Hernia | Issue 1/2021

Abstract

Introduction

The 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 complication-related 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.

Liang MK, Holihan JL, Itani K, Alawadi ZM, Flores Gonzales JR, Askenasi EP et al (2017) Ventral hernia management—expert consensus guided by systematic review. Ann Surg 265:80–89. https://doi.org/10.1097/SLA.0000000000001701CrossRefPubMed

Earle D, Roth JS, Saber A, Haggerty S, Bradley JF, Fanelli R et al (2016) SAGES guidelines for laparoscopic ventral hernia repair Surg Endosc 30:3163–3183. https://doi.org/10.1007/s00464-016-5072-xCrossRef

Silecchia G, Campanile FC, Sanchez L, Ceccarelli G, Antinori A, Ansaloni L et al (2015) Laparoscopic ventral/incisional hernia repair: updated guidelines from the EAES and EHS endorsed consensus development conference. Surg Endosc 29:2463–2584. https://doi.org/10.1007/s00464-015-4293-8CrossRefPubMed

Bittner R, Bingener-Casey J, Dietz U, Fabian M, Ferzli GS, Fortelny RH, Köckerling F et al (2014) Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS))-Part 1. Surg Endosc 28:2–29. https://doi.org/10.1007/s00464-013-3170-6CrossRefPubMed

Bittner R, Bingener-Casey J, Dietz U, Fabian M, Ferzli GS, Fortelny RH, Köckerling F et al (2014) Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS))-Part 2. Surg Endosc 28:353–379. https://doi.org/10.1007/s00464-013-3171-5CrossRefPubMed

Bittner R, Bingener-Casey J, Dietz U, Fabian M, Ferzli GS, Fortelny RH, Köckerling F et al (2014) Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS))-Part 3. Surg Endosc 28:380–404. https://doi.org/10.1007/s00464-013-3172-4CrossRefPubMed

Bittner R, Bain K, Bansal VK, Berrevoet F, Bingener-Casey J, Chen D et al (2019) Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS))-Part A. Surg Endosc 33:3069–3139. https://doi.org/10.1007/s00464-019-06907-7CrossRefPubMedPubMedCentral

Bittner R, Bain K, Bansal VK, Berrevoet F, Bingener-Casey J, Chen D et al (2019) Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS))-Part B. Surg Endosc 33:3511–3549. https://doi.org/10.1007/s00464-019-06908-6CrossRefPubMedPubMedCentral

Luijendijk RW, Hop WCJ, van den Tol MP, de Lange DCD, Braaksma MMJ, IJzermans JNM et al (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med. 343:392–398CrossRef

10.

Burger JWA, Luijendijk RW, Hop WCJ, Halm JA, Verdaasdonk EGG, Jeekel J (2004) Long-term follow-up of a randomized controlled trial of suture vs. mesh repair on incisional hernia. Ann Surg 240:578–585. https://doi.org/10.1097/01.sla.0000141193.08524.e7CrossRefPubMedPubMedCentral

11.

Flum DR, Horvath K, Koepsell T (2003) Have outcomes on incisional hernia repair improved with time? A population-based analysis. Ann Surg 237(1):129–135CrossRef

12.

Köckerling F, Koch A, Lorenz R, Schug-Pass C, Stechemesser B, Reinpold W (2015) How long do we need to follow-up our hernia patients to find the real recurrence rate? Front Surg 2:24. https://doi.org/10.3389/fsurg.2015.00024CrossRefPubMedPubMedCentral

13.

Köckerling F (2019) Recurrent incisional hernia repair—an overview. Front Surg 6:26. https://doi.org/10.3389/fsurg.2019.00026CrossRefPubMedPubMedCentral

14.

Slater NJ, Montgomery A, Berrevoet F, Carbonell AM, Chang A, Franklin M et al (2014) Criteria for definition of a complex abdominal wall hernia. Hernia 18:7–17. https://doi.org/10.1007/s10029-013-1168-6CrossRefPubMed

15.

Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault DD, Chelala E et al (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13:407–414. https://doi.org/10.1007/s10029-009-0518-xCrossRefPubMedPubMedCentral

16.

Horne C, Prabhu A. Recurrent ventral hernia repair. The SAGES manual of hernia surgery (2019). doi: https://doi.org/10.1007/978-3-319-78411-3_26

17.

Davila DG, Parikh N, Frelich MJ, Goldblatt MI (2016) The increased cost of ventral hernia recurrence: a cost analysis. Hernia 20:811–817. https://doi.org/10.1007/s10029-016-15-5CrossRefPubMed

18.

Rios A, Rodriguez JM, Munitiz V, Alcaraz D, Perez D, Parilla P (2001) Factors that affect recurrence after incisional herniorrhaphy with prosthetic material. Eur J Surg 167:855–859CrossRef

19.

Owei L, Swendiman RA, Torres-Landa S, Dempsey DT, Dumon KR (2019) Impact of body mass index on minimally invasive ventral hernia repair: an ACS-NSQIP analysis. Hernia. https://doi.org/10.1007/s10029-019-01944-6CrossRefPubMed

20.

Kaoutzanis C, Leichtle SW, Mouawad NJ, Welch KB, Lampman RM, Wahl WL, Cleary RK (2015) Risk factors for postoperative wound infections and prolonged hospitalization after ventral/incisional hernia repair. Hernia 19:113–123. https://doi.org/10.1007/s10029-013-1155-yCrossRefPubMed

21.

Ferrari G, Bertoglio C, Magistro C, Girardi V, Mazzola M, Di Lernia S, Pugliese R (2013) Laparoscopic repair for recurrent incisional hernias: a single institute experience of 10 years. Hernia 17:573–580. https://doi.org/10.1007/s10029-013-1098-3CrossRefPubMed

22.

McKinlay R, Park A (2004) Laparoscopic ventral incisional hernia repair: a more effective alternative to conventional repair of recurrent incisional hernia. J Gastrointest Surg 8(6):670–674. https://doi.org/10.1016/j.gassur.2003.11.006CrossRefPubMed

23.

Verbo A, Petito L, Manno A, Coco C, Mfascrs CM, Lurati M, Pedretti G et al (2007) Laparoscopic approach to recurrent incisional hernia repair: a 3-year experience. J Laparoendosc Adv Surg Tech 17:5. https://doi.org/10.1089/lap.2006.0133CrossRef

24.

Meyer R, Häge A, Zimmermann M, Bruch HP, Keck T, Hoffmann M, Schlöricke E (2015) Is laparoscopic treatment of incisional and recurrent hernias associated with an increased risk for complications? Intern J Surg 19:121–127. https://doi.org/10.1016/j.ijsu.2015.05.046CrossRef

25.

Uranues S, Salehi B, Bergamaschi R (2008) Adverse events, quality of life, and recurrence rates after laparoscopic adhesiolysis and recurrent incisional hernia mesh repair in patients with previous failed repairs. J Am Coll Surg 207:5. https://doi.org/10.1016/j.jamcollsurg.2008.06.330CrossRef

26.

Picazo-Yeste J, Moreno-Sanz C, Sedano-Vizcaino C, Morandeira-Rivas A, Sanchez-De Pedro F (2017) Outcomes after laparoscopic ventral hernia repair: does the number of previous recurrences matter? A prospective study. Surg Endosc 31:4514–4521. https://doi.org/10.1007/s00464-017-5510-4CrossRefPubMed

27.

Berry MF, Paisley S, Low DW, Rosato EF (2007) Repair of large complex recurrent incisional hernias with retromuscular mesh and panniculectomy. Am J Surg 194:199–204. https://doi.org/10.1016/j.amjsurg.2006.10.031CrossRefPubMed

28.

Temudom T, Siadati M, Sarr MG (1996) Repair of complex giant or recurrent ventral hernias by using tension-free intraparietal prosthetic mesh (Stoppa technique): lessons learned from our initial experience (fifty patients). Surg 120:738–744CrossRef

29.

Novitsky YW, Porter JT, Ruch ZC, Getz SB, Pratt BL, Kercher KW, Heniford BT (2006) Open preperitoneal retrofascial mesh repair for multiply recurrent ventral incisional hernias. J Am Coll Surg 203:3. https://doi.org/10.1016/j.jamcollsurg.2006.05.297CrossRef

30.

DiBello J, Moore JH (1996) Sliding myofascial flap of the rectus abdominus muscles for the closure of recurrent ventral hernias. Plast Reconstr Surg 98:464CrossRef

31.

Stechemesser B, Jacob DA, Schug-Pass C, Köckerling F (2012) Herniamed: an internet-based registry for outcome research in hernia surgery. Hernia 16:269–276. https://doi.org/10.1007/s10029-012-0908.3CrossRefPubMed

32.

Kyle-Leinhase I, Köckerling F, Jorgensen LN, Montgomery A, Gillion JF et al (2018) Comparison of hernia registries: the CORE project. Hernia 22:561–575. https://doi.org/10.1007/s10029-017-1724-6CrossRefPubMedPubMedCentral

33.

Köckerling F, Simon T, Hukauf M, Hellinger A, Fortelny R, Reinpold W, Bittner R (2018) The importance of registries in the postmarketing surveillance of surgical meshes. Ann Surg 268:1097–1104. https://doi.org/10.1097/SLA.0000000000002326CrossRefPubMed

34.

Köckerling F, Simon T, Adolf D, Köckerling D, Mayer F, Reinpold W, Weyhe D, Bittner R (2018) Laparoscopic IPOM versus open sublay technique for elective incisional hernia repair: a registry-based, propensity score-matched comparison of 9907 patients. Surg Endosc 33(10):3361–3369. https://doi.org/10.1007/s00464-018-06629-2CrossRef

35.

Yang GPC (2017) From intraperitoneal onlay mesh repair to preperitoneal onlay mesh repair. Asian J Endosc Surg 10(2):119–127. https://doi.org/10.1111/ases.12388CrossRefPubMed

36.

Wassenaar EB, Schoenmaeckers EJP, Raymakers JTFJ, Rakic S (2010) Subsequent abdominal surgery after laparoscopic ventral and incisional hernia repair with an expanded polytetrafluoroethylene mesh: a single institution experience with 72 reoperations. Hernia 14(2):137–142. https://doi.org/10.1007/s10029-009-0568-0CrossRefPubMed

37.

Baucom RB, Ousley J, Feurer ID, Beveridge GB, Pierce RA, Holzman MD, Sharp KW, Poulose BK (2016) Patient reported outcomes after incisional hernia repair—establishing the ventral hernia recurrence inventory. Am J Surg 212:81–88. https://doi.org/10.1016/j.amjsurg.2015.06.007CrossRefPubMed

38.

Köckerling F, Hoffmann H, Adolf D, Reinpold W, Mayer F, Kirchhoff P, Mayer F, Weyhe D, Lammers B, Emmanuel K (2020) Potential influencing factors on the outcome in incisional hernia repair—a registry-based multivariable analysis of 22,895 patients. Hernia. https://doi.org/10.1007/s10029-020-02184-9CrossRefPubMedPubMedCentral

39.

Coelho JCU, Dalledone GO, Schiel W, Berbardin J, Claus CMP, Matias JEF, Freitas ACT (2019) Does male gender increase the risk of laparoscopic Cholecystectomy. ABCD Arq Bras Cir Dig 32:e1438. https://doi.org/10.1590/0102-672020190001e1438CrossRefPubMed

40.

Ambe PC, Köhler L (2015) Is the male gender and independent risk factor for complication in patients undergoing laparoscopic cholecystectomy for acute cholecystitis? Int Surg 100:854–859. https://doi.org/10.9738/INTSURG-D-14-00151.1CrossRefPubMedPubMedCentral

41.

Pereira JA, Montcusi B, Lopez-Cano M, Hernandez-Granados P, Fresno de Prado L, Members of the EVEREG Registry (2018) Risk factors for bad outcomes in incisional hernia repair: lessons learned from the national registry of incisional hernia (EVEREG). Cir Esp 96:436–442CrossRef

42.

Helgstrand F, Rosenberg J, Kehlet H, Jorgensen LN, Bisgaard T (2013) Nationwide prospective study of outcomes after elective incisional hernia repair. J Am Coll Surg 216:217–228. https://doi.org/10.1016/j.jamcollsurg.2012.10.013CrossRefPubMed

43.

Kroese LF, Kleinrensink GJ, Lange JF, Gillion JF, Hernia-Club Members (2017) External validation of the European Hernia society classification for postoperative complications after incisional hernia repair: a cohort study of 2,191 Patients. Am Col Surg. https://doi.org/10.1016/j.jamcollsurg.2017.11.018CrossRef

44.

Langbach O, Bukholm I, Benth JŠ, Røkke O (2015) Long term recurrence, pain and patient satisfaction after ventral hernia mesh repair. World J Gastrointest Surg 7(12):384–393. https://doi.org/10.4240/wjgs.v7.i12.384CrossRefPubMedPubMedCentral

45.

Gronnier C, Wattier JM, Favre H, Piessen G, Mariette C (2012) Risk factors for chronic pain after open ventral hernia repair by underlay mesh placement. World J Surg 36(7):1548–1554. https://doi.org/10.1007/s00268-012-1523-2CrossRefPubMed

46.

Köckerling F, Hoffmann H, Adolf D, Weyhe D, Reinpold W, Koch A, Kirchhoff P (2019) Female gender as independent risk factor for chronic pain following elective incisional hernia repair—a registry-based, propensity score-matched comparison of 22895 patients. Hernia. https://doi.org/10.1007/s10029-019-02089-2CrossRefPubMedPubMedCentral

47.

Reinpold W, Schröder M, Berger C et al (2019) Mini- or less-open sublay operation (MILOS): a new minimally invasive technique for the extraperitoneal mesh repair of incisional hernias. Ann Surg 269(4):748–755. https://doi.org/10.1097/SLA.0000000000002661CrossRefPubMed

48.

Belyansky I, Daes J, Radu VG et al (2018) A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair. Surg Endosc 32(3):1525–1532. https://doi.org/10.1007/s00464-017-5840-2CrossRefPubMed

Title: Analysis of 4,015 recurrent incisional hernia repairs from the Herniamed registry: risk factors and outcomes
Authors: H. Hoffmann
F. Köckerling
D. Adolf
F. Mayer
D. Weyhe
W. Reinpold
R. Fortelny
P. Kirchhoff
Publication date: 01-02-2021
Publisher: Springer Paris
Keyword: Incisional Hernia
Published in: Hernia / Issue 1/2021
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-020-02263-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

Changes in the lateral abdominal wall following endoscopic subcutaneous anterior component separation

Would surgeons be definitively forbidden to restore the abdominal wall without using a mesh?

Single-blind randomized clinical trial of transinguinal preperitoneal repair using self-expanding mesh patch vs. Lichtenstein repair for adult male patients with primary unilateral inguinal hernia

A comparison of robotic mesh repair techniques for primary uncomplicated midline ventral hernias and analysis of risk factors associated with postoperative complications

Use of polyvinylidene fluoride (PVDF) meshes for ventral hernia repair in emergency surgery

Propensity score matching analysis of short-term outcomes in robotic ventral hernia repair for patients with a body mass index above and below 35 kg/m2