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Open Access 01-04-2021 | Incisional Hernia | Original Article

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

Authors: L. Verstoep, G. H. J. de Smet, D. Sneiders, L. F. Kroese, G.-J. Kleinrensink, J. F. Lange, J.-F. Gillion, The Hernia-Club Members

Published in: Hernia | Issue 2/2021

Abstract

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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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-xCrossRefPubMedPubMedCentral

Baker JJ, Oberg S, Andresen K, Klausen TW, Rosenberg J (2018) Systematic review and network meta-analysis of methods of mesh fixation during laparoscopic ventral hernia repair. Br J Surg 105(1):37–47. https://doi.org/10.1002/bjs.10720CrossRefPubMed

Harslof S, Krum-Moller P, Sommer T, Zinther N, Wara P, Friis-Andersen H (2018) Effect of fixation devices on postoperative pain after laparoscopic ventral hernia repair: a randomized clinical trial of permanent tacks, absorbable tacks, and synthetic glue. Langenbecks Arch Surg 403(4):529–537. https://doi.org/10.1007/s00423-018-1676-zCrossRefPubMed

Khan RMA, Bughio M, Ali B, Hajibandeh S, Hajibandeh S (2018) Absorbable versus non-absorbable tacks for mesh fixation in laparoscopic ventral hernia repair: a systematic review and meta-analysis. Int J Surg 53:184–192. https://doi.org/10.1016/j.ijsu.2018.03.042CrossRefPubMed

Lindmark M, Strigard K, Lowenmark T, Dahlstrand U, Gunnarsson U (2018) Risk factors for surgical complications in ventral hernia repair. World J Surg 42(11):3528–3536. https://doi.org/10.1007/s00268-018-4642-6CrossRefPubMedPubMedCentral

Kockerling F, Schug-Pass C, Adolf D, Reinpold W, Stechemesser B (2015) Is pooled data analysis of ventral and incisional hernia repair acceptable? Front Surg 2:15. https://doi.org/10.3389/fsurg.2015.00015CrossRefPubMedPubMedCentral

Kroese LF, Gillion JF, Jeekel J, Kleinrensink GJ, Lange JF, Hernia-Club M (2018) Primary and incisional ventral hernias are different in terms of patient characteristics and postoperative complications—a prospective cohort study of 4565 patients. Int J Surg 51:114–119. https://doi.org/10.1016/j.ijsu.2018.01.010CrossRefPubMed

Stirler VM, Schoenmaeckers EJ, de Haas RJ, Raymakers JT, Rakic S (2014) Laparoscopic repair of primary and incisional ventral hernias: the differences must be acknowledged: a prospective cohort analysis of 1088 consecutive patients. Surg Endosc 28(3):891–895. https://doi.org/10.1007/s00464-013-3243-6CrossRefPubMed

Stabilini C, Cavallaro G, Dolce P, Capoccia Giovannini S, Corcione F, Frascio M, Sodo M, Merola G, Bracale U (2019) 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. Hernia 23(5):831–845. https://doi.org/10.1007/s10029-019-02033-4CrossRefPubMed

10.

Kockerling F, Hoffmann H, Adolf D, Reinpold W, 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

11.

Agha RA, Borrelli MR, Vella-Baldacchino M, Thavayogan R, Orgill DP, Group S (2017) The STROCSS statement: strengthening the reporting of cohort studies in surgery. Int J Surg 46:198–202. https://doi.org/10.1016/j.ijsu.2017.08.586CrossRefPubMedPubMedCentral

12.

Muysoms FE, Deerenberg EB, Peeters E, Agresta F, Berrevoet F, Campanelli G, Ceelen W, Champault GG, Corcione F, Cuccurullo D, DeBeaux AC, Dietz UA, Fitzgibbons RJ Jr, Gillion JF, Hilgers RD, Jeekel J, Kyle-Leinhase I, Kockerling F, Mandala V, Montgomery A, Morales-Conde S, Simmermacher RK, Schumpelick V, Smietanski M, Walgenbach M, Miserez M (2013) Recommendations for reporting outcome results in abdominal wall repair: results of a Consensus meeting in Palermo, Italy, 28–30 June 2012. Hernia 17(4):423–433. https://doi.org/10.1007/s10029-013-1108-5CrossRefPubMed

13.

Vandenbroucke JP, von Elm E, Altman DG, Gotzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M, Initiative S (2007) Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. PLoS Med 4(10):e297. https://doi.org/10.1371/journal.pmed.0040297CrossRefPubMedPubMedCentral

14.

Muysoms F, Campanelli G, Champault GG, DeBeaux AC, Dietz UA, Jeekel J, Klinge U, Kockerling F, Mandala V, Montgomery A, Morales Conde S, Puppe F, Simmermacher RK, Smietanski M, Miserez M (2012) EuraHS: the development of an international online platform for registration and outcome measurement of ventral abdominal wall hernia repair. Hernia 16(3):239–250. https://doi.org/10.1007/s10029-012-0912-7CrossRefPubMedPubMedCentral

15.

Altemeier WA (1982) Sepsis in surgery. Presidential address. Arch Surg 117(2):107–112. https://doi.org/10.1001/archsurg.1982.01380260001001CrossRefPubMed

16.

DeBord J, Novitsky Y, Fitzgibbons R, Miserez M, Montgomery A (2018) SSI, SSO, SSE, SSOPI: the elusive language of complications in hernia surgery. Hernia 22(5):737–738. https://doi.org/10.1007/s10029-018-1813-1CrossRefPubMed

17.

Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg 238(3):391–399. https://doi.org/10.1097/01.sla.0000086662.49499.ab ((discussion 399–400))CrossRefPubMedPubMedCentral

18.

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(2):217–228. https://doi.org/10.1016/j.jamcollsurg.2012.10.013CrossRefPubMed

19.

Thankam FG, Palanikumar G, Fitzgibbons RJ, Agrawal DK (2019) Molecular mechanisms and potential therapeutic targets in incisional hernia. J Surg Res 236:134–143. https://doi.org/10.1016/j.jss.2018.11.037CrossRefPubMed

20.

Kokotovic D, Bisgaard T, Helgstrand F (2016) Long-term recurrence and complications associated with elective incisional hernia repair. JAMA 316(15):1575–1582. https://doi.org/10.1001/jama.2016.15217CrossRefPubMed

21.

Dietz UA, Winkler MS, Hartel RW, Fleischhacker A, Wiegering A, Isbert C, Jurowich C, Heuschmann P, Germer CT (2014) Importance of recurrence rating, morphology, hernial gap size, and risk factors in ventral and incisional hernia classification. Hernia 18(1):19–30. https://doi.org/10.1007/s10029-012-0999-xCrossRefPubMed

22.

Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240(4):578–583. https://doi.org/10.1097/01.sla.0000141193.08524.e7 ((discussion 583–575))CrossRefPubMedPubMedCentral

23.

Rutkow IM (2003) Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surg Clin N Am 83(5):1045–1051. https://doi.org/10.1016/S0039-6109(03)00132-4 ((v–vi))CrossRefPubMed

Title: Hernia width explains differences in outcomes between primary and incisional hernias: a prospective cohort study of 9159 patients
Authors: L. Verstoep
G. H. J. de Smet
D. Sneiders
L. F. Kroese
G.-J. Kleinrensink
J. F. Lange
J.-F. Gillion
The Hernia-Club Members
Publication date: 01-04-2021
Publisher: Springer Paris
Keywords: Incisional Hernia
Hernia Surgery
Published in: Hernia / Issue 2/2021
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-020-02340-1

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

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

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Abstract

Purpose

Methods

Results

Conclusion

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