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01-08-2021 | Original Article

What is the reality in epigastric hernia repair?–a trend analysis from the Herniamed Registry

Authors: F. Köckerling, D. Adolf, K. Zarras, R. Fortelny, R. Lorenz, B. Lammers, W. Reinpold, B. Stechemesser, C. Schug-Pass, D. Weyhe

Published in: Hernia | Issue 4/2021

Abstract

Introduction

The proportion of epigastric hernias in the total collective of all operated abdominal wall hernias is 3.6–6.9%. The recently published guidelines for treatment of epigastric hernias of the European Hernia Society and the Americas Hernia Society recommend the use of a mesh for defect size of ≥ 1 cm, i.e., a preperitoneal flat mesh technique for sizes 1–4 cm, and laparoscopic IPOM technique for defects > 4 cm and/or obesity. Against that background, this analysis of data from the Herniamed Registry now aims to explore trends in epigastric hernia repair.

Methods

To detect trends, the perioperative outcome was calculated separately for the years 2010 to 2019 and the 1-year follow-up for the years 2010 to 2018 and significant differences were identified. Analysis was based on 25,518 primary elective epigastric hernia repairs. The rates of postoperative surgical complications, pain at rest, pain on exertion, chronic pain requiring treatment and recurrence associated with the various surgical techniques were calculated separately for each year. Fisher’s exact test for unadjusted analysis between years was applied with Bonferroni adjustment for multiple testing.

Results

The proportion of laparoscopic IPOM repairs declined from 26.0% in 2013 to 18.2% in 2019 (p < 0.001). Instead, the proportion of open sublay repairs rose from 16.5% to 21.8% (p < 0.001). That was also true for innovative techniques such as the EMILOS, MILOS, eTEP and preperitoneal flat mesh technique (8.3% vs 15.3%; p < 0.001). This change in indication for the various surgical techniques led to a significant improvement in the postoperative surgical complication rate (3.8% vs 1.9%; p < 0.001).

Conclusion

The trend is for epigastric hernia repair to be performed less often in laparoscopic IPOM technique and instead more often in open sublay technique or the new innovative techniques.

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Title: What is the reality in epigastric hernia repair?–a trend analysis from the Herniamed Registry
Authors: F. Köckerling
D. Adolf
K. Zarras
R. Fortelny
R. Lorenz
B. Lammers
W. Reinpold
B. Stechemesser
C. Schug-Pass
D. Weyhe
Publication date: 01-08-2021
Publisher: Springer Paris
Published in: Hernia / Issue 4/2021
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-021-02408-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

What is the reality in epigastric hernia repair?–a trend analysis from the Herniamed Registry

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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