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01-04-2018 | Original Article

Long-term follow-up (at 5 years) of midline incisional hernia repairs using a primary closure and prosthetic onlay technique: recurrence and quality of life

Authors: M. Juvany, C. Hoyuela, F. Carvajal, M. Trias, A. Martrat, J. Ardid

Published in: Hernia | Issue 2/2018

Abstract

Introduction and objectives

The recurrence rate of incisional hernia (IH) repair is usually underestimated due to a lack of long-term follow-up. The objective of this study was to evaluate recurrence rate for patients operated on midline IH surgery, using a primary closure and prosthetic onlay technique, 5 years after the procedure.

Materials and methods

From January 2009 to January 2011, all 92 patients operated on elective midline IH repair by primary closure and prosthetic onlay technique in a General Surgery Department were retrospectively included in the study. Exclusion criteria were absence of follow-up or death. Recurrence rate and quality of life were assessed. Demographic, surgical data and quality of life in patients with and without 5-year recurrence were compared.

Results

Mean follow-up was 64 months. Ultimately, 76 patients were included in the study, representing 82% of the selected patients during the study period (76/92), of whom 24 presented a recurrence (32%). Half (12) were diagnosed for recurrence more than 3 years after the surgery. Patients who developed a recurrence had more percentage of obesity (64 vs. 29%, p = 0.016), which denoted an odds ratio (OR) for recurrence of 4.4 (1.2–15.7; p = 0.01) and they punctuated lower in quality of life (6.0 ± 2.9 vs. 7.6 ± 2.6, p = 0.006).

Conclusions

Recurrence rate on midline IH repair is still a concern (32% at 5 years). It is advisable to look for other strategies and more efficient surgical techniques for IH surgery, especially in obese patients.

Sugerman HJ, Kellum JM Jr, Reines HD et al (1996) Greater risk of incisional hernia with morbidly obese than steroid-dependent patients and low recurrence with prefascial polypropylene mesh. Am J Surg 171:80–84CrossRefPubMed

Hodgson NC, Malthaner RA, Ostbye T et al (2000) The search for an ideal method of abdominal fascial closure: a meta-analysis. Ann Surg 231:436–442CrossRefPubMedPubMedCentral

Hoer J, Lawong G, Klinge U et al (2002) Factors influencing the development of incisional hernia: a retrospective study of 2,983 laparotomy patients over a period of 10 years. Chirurg 73:474–480CrossRefPubMed

Andersen LP, Klein M, Gögenur I et al (2009) Long-term recurrence and complication rates after incisional hernia repair with the open onlay technique. BMC Surg. 28(9):6CrossRef

Burger JW, Luijendijk RW, Hop WC et al (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240(4):578–583PubMedPubMedCentral

Fink C, Baumann P, Wente MN et al (2014) Incisional hernia rate 3 years after midline laparotomy. Br J Surg 101(2):51–54CrossRefPubMed

Gillion JF, Sanders D, Miserez M, et al (2016) The economic burden of incisional ventral hernia repair: a multicentric cost analysis. Hernia (Epub ahead of print)

Oprea V, Matei O, Leucã D et al (2013) Late results and quality of life after Rives-Stoppa repair for incisional hernias: a prospective clinical study. Chirurgia 108:679–683 (No. 5) PubMed

Gysel C (1974) Adolphe Quetelet. The statistics and biometry of growth. Orthod Fr 45(1):643–677PubMed

10.

World Health Organization (WHO): obesity and overweight. Fact Sheet No 311. Updated January 2015

11.

Langer S, Christiansen J (1985) Long-term results after incisional hernia repair. Acta Chirst Scand 151(3):217–219

12.

Klinge U, Fiebeler A (2010) Two controversial concepts: standard Procedure in a standard patient versus tailored surgery with procedures adjusted to individual patients. In: Volker S, Fitzgibbons RJ (eds) Hernia repair sequelae. Springer, Berlin, pp 467–472CrossRef

13.

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

14.

Cobb WS, Warren JA, Ewing JA et al (2015) Open retromuscular mesh repair of complex incisional hernia: predictors of wound events and recurrence. J Am Coll Surg 220(4):606–613CrossRefPubMed

15.

Carter SA, Hicks SC, Brahmbhatt R et al (2014) Recurrence and pseudorecurrence after laparoscopic ventral hernia repair: predictors and patient-focused outcomes. Am Surg 80(2):138–148PubMed

16.

Vilallonga R, Fort JM, Gonzalez O et al (2011) Management of patients with hernia or incisional hernia undergoing surgery for morbid obesity. J Obes 2011:860942CrossRefPubMed

17.

Raziel A, Sakran N, Szold A et al (2014) Concomitant bariatric and ventral/incisional hernia surgery in morbidly obese patients. Surg Endosc 16(4):1209–1212CrossRef

18.

Langer C, Schaper A, Liersch T et al (2005) Prognosis factors in incisional hernia surgery: 25 years of experience. Hernia 9(1):16–21CrossRefPubMed

19.

Froylich D, Segal M, Weinstein A et al (2016) Laparoscopic versus open ventral hernia repair in obese patients: a long-term follow-up. Surg Endosc 30(2):670–675CrossRefPubMed

20.

Den Hartog D, Dur AH, Tuinebreijer WE et al (2008) Open surgical procedures for incisional hernias. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD006438.pub2 PubMed

21.

Timmermans L, de Goede B, van Dijk SM et al (2014) Meta-analysis of sublay versus onlay mesh repair in incisional hernia surgery. Am J Surg 207(6):980–988CrossRefPubMed

22.

Hernandez-Granados P, Pereira JA, Feliu X, Lopez-Cano M, Fernandez F, Delgado I (2014) Spanish registry of incisional hernia. Preliminary results after 1 year of implementation. Hernia 18(suppl. 2):S31

23.

Kokotovic D, Gögenur I, Helgstrand F (2017) Substantial variation among hernia experts in the decision for treatment of patients with incisional hernia: a descriptive study on agreement. Hernia 21(2):271–278CrossRefPubMed

24.

Ramirez OM, Ruas E, Dellon AL (1990) “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 86(3):519–526CrossRefPubMed

25.

Cornette B, De Bacquer D, Berrevoet F (2017) Component separation technique for giant incisional hernia: a systematic review. Am J Surg. https://doi.org/10.1016/j.amsurg.2017.07.032 PubMed

26.

Pauli EM, Rosen MJ (2013) Open ventral hernia repair with component separation. Surg Clin North Am 93(5):1111–1133CrossRefPubMed

27.

Novitsky YW, Fayezizadeh M, Majumder A, Neupane R, Elliott HL, Orenstein SB (2016) Outcomes of posterior component separation with transversus abdominis muscle release and synthetic mesh sublay reinforcement. Ann Surg 264(2):226–232CrossRefPubMed

28.

Sauerland S, Walgenbach M, Habermalz B et al (2011) Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD007781.pub2

29.

Al Chalabi H, Larkin J, Mehigan B et al (2015) A systematic review of laparoscopic versus open abdominal incisional hernia repair, with meta-analysis of randomized controlled trials. Int J Surg 20:65–74CrossRefPubMed

30.

López-Cano M (2013) Evidence-based surgery. Rev Hispanoam Hernia 1(1):18–26CrossRef

31.

Hoyuela C, Trias M, Juvany M et al (2015) Preoperative progressive pneumoperitoneum and anterior component separation techniques for the treatment of a huge incisional hernia with loss of domain. Cir Esp 93(Special Congress):919

32.

Bueno-Lledó J, Torregrosa A, Ballester N, Carreño O, Carbonell F, Pastor PG, Pamies J, Cortés V, Bonafé S, Iserte J (2017) Preoperative progressive pneumoperitoneum and botulinum toxin type A in patients with large incisional hernia. Hernia 21(2):233–243CrossRefPubMed

Title: Long-term follow-up (at 5 years) of midline incisional hernia repairs using a primary closure and prosthetic onlay technique: recurrence and quality of life
Authors: M. Juvany
C. Hoyuela
F. Carvajal
M. Trias
A. Martrat
J. Ardid
Publication date: 01-04-2018
Publisher: Springer Paris
Published in: Hernia / Issue 2/2018
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-018-1730-3

At a glance: The STEP trials

Springer Medicine

Long-term follow-up (at 5 years) of midline incisional hernia repairs using a primary closure and prosthetic onlay technique: recurrence and quality of life

Abstract

Introduction and objectives

Materials and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction and objectives

Materials and methods

Results

Conclusions

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