High rates of readmission and recurrence from elective incisional hernia repairs

Jan 8th – Elective incisional hernia repairs result in high rates of recurrence and subsequent reoperation.[tabs tab1=”2MM Rundown” tab2=”Full 2MM Report” tab3=”About the Authors”]

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1. Elective incisional hernia repairs result in high rates of recurrence and subsequent reoperation.

2. Risk factors for recurrence and readmission were open repair, young age and large defect repair. Sublay mesh repair resulted lower risk of reoperation.

Hernia repair is a common elective procedure that can be done with a multitude of techniques. Although generally considered a simple operation, a hernia repair can have a high risk of recurrence and reoperation as shown by this Danish study. Specific risk factors such as large defects and open repair carry a higher probability of early and late recurrence and need for further surgery.

Click to read the study in Journal of American College of Surgeons

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Image: PD

1. Elective incisional hernia repairs result in high rates of recurrence and subsequent reoperation.

2. Risk factors for recurrence and readmission were open repair, young age and large defect repair. Sublay mesh repair resulted lower risk of reoperation.

Primer: Ventral hernia repair is a bread-and-butter operation within general surgery. Abdominal contents can herniate through a defect in the abdominal wall due to prior intervention, congenital anomaly or fascial weakness. Incisional hernias occur at the site of a prior procedure. Failure of the deep inguinal ring to close in the embryonic stage can result in visceral organs passing through the inguinal canal into the testicular sac, creating an indirect inguinal hernia. Spontaneous hernias are classified by their location: direct, inguinal, umbilical, femoral or Spigelian.

Hernias are repaired electively to avoid potential for bowel incarceration, which is a surgical emergency. Sublay mesh repair, open or laparoscopic approaches have been shown to provide the best outcomes. However, depending on the size and location of the hernia, as well as surgeon comfort, primary suture repair and inlay or onlay mesh can be used. Onlay mesh is characterized as external to all aponeuroses, whereas sublay is retromuscular or preperitoneal, and inlay is intraperitoneal. Hernia recurrence is a common complication of repair; other complications include hematoma/seroma formation and wound infection.

Background reading:

1. Cochrane Review: Laparoscopic techniques versus open techniques for inguinal hernia repair

2. Cochrane Review: Open Mesh versus non-Mesh for groin hernia repair

This [prospective database review] study: Authors examined 3,258 elective hernia repair patients from the Danish Ventral Hernia Database. 30 day readmission and re-op rate was 13.3% and 2.2%, respectively.  Significant risk factors for poor early outcomes were advanced age, open repair, large defect and vertical primary incision (p < 0.05). Additionally, open repair had a 21.1% risk of recurrence, compared with a 15.5% risk after laparoscopic repair (p=0.03). Open repair and large defects were also risk factors for poor late outcomes, as were young age and type of mesh used (onlay and intraperitoneal) in open repairs (p < 0.05).

In sum: Hernia repair is a common elective procedure that can be done with a multitude of techniques. Although generally considered a simple operation, a hernia repair can have a high risk of recurrence and reoperation as shown by this Danish study. Specific risk factors such as large defects and open repair carry a higher probability of early and late recurrence and need for further surgery.

Click to read the study in Journal of American College of Surgeons

By [AO] and [AH]

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Asya Ofshteyn: Asya is a 3rd year M.D. candidate at University of California, San Francisco.

Allen Ho: Allen is a 4th year M.D. candidate at Harvard Medical School.

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