Abstract
BackgroundPatients with inflammatory bowel disease (IBD) have a high-life time risk undergoing abdominal surgery and are prone to develop incisional hernias (IH) in the postoperative course. Therefore, we investigated the role of IBD as perioperative risk factor in open ventral hernia repair (OVHR) as well as the impact of IBD on hernia recurrence during postoperative follow-up.MethodsThe postoperative course of 223 patients (Non-IBD (n = 199) and IBD (n = 34)) who underwent OVHR were compared by means of extensive group comparisons and binary logistic regressions. Hernia recurrence was investigated in the IBD group according to the Kaplan–Meier method and risk factors for recurrence determined by Cox regressions.ResultsGeneral complications (≥ Clavien-Dindo I) occurred in 30.9% (72/233) and major complications (≥ Clavien-Dindo IIIb) in 7.7% (18/233) of the overall cohort with IBD being the single independent risk-factor for major complications (OR = 4.2, p = 0.007). Further, IBD patients displayed a recurrence rate of 26.5% (9/34) after a median follow-up of 36 months. Multivariable analysis revealed higher rates of recurrence in patients with ulcerative colitis (UC, 8/15, HR = 11.7) compared to patients with Crohn’s disease (CD, 1/19, HR = 1.0, p = 0.021).ConclusionIBD is a significant risk factor for major postoperative morbidity after OVHR. In addition, individuals with IBD show high rates of hernia recurrence over time with UC patients being more prone to recurrence than patients with CD.
Highlights
Incisional hernias (IH) are a common complication after abdominal surgery with an incidence of up to 20% [1]
Various techniques with partly biological and partly synthetic mesh implants have been included in some of the studies [2]. This limited data within in the literature allows only a limited analysis of the longterm outcome after incisional hernias (IH) repair in inflammatory bowel disease (IBD) patients. It remains to be determined whether patients with IBD are subject to a higher perioperative risk in IH repair compared to non-IBD patients, especially concerning implantation of a synthetic mesh prosthesis
We observed no significant differences between the groups regarding preoperative characteristics except for a higher body mass index (BMI) in the Non-IBD group (Non-IBD: 29.0 ± 5.9 kg/m2 vs. IBD: 27.0 ± 5.5 kg/m2; p = 0.043)
Summary
Incisional hernias (IH) are a common complication after abdominal surgery with an incidence of up to 20% [1]. Various techniques with partly biological and partly synthetic mesh implants have been included in some of the studies [2]. This limited data within in the literature allows only a limited analysis of the longterm outcome after IH repair in IBD patients. We further aimed to determine the long-term outcome of OVHR in IBD patients and to identify risk factors that are associated with hernia recurrence. Patients with inflammatory bowel disease (IBD) have a high-life time risk undergoing abdominal surgery and are prone to develop incisional hernias (IH) in the postoperative course. We investigated the role of IBD as perioperative risk factor in open ventral hernia repair (OVHR) as well as the impact of IBD on hernia recurrence during postoperative follow-up
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