Primary Ventral Hernia Repair Research Articles

Outcome of primary ventral hernia repair with monofilament polyester composite ventral patch in a community-based hospital

Background: Ventral hernia repair (VHR) is one of the common surgical procedures carried out in general surgery. This study assessed the post operative outcomes in patients with primary ventral hernia undergoing repair using monofilament polyester composite ventral patch Parietex™ Covidien (PCO-VP). Methods: A prospective single proportion observational study of 54 patients undergoing open VHR for primary ventral hernia with the PCO-VP in a community-based hospital was carried out. The patients were followed up for a period of one year from day of surgery. Primary outcome was recurrence, and secondary outcomes were reoperations and complications including seroma, hematomas, abdominal wall abscess, wound infections, and mesh infections. Results: Our sample size of (n=54) included 35 (65%) females and 19 (35%) males with a mean hernia defect diameter of 3.5±0.4 cm. 83% (45) underwent elective surgery (EL) and 17% (9) underwent emergency surgery with a mean operative time of 98.5 minutes, 11% (n=6) patients needed alteration of the technique and 20% (n=11) patients needed mesh repositioning, 12 adverse events were noted during the hospital stay. No mesh infections, early recurrences, readmissions or revision surgeries were noted. Patients had a average Carolina comfort scale score of 4/115 noted at the end of study. Conclusions: The use of PCO-VP to repair primary ventral hernia yielded nearly nil early recurrence rate, low postoperative complications and high satisfaction ratings, PCO-VP repair is a highly effective method for small and moderate size ventral hernias in both elective and emergency setting.

Comparison between the open and the laparoscopic approach in the primary ventral hernia repair: a systematic review and meta-analysis

BackgroundVentral hernia repair underwent various developments in the previous decade. Laparoscopic primary ventral hernia repair may be an alternative to open repair since it prevents large abdominal incisions. However, whether laparoscopy improves clinical outcomes has not been systematically assessed.ObjectivesThe aim is to compare the clinical outcomes of the laparoscopic versus open approach of primary ventral hernias.MethodsA systematic search of MEDLINE (PubMed), Scopus, Web of Science, and Cochrane Central Register of Controlled Trials was conducted in February 2023. All randomized controlled trials comparing laparoscopy with the open approach in patients with a primary ventral hernia were included. A fixed-effects meta-analysis of risk ratios was performed for hernia recurrence, local infection, wound dehiscence, and local seroma. Meta-analysis for weighted mean differences was performed for postoperative pain, duration of surgery, length of hospital stay, and time until return to work.ResultsNine studies were included in the systematic review and meta-analysis. The overall hernia recurrence was twice less likely to occur in laparoscopy (RR = 0.49; 95%CI = 0.32–0.74; p < 0.001; I2 = 29%). Local infection (RR = 0.30; 95%CI = 0.19–0.49; p < 0.001; I2 = 0%), wound dehiscence (RR = 0.08; 95%CI = 0.02–0.32; p < 0.001; I2 = 0%), and local seroma (RR = 0.34; 95%CI = 0.19–0.59; p < 0.001; I2 = 14%) were also significantly less likely in patients undergoing laparoscopy. Severe heterogeneity was obtained when pooling data on postoperative pain, duration of surgery, length of hospital stay, and time until return to work.ConclusionThe results of available studies are controversial and have a high risk of bias, small sample sizes, and no well-defined protocols. However, the laparoscopic approach seems associated with a lower frequency of hernia recurrence, local infection, wound dehiscence, and local seroma.

The results of clinical application of the mesh with anti-adhesive fluoropolymer coating in laparoscopic intraperitoneal repair of primary ventral hernia

The purpose of the study was to evaluate the results of using fluoropolymer-coated mesh during intraperitoneal onlay mesh hernia repair in patients with primary ventral hernias. The multicenter, non-randomized, controlled clinical study included 88 patients of both sexes who were operated on using a laparoscopic approach using the IPOM technique for a primary ventral hernia. The duration of observation ranged from 3 to 12 months. In the main group, 48 patients received fluoropolymer-coated meshes (Ftorex). A comparison was made with a retrospective group of 40 patients who were treated with anti-adhesive collagen-coated meshes (Parietene composite, Parietex Composite, Symbotex). The number of early and late postoperative complications in the groups did not have significant differences, at the same time, their number was lower in the group of patients in whom fluoropolymer-coated meshes were used. Most of the complications corresponded to Clavien-Dindo class I and II and did not pose a significant threat to health. There were no recurrences of hernias observed in patients included in the study. There were slightly more adhesions in the fluoropolymer-coated mesh group (35.4% vs. 25.0% in the collagen-coated mesh group). The quality of life of patients in the study groups did not differ. In laparoscopic IPOM hernia repair fluoropolymer-coated meshes are not inferior in effectiveness and safety to traditionally used collagen-coated meshes and can be recommended for use in patients with primary ventral hernias.

Comparison of quality of life in laparoscopic and open primary ventral hernia repair according to European registry for abdominal wall hernias quality of life score

Background Ventral hernia can be defined as noninguinal and nonhiatal hernia in the fascia of the abdominal wall. Laparoscopic repair become a popular method with decreased overall complications nowadays. We aimed to provide an efficient management for ventral hernia through comparison of quality of life (QoL) postlaparoscopic and open techniques according to European registry for abdominal wall hernias quality of life (EuraHS-QOL) score. Patients and methods The data of 54 patients with primary ventral hernia were collected prospectively. Of these patients, 27 underwent open repair, and 27 underwent laparoscopic repair after excluding patients with a complicated and recurrent ventral hernia and incisional hernia. Perioperative QoL was assessed according to the EuraHS score. Results Two groups were designed, each including 27 patients. The most common complication was seroma (25.9%) in open repair, followed by infection (18.5%), while only one case in laparoscopic repair had port site infection; the difference was statistically significant (P&lt;0.05). The mean operative time in open repair was 51.2±5.1 and 89.7±9.5 in laparoscopic repair; the difference was highly significant (P&lt;0.001). The mean length of stay in the hospital was 23.1±7.3, and it was 19.1±6 in laparoscopic repair; the difference was significant (P&lt;0.05). All cases in open repair had subcutaneous drain; but not in laparoscopic repair; the difference was highly significant (P&lt;0.001). The EuraHS score in all its items was significant in favor of laparoscopic repair. Conclusion Laparoscopic repair was associated with high QoL, less complications, and recovery time as compared with open repair of ventral hernia.

Short-term outcomes after open versus robot-assisted repair of ventral hernias: a nationwide database study

PurposeThe robotic platform is widely implemented; however, evidence evaluating outcomes of robotic ventral hernia repair is still lacking. The aim of the study was to evaluate the short-term outcomes after open and robot-assisted repair of primary ventral and incisional hernias.MethodsNationwide register-based cohort study with data from the Danish Ventral Hernia Database and the National Danish Patients Registry was from January 1, 2017 to August 22, 2022. Robot-assisted ventral hernia repairs were propensity score matched 1:3 with open repairs according to the confounding variables defect size, Charlson comorbidity index score, and age. Logistic regression analyses were performed for factors associated with length of stay > 2 days, readmission, and reoperation within 90 days.ResultsA total of 528 and 1521 patients underwent robot-assisted and open repair, respectively. The mean length of hospital stay in days was 0.5 versus 2.1 for robot-assisted and open approach, respectively (P < 0.001) and open approach was correlated with risk of length of stay > 2 days (OR 23.25, CI 13.80–39.17, P < 0.001). The incidence of readmission within 90 days of discharge was significantly lower after robot-assisted repair compared to open approach (6.2% vs. 12.1%, P < 0.001). Open approach was independently associated with increased risk of readmission (OR 21.43, CI 13.28–39.17, P = 0.005, P < 0.001).ConclusionRobot-assisted ventral hernia repair is safe and feasible and associated with shorter length of stay and decreased risk of readmission compared with open ventral hernia repair.

Obesity increases the surgical complexity and risk of recurrence after midline primary ventral hernia repair: results on 2307 patients from the French Society of hernia surgery (SFCP-CH) registry database.

Obesity is a known risk factor of recurrence after hernia surgery, but available data often concern pooled cases of primary and incisional hernia, with short follow-up. We aimed to analyze the impact of severe obesity (BMI ≥ 35kg/m2) on the results of midline primary ventral hernia repair (mPVHR), in comparison with non-severely obese patients. Data were extracted from a multicentric registry, in which patients' data are consecutively and anonymously collected. We conducted a retrospective comparative study on patients with severe obesity (sOb) versus non-severely obese patients (non-sOb), who underwent surgery, with a minimal 2-year follow-up after their mPVHR. Among 2307 patients, 267 sOb and 2040 non-sOb matched inclusion criteria. Compared with non-sOb, sOb group gathered all the worse conditions and risk factors: more ASA3-4 (39.3% vs. 10.2%; p < 0.001), symptomatic hernia (15.7% vs. 6.8%; p < 0.001), defect > 4cm in diameter (24.3% vs. 8.8%; p < 0.001), emergency surgery (6.1% vs. 2.5%; p = 0.003), and Altemeir class > 1 (9.4% vs. 2.9%; p < 0.001). Laparoscopic IPOM was used more often in sOb patients (40% vs. 32%; p = 0.016), but with smaller Hauters' ratio (46 vs. 73; p < 0.001). Compared with the non-sOb, the rate of day-case surgery was lower (48% vs. 68%; p < 0.001), the surgical site occurrences were significantly more frequent (6.4 %vs. 2.5%; p < 0.001). The main outcome, 2-year recurrence, was 5.9% in the sOb vs. 2.1% (p = 0.008), and 2-year reoperations was 3% vs. 0.3% (p = 0.006). In the adjusted analysis, severe obesity was an independent risk factor for recurrence [OR = 2.82, (95%CI, 1.45; 5.22); p = 0.003]. In patients with severe obesity, mPVHR is technically challenging and recurrence rate is three times higher than that of non-severely obese patients.

Primary Ventral Hernia Repair and the Risk of Postoperative Small Bowel Obstruction: Intra Versus Extraperitoneal Mesh.

The aim of this study was to compare the likelihood of bowel obstruction according to the placement of the mesh (either intraperitoneal or extraperitoneal) in ventral hernia repairs. Patients were divided into two groups, an intraperitoneal (IP) group (mesh placed by laparoscopy or with an open approach) and an extraperitoneal (EP) group, all operated on in the Digestive Surgery Department at the Dijon University Hospital. The primary outcome was the occurrence of an episode of bowel obstruction requiring hospitalization and confirmed by abdominal CT scan. Between March 2008 and July 2021, 318 patients were included, with 99 patients in the EP group (71 meshes placed preperitoneally and 28 placed retromuscularly) and 219 patients in the IP group (175 patients operated on laparoscopically versus 44 patients by direct approach). Three patients presented an episode of acute intestinal obstruction, with no difference between the two groups (p = 0.245), although all bowel obstructions occurred in the IP group and with the laparoscopic approach (1.7% of patients operated on by laparoscopy). The occlusive events occurred at 1 month, 2 years, and 3 years. There was no difference in terms of recurrence or postoperative chronic pain. There were more seroma and mesh infections in the EP group (p < 0.05). Two patients operated on by laparoscopy had undetected bowel injuries, prompting emergent surgery for peritonitis. No statistically significant difference was found in terms of bowel obstruction between the intraperitoneal and the extraperitoneal position, but all cases of obstruction happened in the intraperitoneal mesh group. Visceral lesions remain a major complication of the laparoscopic approach that should not be neglected.

Modifiable comorbidities impact on ventral hernia recurrence following robotic abdominal wall reconstruction using resorbable biosynthetic mesh: 36-month follow-up

BackgroundThere is an ongoing debate on the role of comorbidities in hernia outcomes, particularly with minimally invasive approaches. This study evaluated the impact of modifiable comorbidities (MCMs) on 36-month hernia recurrence rates after robotic transversus abdominis release (TAR) with resorbable biosynthetic mesh underlay for primary ventral hernia repair. MethodsA review of medical records for patients who underwent the robotic TAR procedure between January 2015 and May 2022 performed by a single surgeon was conducted. Patients were separated into three groups: those with 0, 1, and 2+ MCMs, followed by a breakdown of comorbidity types and combinations of comorbidities. MCMs included obesity, diabetes, and tobacco use. The primary outcomes included hernia recurrence at 36 months and the time between surgery and recurrence. Results175 patients met the inclusion criteria, with a mean hernia diameter of 12.9 ± 5.4 cm and a mean BMI of 34 ± 8 kg/m2. 9.7 % of patients experienced hernia recurrence at 36-month follow-up. No significant difference in the recurrence rate and length of time between surgery and recurrence was observed between the groups (p = .265 and p = .283, respectively). No group, single comorbidity, or a combination of comorbidities was found to have significantly increased odds of recurrence at 36 months. ConclusionThe presence of MCMs, either alone or in combination with another, did not significantly increase the odds of hernia recurrence at 36 months following ventral hernia repair using this approach. Future studies with larger sample sizes and multiple surgeons are needed to corroborate this data. Key messageModifiable comorbidities have previously been shown to increase the risk of hernia recurrence after ventral hernia repair. Our study found relatively low rates of hernia recurrence and no significantly increased odds of recurrence among different comorbid groups at 36-month follow-up following robotic transversus abdominis release with resorbable biosynthetic mesh underlay.

Quality of life, post-operative complications, and hernia recurrence following enhanced-view Totally Extra-Peritoneal (eTEP) Rives-Stoppa for incisional and primary ventral hernia repair.

The purpose of this study was to evaluate the quality of life (QoL), early post-operative complications, and hernia recurrence rate following laparoscopic enhanced-view Totally Extra-Peritoneal (eTEP) Rives-Stoppa (RS) for incisional and primary ventral hernia repair. Retrospective review of a prospectively maintained database of all patients undergoing eTEP-RS between 2017 and 2020. Data retrieved included demographics, and clinical and operative variables. QoL was assessed using the EuraHS-QoL scale prior to- and following eTEP-RS. During the study period, 61 patients met the inclusion criteria. Age and BMI were 62 (60.4 ± 13.8) years and 29.7 (30.4 ± 6)kg/m2, respectively. Incisional hernia was the most common pathology (n = 40, 65%) followed by primary ventral hernia (n = 21, 35%), with 24 patients (39%) having a previous hernia repair. Diastasis-recti repair was undertaken in 34 patients (55%), a concomitant inguinal hernia was repaired in 6 patients (10%), and 13 patients (21%) underwent transversus abdominis release (TAR). Median follow-up time was 13months and 15 patients (25%) had at least 2years of follow-up. Hernia recurrence was found in 4 patients (6.5%). Pre-operative and post-operative EuraHS-QOL questionnaire scores were available for 46 patients (75%) and showed significant improvement in pain (7 vs. 0.5, p < 0.0001; 5 vs. 0.5, p < 0.0001; 5 vs. 1.5; p < 0.006), restrictions (median of 5 vs. 0.5, p < 0.0001; 5 vs. 0, p < 0.0001; median of 5 vs. 1, p < 0.0001, of 6.5 vs. 1.5, p < 0.0001), and cosmetic appearance (8 vs. 4, p < 0.0001). Abdominal wall repair using the eTEP-RS approach significantly improves subjective QoL variables with an acceptable post-operative complications and hernia recurrence rates in a short-term follow-up.

Prospective, international analysis of quality of life outcomes in recurrent versus primary ventral hernia repairs

BackgroundQuality of life (QOL) has become a key outcome measure following ventral hernia repair (VHR), but recurrent and primary VHR have not been compared in this context previously. MethodsThe International Hernia Mesh Registry (2008–2019) was used to identify patients with QOL data scored by the Carolinas Comfort Scale preoperatively and postoperatively at 1 year. ResultsRepairs were performed in 227 recurrent and 1,122 primary VHs. Recurrent patients had a higher BMI, larger defects, and were more likely to have preoperative pain, but other comorbidities were equal. Recurrence rates at 1 year were equivalent. Recurrent patients had a greater improvement in pain (−6.3 ± 10.2 vs −4.3 ± 8.3,p = 0.002) and movement limitation (−5.5 ± 10.0 vs −3.2 ± 7.2,p < 0.001) compared to primary patients, but they had increased postoperative mesh sensation (4.6 ± 7.7 vs 2.7 ± 5.5,p < 0.001). ConclusionsRecurrent VHRs led to improved pain and movement limitation, but increased mesh sensation. These findings may be useful for preoperative counseling in the elective setting.

Impact of methocarbamol on opioid use after primary ventral and inguinal hernia repair

BackgroundMultimodal analgesia is now a mainstay of perioperative care. Our aim is to assess the impact of adding methocarbamol on opioid use for patients undergoing primary ventral (umbilical and epigastric) hernia repair (PVHR) and inguinal hernia repair (IHR). MethodsRetrospective review of patients undergoing PVHR and IHR who received methocarbamol, propensity score matched in a 2:1 fashion to patients not receiving methocarbamol. ResultsFifty-two PVHR patients receiving methocarbamol were matched to 104 control patients. Study patients were prescribed fewer opioids (55.8 vs 90.4%; p < 0.001) and received lower MME (20 vs 50; p < 0.001), with no difference in refills or rescue opioids. For IHR, study patients received fewer prescriptions (67.3 vs 87.5%; p < 0.001) and received lower MME (25 vs 40; p < 0.001), with no difference in rescue opioid (5.9 vs 0%; p = 0.374). ConclusionsMethocarbamol significantly reduced opioid prescribing in patients undergoing PVHR and IHR without increasing the risk of refill or rescue opioid.

Association of body mass index with morbidity following elective ventral hernia repair

BackgroundPrior work has linked body mass index (BMI) with postoperative outcomes of ventral hernia repair (VHR), though recent data characterizing this association are limited. This study used a contemporary national cohort to investigate the association between BMI and VHR outcomes. MethodsAdults ≥ 18 years undergoing isolated, elective, primary VHR were identified using the 2016–2020 American College of Surgeons National Surgical Quality Improvement Program database. Patients were stratified by BMI. Restricted cubic splines were utilized to ascertain the BMI threshold for significantly increased morbidity. Multivariable models were developed to evaluate the association of BMI with outcomes of interest. ResultsOf ~89,924 patients, 0.5 % were considered Underweight, 12.9 % Normal Weight, 29.5 % Overweight, 29.1 % Class I, 16.6 % Class II, 9.7 % Class III, and 1.7 % Superobese. After risk adjustment, class I (Adjusted Odds Ratio [AOR] 1.22, 95 % Confidence Interval [95%CI]: 1.06–1.41), class II (AOR 1.42, 95%CI: 1.21–1.66), class III obesity (AOR 1.76, 95%CI: 1.49–2.09) and superobesity (AOR 2.25, 95 % CI: 1.71–2.95) remained associated with increased odds of overall morbidity relative to normal BMI following open, but not laparoscopic, VHR. A BMI of 32 was identified as the threshold for the most significant increase in predicted rate of morbidity. Increasing BMI was linked to a stepwise rise in operative time and postoperative length of stay. ConclusionBMI ≥ 32 is associated with greater morbidity following open, but not laparoscopic VHR. The relevance of BMI may be more pronounced in open VHR and must be considered for stratifying risk, improving outcomes, and optimizing care. Key messageBody mass index (BMI) continues to be a relevant factor in morbidity and resource use for elective open ventral hernia repair (VHR). A BMI of 32 serves as the threshold for significant increase in overall complications following open VHR, though this association is not observed in operations performed laparoscopically.

A Standardized Protocol for Opioid Prescribing After Surgery Decreases Total Morphine Equivalents Prescribed.

Perioperative opioid analgesia has been extensively reexamined during the opioid epidemic. Multiple studies have demonstrated over prescription of opioids, demonstrating the need for change in prescribing practices. A standard opioid prescribing protocol was implemented to evaluate opioid prescribing trends and practices. To evaluate opioid use after primary ventral, inguinal, and incisional hernia repair and to assess clinical factors that may impact opioid prescribing and consumption. Secondary outcomes include the number of refills, patients without opioid requirement, difference in opioid use based on patient characteristics and adherence to prescribing protocol. This is a prospective observational study examining patients undergoing inguinal, primary ventral and incisional hernias between February and November 2019. A standardized prescribing protocol was implemented and utilized for postoperative prescribing. All data was captured in the abdominal core health quality collaborative (ACHQC) and opioid use was standardized via morphine milligram equivalents (MME). 389 patients underwent primary ventral, incisional, and inguinal hernia repair, with a total of 285 included in the final analysis. 170 (59.6%) of patients reported zero opioid use postoperatively. Total opioid MME prescribed and high MME consumption were significantly higher after incisional hernia repair with a greater number of refills were required. Compliance with prescribing protocol resulted in lower MME prescription, but not actual lower MME consumption. Implementation of a standardized protocol for opioid prescribing after surgery decreases the total MME prescribed. Compliance with our protocol significantly reduced this disparity, which has the potential for decreasing abuse, misuse, and diversion of opioids by better estimating actual postoperative analgesic requirements.

BJS-01 NATIONWIDE ANALYSIS OF SHORT-TERM OUTCOMES AFTER OPEN VS. ROBOT-ASSISTED REPAIR OF VENTRAL HERNIA

Abstract Background The aim was to evaluate short-term outcomes after robot-assisted and open repair of primary ventral and incisional hernia. Methods Nationwide register-based cohort study with data from the Danish Ventral Hernia Database and the National Danish Patients Registry from January 1, 2017 to August 22, 2022. Robot-assisted ventral hernia repairs were propensity score matched 1:3 with open repairs according to the confounding variables defect size, type of hernia, Charlson comorbidity index score, and age. Logistic regression analyses were performed for factors associated with length of stay &amp;gt; 2 days, readmission, and reoperation within 90 days. Results A total of 550 and 1,655 patients underwent robot-assisted and open repair, respectively. The mean length of hospital stay in days was 0.5 vs. 1.9 for robot-assisted and open approach, respectively, (P &amp;lt; 0.001) and open approach was correlated with risk of length of stay &amp;gt; 2 days (OR 4.69, CI 6.56–7.85, P &amp;lt; 0.001). The incidence of readmission and reoperation within 90 days of discharge was significantly lower after robot-assisted repair compared to open approach (7.0% vs. 15.6%, P &amp;lt; 0.001) and (2.0% vs. 4.4%, P = 0.013), respectively. Open approach was independently associated with increased risk of readmission and reoperation (OR 2.46, CI 1.73–3.51, P = 0.005) and (OR 2.30, CI 1.21–4.38, P = 0.011), respectively. Conclusion Robot-assisted ventral hernia repair is safe and feasible and associated with shorter length of stay and decreased risk of readmission and surgical reintervention compared with open ventral hernia repair.

Patient-reported outcomes of laparoscopic versus robotic primary ventral and incisional hernia repair: a systematic review and meta-analysis.

Patient-Reported Outcome Measures (PROM's) are increasingly used to assess surgical outcomes in low-risk surgeries such as minimally invasive primary ventral and incisional hernia repair. The purpose of this meta-analysis was to systematically summarize the available evidence for the effect of laparoscopic versus robotic primary ventral and incisional hernia repair on PROM's. A systematic review and meta-analysis were performed in accordance with PRISMA guidelines. Randomised control trials, retrospective and prospective studies were included. Medline, Embase, SCOPUS, Web of Science, and Cochrane CENTRAL, and two trial registers were searched. Pooled effect sizes and 95% confidence intervals were calculated using the Mantel-Haenszel method. The overall quality of evidence was assessed using GRADE. Of the 2728 titles screened, eight studies involving 41,205 participants were included. Return to activities of daily living, return to work day and recurrence rate were statistically better in the robotic group. Length of stay, readmission, postoperative pain, quality of life, body image, and patient satisfaction were similar in both groups. The GRADE rating of the quality of evidence was moderate for postoperative pain and low to very low for the quality of life, length of stay, recurrence and readmission. The available data of PROM's of laparoscopic and robotic primary ventral and incisional hernia repair is scarce and highly heterogeneous, thus making it difficult to assess the superiority of the laparoscopic technique over the robotic technique. Further studies with uniform reporting of PROM's in laparoscopic and robotic primary ventral and incisional hernia repair are needed.

Predictors of postoperative complications in patients with ventral hernia

To evaluate potential predictors of 1-month postoperative complications after primary ventral hernia repair using database of the 1st Clinic of the Samarkand State Medical University. A cohort study included 348 patients who underwent ventral hernia surgery in the 1st Clinic of the Samarkand State Medical University between January 1, 2014 and January 1, 2021. We performed logistic regression analysis to identify risk factors of postoperative complications. More than one complication within 1-month after surgery developed in 87 (25%) patients. Those factors associated with complications in univariate analysis (p<0.05) and clinically important factors were included in multivariate analysis. In multivariate analysis, age, body mass index, hypertension, hernia size, hospital-stay and surgery time were independent risk factors. Age, BMI, hypertension, anamnesis and size of hernia, as well as surgery time correlated with postoperative complications. Therefore, these factors should be used in preoperative risk assessment.

Evaluation of Treatment Differences Between Men and Women Undergoing Ventral Hernia Repair: An Analysis of the Abdominal Core Health Quality Collaborative

INTRODUCTION: Sex is emerging as an important clinical variable associated with surgical outcomes and decision-making. Its impact on baseline and treatment differences in primary and incisional ventral hernia repair remains unclear. METHODS: This retrospective cohort study uses the Abdominal Core Health Quality Collaborative (ACHQC) database to identify elective umbilical, epigastric, or incisional hernia repair. Propensity matching was performed to investigate confounder-adjusted treatment differences between men and women. Treatments of interest included surgical approach, mesh use, mesh type, mesh position, anesthesia type, myofascial release, fascial closure, and fixation use. RESULTS: A total of 8,489 umbilical, 1,801 epigastric, and 16,626 incisional hernia repairs were identified. Women undergoing primary ventral hernia repair were younger (umbilical 46.4 vs 54 years, epigastric 48.7 vs 52.7 years), with lower BMI (umbilical 30.4 vs 31.5, epigastric 29.2 vs 31.1), and less likely diabetic (umbilical 9.9% vs 11.4%, epigastric 6.8% vs 8.8%). Women undergoing incisional hernia repair were also younger (mean 57.5 vs 59.1 years), but with higher BMI (33.1 vs 31.5), and more likely diabetic (21.4% vs 19.1%). Propensity analysis included 3,644 umbilical, 1,232 epigastric, and 12,480 incisional hernias. Women with incisional hernia were less likely to undergo an open repair (60.2% vs 63.4%, p < 0.001) and have mesh used (93.8% vs 94.8%, p = 0.02). Women had a higher rate of intraperitoneal mesh placement, and men had a higher rate of preperitoneal and retromuscular mesh placement. CONCLUSION: Small but statistically significant treatment differences regarding operative approach, mesh use, and mesh position exist between men and women undergoing ventral hernia repair.

P-149 FEASIBILITY AND SAFETY OF AMBULATORY ETEP RETRORECTUS RIVES-STOPPA REPAIR FOR VENTRAL HERNIA

Abstract Introduction Endoscopic totally extraperitoneal retromuscular repair (eTEP-RS) was recently introduced as a new technique for ventral hernia repair. It has been reported to have a significant reduction in analgesia need and reduce length of stay compared to laparoscopic intraperitoneal repair. We aim to evaluate the safety and feasibility of ambulatory primary ventral hernia and incisional hernia repair using eTEP technique. Methods Patients planned for ambulatory eTEP ventral hernia repair between October 2020 to April 2022 were retrospectively analyzed Results 11 patients who were deemed suitable for day surgery preoperatively were included in the analysis. Median age was 48.3 years. Defect sizes ranged from 3–6 cm. 5 patients had more than 1 midline defect, 1 patient had a spigelian hernia and 1 patient had bilateral inguinal hernias which were repaired. 7 patients were successfully managed as day case eTEP-RS. 1 patient required a conversion to open RS due to additional, large defects found intraoperatively, 1 patient stayed for 1 night for urinary retention, 1 patient was drowsy and could not be discharged on the day of surgery and 1 patient was converted to IPOM repair. There were no postoperative complications or recurrences. Conclusion Ambulatory eTEP is feasible, safe and effective in selected patients.

BJS-02 LONG-TERM REOPERATION RATE FOLLOWING PRIMARY VENTRAL HERNIA REPAIR: A REGISTER-BASED STUDY

Abstract Aim The aim of this study was to analyse the risk for reoperation following primary ventral hernia repair. Methods The study was based on umbilical hernia and epigastric hernia repairs registered in the population-based Swedish National Patient Register (NPR) 2010–2019. Reoperation was defined as repeat repair after primary repair. Results Altogether 30,253 umbilical hernia repairs and 7407 epigastric hernia repairs were identified. There were 624 reoperations registered following primary umbilical repair and 137 following primary epigastric repairs. In multivariable Cox proportional hazard analysis, the hazard ratio (HR) for reoperation was 0.284 (95% confidence interval (CI) 0.106–0.760) after open onlay mesh repair, 0.476 (CI 0.359–0.629) after open interstitial mesh repair, 0.368 (CI 0.230–0.590) after open sublay mesh repair, 0.446 (CI 0.167–1.194) after open intraperitoneal onlay mesh repair, 0.931 (CI 0.639–1.357) after laparoscopic repair, and 0.939 (CI 0.502–1.757) after other (unknown) techniques, when compared to open suture repair as reference method. Following umbilical hernia repair, the risk for reoperation was also significantly higher for patients aged ≤49 years (HR 1.669, CI 1.391–2.002), for women (HR 1.390, CI 1.178–1.641), and for patients with liver cirrhosis (HR 2.546, CI 1.050–6.174). For patients undergoing epigastric hernia repair, the only significant risk factor for reoperation was age ≤49 years (HR 2.079, CI 1.380–3.134). Conclusions All types of open mesh repair were associated with lower reoperation rates than open suture repair and laparoscopic repair. Female sex, young age and liver cirrhosis were risk factors for reoperation due to hernia recurrence, regardless of method.

OC-033 SLOWLY RESORBABLE VERSUS PERMANENT SYNTHETIC MESH IN OPEN RETROMUSCULAR VENTRAL HERNIA REPAIR - 3 YEAR RESULTS OF A RANDOMIZED CONTROLLED TRIAL

Abstract Introduction Implantation of synthetic meshes provides long-term hernia repair, but may result in mesh-related complications. The longterm resorbable mesh used in this study maintains more than 50% of its strength for 6 months and is completely resorbed after 3 years. Methods This multi-centre, randomized controlled trial compared the use of the TIGR® Matrix Surgical Mesh (Novus Scientific, Sweden) with a large-pore polypropylene mesh (Soft®mesh, BD, UK) in primary ventral and incisional hernia repair. Retromuscular mesh repair was performed. Primary endpoint was hernia recurrence rate after a 3 year follow-up period. Secondary endpoints were hernia recurrence rate at 1 year and 2 years, as well as perioperative morbidity and longterm complications including pain. Results Seventy-nine patients were included, but 69 patients received study treatment. Fifty-seven patients (82.6%) completed follow-up of 3 years. One patient (2.9%) developed a seroma after hernia repair with TIGR mesh. Three patients had a reintervention for hematoma (8.6%) in the control group versus two reinterventions (5.9%) after repair with TIGR mesh (p=0.673. One patient underwent late re-operation and mesh removal after hernia repair with TIGR mesh due to chronic wound infection. During three years follow-up, seven (10.1%) patients experienced a hernia recurrence, two (5.7%) in the control group and five (14.7%) after TIGR mesh (p=0.15). Conclusion Although not statistically significant, this multicentric RCT showed a higher recurrence rate for longterm degradable mesh patients after 3 years of follow-up. These results call for larger studies with long-term follow-up comparing slowly resorbable mesh materials with permanent mesh products.