Primary Ventral Hernia Repair Research Articles

Clinical outcomes and quality of life associated with the use of a biosynthetic mesh for complex ventral hernia repair: analysis of the \u201cItalian Hernia Club\u201d registry

With the development of newer meshes and approaches to hernia repair, it is currently difficult to evaluate their performances while considering the patients’ perspective. The aim of the study was to assess the clinical outcomes and quality of life consequences of abdominal hernia repairs performed in Italy using Phasix and Phasix ST meshes through the analysis of real-world data to support the choice of new generation biosynthetic meshes. An observational, prospective, multicentre study was conducted in 10 Italian clinical centres from May 2015 to February 2018 and in 15 Italian clinical centres from March 2018 to May 2019. The evaluation focused on patients with VHWG grade II–III who underwent primary ventral hernia repair or incisional hernia intervention with a follow-up of at least 18 months. Primary endpoints included complications’ rates, and secondary outcomes focused on patient quality of life as measured by the EuroQol questionnaire. Seventy-five patients were analysed. The main complications were: 1.3% infected mesh removal, 4.0% superficial infection requiring procedural intervention, 0% deep/organ infection, 8.0% recurrence, 5.3% reintervention, and 6.7% drained seroma. The mean quality of life utility values ranged from 0.768 (baseline) to 0.967 (36 months). To date, Phasix meshes have proven to be suitable prostheses in preventing recurrence, with promising outcomes in terms of early and late complications and in improving patient quality of life.

Smoking and obesity are associated with increased readmission after elective repair of small primary ventral hernias: A nationwide database study

BackgroundSmoking and obesity are well-known risk factors for surgical site infection, but it is unknown whether these factors influence outcomes after repair of small umbilical and epigastric hernias with defects ≤2 cm. The aim of this study was to evaluate whether smoking and obesity are associated with readmission, reoperation for complications, and recurrence rates after elective repair of small umbilical and epigastric hernias. MethodsData on hernia type, size, repair method, smoking status, and body mass index after elective repair were available from the Danish Hernia Database from January 2017 through December 2018. Data on 90-day readmission and reoperation were available from the Danish National Patients Registry. ResultsA total of 1,965 patients were included for final analysis, of whom 85.1% (1,672 of 1,965) were repaired by open approach and 70.8% (1,391 of 1,965) with mesh reinforcement. A 100% follow-up was secured, and median follow-up time was 307 (138–432) days. Readmission was significantly higher in smokers (9.6% [34 of 353]) compared with nonsmokers (6.4% [103 of 1,612]), P = .030. The reoperation rate for complications was also significantly higher for smokers (4.0% [14 of 353])) compared with nonsmokers (2.0% [32 of 1,612]) (P = .026). Patients with a body mass index ≥35 kg/m2 were more frequently readmitted (11.7%; 12 of 102) compared with 6.7% (125 of 1,965) of patients with body mass index ≤34.9 kg/m2 (P = .046). In multivariate analyses adjusted for age, sex, presence of chronic obstructive pulmonary disease, diabetes, and cardiovascular disease, smoking (odds ratio = 1.52 [1.02–2.30]) and body mass index >40 kg/m2 (odds ratio = 6.07 [2.03–18.10]) were independent risk factors for readmission. ConclusionSmoking and obesity have a significantly negative impact on outcomes even after elective repair of small umbilical and epigastric hernias.

Endoscopic totally extraperitoneal approach (TEA) technique for primary ventral hernia repair

BackgroundUp to now the totally extraperitoneal (TEP) technique is limited to the treatment of inguinal hernias. Applying this anatomical repair concept to the treatment of other abdominal wall hernias, we developed an endoscopic totally extraperitoneal approach (TEA) to treat primary midline ventral hernias, including umbilical and epigastric hernias, in which for mesh placement, an anatomical space is developed between the peritoneum and the posterior rectus sheath in the ventral part of the abdominal wall (preperitoneal space).MethodsBetween September 2017 and December 2019 according to the selection criterions, 28 consecutive primary midline ventral hernias were repaired using TEA. After extensive endoscopic development of the midline extraperitoneal plane, which was started in the suprasymphysic area, and reduction of the hernia sac, the hernia defect was closed and a large mesh was placed in the preperitoneal position to enforce the anterior abdominal wall.ResultsAll operations were successfully performed without conversion to open surgery. The mean operation time was 103.3 min (range 85–145 min). Patient-reported postoperative pain was qualitatively mild with a mean pain visual analogue scale score of 1.9 on postoperative day 1. The average hospital stay was 1.9 days (range 1–3 days). Three patients developed minor complications and were treated with no long-term adverse effects. Readmissions within 30 days or hernia recurrences were not observed with a mean follow-up period of 18 months (range 10–27 months).ConclusionIn selected cases, TEA is a safe and feasible minimally invasive alternative in treating primary ventral hernias. This technique preserves the anatomical and physiological structure of the abdominal wall and may significantly reduce trauma and postoperative complications. Additionally, anti-adhesion-coated meshes and fixation tackers are not required, thus being cost-effective. Further studies are necessary to proof the true clinical efficacy in comparison to well-known alternative techniques.

Robotic versus open primary ventral hernia repair: A randomized controlled trial (Robovent Trial)

BackgroundThe objective of the present study is to compare the outcomes open PVHR and robotic PVHR. Methods/DesignThe present study will be a randomized single-blinded controlled trial with intention-to-treat analysis comparing robotic PVHR to open PVHR in adult patients undergoing elective PVHR with a defect ranging between 1–5 cm. Patient refusing to participate, not able to give informed consent, with history of intra-abdominal surgery contraindicating a robotic surgical approach will be excluded. The intervention will consist in laparoscopic robotically assisted trans-abdominal pre-peritoneal epigastric or umbilical PVHR with closure of fascial defect and non-adsorbable mesh reinforcement. The control will be open pre-peritoneal epigastric or umbilical hernia repair with closure of fascial defect and non-absorbable mesh reinforcement. The primary outcome will be the incidence of wound-related complication within 1 month. The secondary outcomes will be esthetic satisfaction, pain, pain-killers consumption, general complications, costs, operative time and early hernia recurrence. DiscussionOpen PVHR is potentially associated to more wound-related complications, but has the advantages of cost-effectiveness, short operative time and totally extra-peritoneal repair. Laparoscopic PVHR has lower wound-related complications but implies placing the mesh in intra-peritoneal position, requires advanced laparoscopic skills, usually does not allow the closure of the defect, and can lead to excessive pain and pain-killers consumption. Robotic PVHR uses the same laparoscopic access as laparoscopic PVHR, but thanks to the extended range of motion given by the robotic system, allows defect closure, pre-peritoneal placement of the mesh and requires less technical skills.In the present randomized controlled trial, we expect to show that robotic PVHR leads to better wound-related outcomes than open PVHR. Trial registrationThe present randomized controlled trial was registered into clinicaltrials.gov under registration number NCT04171921.

Robotic Versus Open Primary Ventral Hernia Repair: a Randomized Controlled Trial

Robotic Versus Open Primary Ventral Hernia Repair: a Randomized Controlled Trial

Long-Term Outcomes of Mesh and Primary Ventral Hernia Repair

Kadakia, Nikita; Mudgway, Ross; Vo, Jonathan MD; Seto, Tiffany MD; Ge, Shaokui PhD; Vong, Vinson; Depew, Aron MD, FACS; Bortz, Pascal MD Author Information

MILOS and EMILOS repair of primary umbilical and epigastric hernias

The currently mainly used techniques of primary ventral hernia repair have specific disadvantages and risks. To minimize complications of the existing open and laparoscopic techniques of ventral hernia repair, the endoscopic-assisted or endoscopic Mini- or Less-Open Sublay (E/MILOS) concept was developed. This paper reports on our experience with the E/MILOS concept for the management of primary umbilical and epigastric hernias. All E/MILOS operations were prospectively documented in the German hernia registry "Herniamed". For 1year follow-up, all patients and their general practitioners received a questionnaire. Five hundred and twenty primary umbilical and 554 epigastric E/MILOS operations with complete 1-year follow-up were included. Concomitant RD were treated in 18.3% and 14.1% of the umbilical and epigastric hernia cohort, respectively. Total perioperative complication rates and reoperation rates were 1.2% and 0.9% for both umbilical and epigastric hernias, respectively. Infection rates were 0.0% and 0.2% after umbilical and epigastric hernia operations, respectively. Recurrence rates 1year after E/MILOS umbilical and epigastric hernia were 0.0% and 0.5%, respectively. One year rates of chronic pain at rest, chronic pain during physical activities, and chronic pain requiring treatment after umbilical and epigastric hernia repair were 1.5% and 2.7%, 2.1% and 4.2%, and 0.6% and 1.8%; respectively. The E/MILOS concept allows the endoscopically assisted (MILOS) or endoscopic (EMILOS) transhernial minimal invasive sublay mesh repair of primary umbilical and epigastric hernias with or without rectus diastasis with low complication, recurrence, and chronic pain rates.

Pooled data analysis of primary ventral (PVH) and incisional hernia (IH) repair is no more acceptable: results of a systematic review and metanalysis of current literature.

Primary (PVHs) and incisional (IHs) ventral hernias represent a common indication for surgery. Nevertheless, most of the papers presented in literature analyze both types of defect together, thus potentially introducing a bias in the results of interpretation. The purpose of this systematic review and meta-analysis is to highlight the differences between these two entities. Methods MEDLINE, Scopus, and Web of Science databases were reviewed to identify studies evaluating the outcomes of both open and laparoscopic repair with mesh of PVHs vs IHs. Search was restricted to English language literature. Risk of bias was assessed with MINORS score. Primary outcome was recurrence, and secondary outcomes were baseline characteristics and intraoperative and postoperative data. Fixed effects model was used unless significant heterogeneity, assessed with the Higgins I square (I2), was encountered. The search resulted in 783 hits, after screening; 11 retrospective trials were selected including 38,727 patients. Mean MINORS of included trials was 15.2 (range 5-21). The estimated pooled proportion difference for recurrence was - 0.09 (- 0.11; - 0.07) between the two groups in favor of the PVH group. On metanalysis, PVHs were smaller in area and diameters, affected younger and less comorbid patients, and were more frequently singular; the operative time and length of stay was quicker. Other complications did not differ significantly. Our paper supports the hypothesis that PVH and IH are different conditions with the latter being more challenging to treat. Accordingly, EHS classifications should be adopted systematically as well as pooling data analysis should be no longer performed in clinical trials.

Two-year patient-related outcome measures (PROM) of primary ventral and incisional hernia repair using a novel three-dimensional composite polyester monofilament mesh: the SymCHro registry study

PurposeThis study examined patient-related outcome measures (PROMs) after repair of ventral primary or incisional hernias using Symbotex™ composite mesh (SCM), a novel three-dimensional collagen-coated monofilament polyester textile.MethodsPre-operative, peri-operative, and post-operative data were obtained from the French “Club Hernie” registry with 12- and 24-month follow-up.ResultsOne-hundred consecutive patients (mean age 62.0 ± 13.7; 51% female) underwent repair of 105 hernias: primary (39/105, 37.1%, defect area 5.2 ± 5.6 cm2) and incisional (66/105, 62.9%, 31.9 ± 38.7.8 cm2). The mean BMI was 29.7 (± 5.6 kg/m2). American Society of Anesthesiologists classifications were I 39.4%, II 37.4% and III 23.2%. 75% had risk factors for healing and/or dissection. Of 38 primary repairs, 37 were completed laparoscopically (combined approach n = 1), and of 62 incisional hernia repairs, 40 were completed laparoscopically, and 20 by open repair (combined approach n = 2). Laparoscopic was quicker than open repair (36.2 ± 23.5 min vs. 67.4 ± 25.8, p < 0001). Before surgery, 86.3% of hernias were reported to cause discomfort/pain or dysesthesia. At 24 months (93 of 100 patients), 91 (97.8%) reported no lump and 81 (87.1%) no pain or discomfort. Of 91 patients, 86 (94.5%) rated their repair “good” or “excellent.” There were nine non-serious, surgeon-detected adverse events (ileus, n = 3; seroma, n = 6) and one hernia recurrence (6–12 months).ConclusionsCompared to baseline, open and laparoscopic surgery improved PROMs 24 months after primary and incisional hernia repair. Minimal complications and recurrence support the long-term efficacy of SCM.

Nationwide Propensity-Score Matched Study of Mesh Versus Suture Repair of Primary Ventral Hernias in Women with a Subsequent Pregnancy.

Mesh reinforcement is recommended for repair of primary ventral hernias; however, this recommendation does not consider a potential subsequent pregnancy. The aim of this prospective cohort study was to compare mesh and suture repair of a primary ventral hernia in women with a subsequent pregnancy. All women of childbearing age who underwent repair of a primary ventral hernia between 2007 and 2014 were identified in the Danish Ventral Hernia Database. Data were merged with the Danish Medical Birth Registry. Women with a subsequent pregnancy and a propensity-score matched control group of women without a subsequent pregnancy were included. A structured questionnaire was sent out, and the primary outcome was hernia recurrence, while the secondary outcome was chronic postoperative pain. In total, 632 women were included, of whom 441 (69.8%) responded to the questionnaire (195 and 246 with and without subsequent pregnancy, respectively). The 8-year cumulative incidence of recurrence was 24.8%. In women with a subsequent pregnancy, mesh repair was associated with a decreased risk of recurrence (hazard ratio 0.44, 95% CI 0.20-0.95, p = 0.038, number needed to treat = 5.1) and an increased risk of chronic pain (OR 5.07, 95% CI 1.20-23.38, p = 0.029, number needed to harm = 4.7) compared with suture repair, in multivariable analyses. Mesh repair was associated with a decreased risk of recurrence, but an increased risk of chronic pain, compared with suture repair in women with a subsequent pregnancy.

Balancing mesh-related complications and benefits in primary ventral and incisional hernia surgery. A meta-analysis and trial sequential analysis.

BackgroundPrimary ventral hernia (PVH) and incisional hernia (IH) repair using a mesh appears to reduce hernia recurrence. However, are the benefits of mesh offset in part by mesh-related complications? The aim of this study was to compare placement of a mesh versus simple suture for recurrence and postoperative complications in the repair of PVH or IH.MethodsFive databases were searched for randomized controlled trials (RCTs). The study population was patients with a PVH or IH undergoing hernia repair. Intervention was placement of a nonabsorbable synthetic mesh, regardless of mesh location, surgical technique, hernia characteristics or surgical setting compared to primary suture. Primary outcome was the incidence of hernia recurrence. Secondary outcomes were wound infection, hematoma, seroma, postsurgical pain, duration of operation, and quality of life. A random-effects meta-analysis with trial sequential analysis (TSA) was used.Results10 RCTs with a total of 1270 patients were included. A significant reduction of the incidence of PVH or IH recurrence using a mesh for repair (risk ratio [RR] 0.39, 95% CI 0.27–0.55; P < 0.00001; I2 = 20%) was observed. TSA for recurrence, the accrued information size (1270) was 312% of the estimated required information size (RIS). Subgroup analysis for PVH and IH confirms reduction of recurrence after using a mesh in both groups. Overall postoperative complications did not show statistically significant differences between the mesh and surgical suture groups (RR 1.31, 95% CI 0.94–1.84; P = 0.12; I2 = 27%) but the accrued information size was only 22.4% of RIS and by subgroups complications were only related with IH repair.ConclusionsEvidence for the efficacy of repair of PVH or IH using a nonabsorbable synthetic mesh in terms of recurrence was found to be robust. Evidence for complications remains inconclusive.

All in: expansion of the acquisition of data for outcomes and procedure transfer (ADOPT) program to an entire SAGES annual meeting hands-on hernia course.

Continuing professional development (CPD) for the surgeon has been challenging because of a lack of standardized approaches of hands-on courses, resulting in poor post-course outcomes. To remedy this situation, SAGES has introduced the ADOPT program, implementing a standardized, long-term mentoring program as part of its hernia hands-on course. Previous work evaluating the pilot program showed increased adoption of learned procedures as well as increased confidence of the mentored surgeons. This manuscript describes the impact of such a program when it is instituted across an entire hands-on course. Following collection of pre-course benchmark data, all participants in the 2016 SAGES hands-on hernia course underwent structured, learner-focused instruction during the cadaveric lab. All faculty had completed a standardized teaching course in the Lapco TT format. Subsequently, course participants were enrolled in a year-long program involving longitudinal mentorship, webinars, conference calls, and coaching. Information about participant demographics, training, experience, self-reported case volumes, and confidence levels related to procedures were collected via survey 3months prior to 9months after the course. Twenty surgeons participated in the SAGES ADOPT 2016 hands-on hernia program. Of these, seventeen completed pre-course questionnaires (85%), ten completed the 3-month questionnaire (50%), and four completed the 9-month questionnaire (20%). Nine of ten respondents of the 3-month survey (90%) reported changes in their practice. In the 9-month survey, significant increases in the annualized procedural volumes were reported for open primary ventral hernia repair, open components separation, and mesh insertion for ventral hernia repair (p < 0.001). The expansion of the ADOPT program to an entire hands-on hernia course is both feasible and beneficial, with evidence of Kirkpatrick Levels 1-4a training effectiveness. This expanded success suggests that it is a useful blueprint for the CPD of surgeons wishing to learn new techniques and procedures for their patients.

Identification of risk factors for 30-day postoperative complications in patients undergoing primary ventral hernia repair: a prospective cohort study of 2,374 patients

BackgroundPrimary ventral hernia is a common condition. Surgical repair is associated with complications, but no clear predictive risk factors have been identified. The European Hernia Society classification offers a structured framework to describe hernias and to analyze postoperative complications. Given this structured nature, the European Hernia Society classification might prove useful for preoperative patient or treatment classification. The objective of this study was to investigate the European Hernia Society classification as a predictor for complications within 30 days after primary ventral hernia surgery. MethodsA registry-based, prospective cohort study was performed, including all patients undergoing primary ventral hernia surgery between September 1, 2011 and February 29, 2016. Univariate analyses and multivariable logistic regression analysis were performed to identify risk factors for postoperative complications. ResultsA total of 2,374 patients were included, of whom 105 (4.4%) patients had ≥1 complications, either a wound, surgical, or medical complication. Factors associated with complications in univariate analyses (P < .10) and clinically relevant factors were included into the multivariable analyses. In the multivariable analyses, age, body mass index, and the duration of the operation were independent risk factors. The diameter of the hernia was not an independent risk factor. ConclusionPrimary ventral hernia repair is associated with a 4.4% rate of complications. No correlation was found between the European Hernia Society classification and postoperative complications. Age, body mass index, and duration of the operation were correlated with postoperative complications. Therefore, age and body mass index should be used in the preoperative risk assessment.

Outcome assessment of primary ventral versus incisional hernia repair by laparoscopic approach

INTRODUCTION: The superiority of laparoscopic approach for a ventral and incisional hernia has been well documented over the traditional open repair. However, there is a paucity of literature comparing the outcomes of laparoscopic repair of primary ventral hernias versus incisional hernias. The objective of our study was to compare the operative variables and short-term outcomes of laparoscopic repair of primary ventral hernia as compared to incisional hernia in our setup. MATERIALS AND METHODS: We reviewed the clinical data of 159 patients who underwent laparoscopic ventral and incisional hernia repair from January 2014 to December 2015. Demographics, operative variables, and short-term outcomes were compared between the two groups. Comparison of outcome variables was done using independent sample t- test for continuous variables and Chi-square test for categorical variables. RESULTS: Of 159 patients, 90 (57%) had primary ventral hernia repair and 69 (43%) underwent incisional hernia repair. Both groups were similar in terms of age, body mass index, comorbid conditions, and high preponderance of females. The number (P CONCLUSIONS: The patients in the incisional hernia group had higher frequency of complex and large hernias. Laparoscopic repair of incisional hernia was associated with extensive adhesiolysis, longer operating time, and longer hospital stay as compared to primary ventral hernias.

Primary ventral or groin hernia in pregnancy: a cohort study of 20,714 women.

Prevalence, management, and risk of emergency operation for primary ventral or groin hernia in pregnancy are unknown. The objective of this study was to estimate the prevalences of primary ventral or groin hernia in pregnancy and the potential risks for elective and emergency repair. This single-institutional retrospective study included all pregnant women attending one or more prenatal consultations at Hvidovre Hospital, Denmark, during a 3-year period. Patients' medical records were electronically retrieved. A free-text search algorithm and subsequent manual review was conducted to identify patients registered with a primary ventral or groin hernia in pregnancy. Follow-up was conducted by review of medical record notes within the Capital Region of Denmark supplemented with structured telephone interviews on indication. In total, 20,714 pregnant women were included in the study cohort. Seventeen (0.08%) and 25 (0.12%) women were registered with a primary ventral and groin hernia, respectively. None underwent elective or emergency repair in pregnancy, and all had uncomplicated childbirth. In 10 women, the groin bulge disappeared spontaneously after delivery. During postpartum follow-up of median 4.4years (range 0.2-6.0years), five (0.02%) and four (0.02%) underwent elective primary ventral and groin hernia repair, respectively. Primary ventral or groin hernia seems rare in pregnancy, and the incidence of emergency repair is extremely low. Watchful waiting strategy is recommended during pregnancy in women suspected for a primary ventral or groin hernia.

Minimally invasive sublay mesh repair of incisional and primary abdominal wall hernias using the MILOS technique

Primary ventral and incisional hernia repair is a routine operation in general surgery. The most widely used techniques, however, have some disadvantages and risks. In order to minimize complications and postoperative pain, we developed the endoscopically assisted mini and less open sublay (MILOS) operation. The surgical steps of this novel technique are described here. The operation is performed via a small incision transhernially with light-armed laparoscopic instruments either under direct visualization or endoscopic view. After creating an extraperitoneal space of at least 8 cm and CO2 insufflation, total extraperitoneal preperitoneal mesh repair (TEP) of ventral and incisional hernias can be performed. The results and complication rates of 715 MILOS operations for incisional hernias are presented. The data of all MILOS operations were prospectively documented in the German hernia database “Herniamed.” The MILOS technique facilitates minimally invasive transhernial repair of primary ventral and incisional hernias using large retromuscular/preperitoneal meshes; the technique is associated with a very low morbidity rate and with less chronic pain.

Adverse Events after Ventral Hernia Repair: The Vicious Cycle of Complications

Ventral hernia repairs are one of the most common procedures performed by the general surgeon. They are also among the most complex procedures performed. We hypothesized that with each surgical failure, subsequent ventral hernia repair becomes more complicated and morbid. We assessed a multicenter database of patients who underwent an elective ventral hernia repair from 2000 to 2012 with at least 6 months of follow-up and elective repairs. Patients were evaluated by the number of previous ventral hernia repairs they had: primary ventral hernia repair (PVHR), first time incisional hernia repair (IHR1), second time incisional hernia repair (IHR2), or third time or greater incisional hernia repair (IHR3). The main outcomes measured were abdominal reoperation, operative duration, surgical site infection (SSI), and hernia recurrence. Complications were assessed and compared between the 4 groups. Time to recurrence was estimated using the Kaplan-Meier curve method by study cohort (PVHR, IHR1, IHR2, IHR3). A total of 794 patients were assessed; of these, 481 (60.6%) had PVHR, 207 (26.1%) had IHR1, 78 (9.8%) had IHR2, and 28 (3.5%) had IHR3. Patients with multiple repairs were more likely to undergo subsequent reoperation, have a longer operative duration, develop SSI, and have a recurrence. At 140 months of follow-up, 37% of primary ventral hernias and 64% of incisional hernias have recurred. The highest recurrence rates are seen in IHR3, with 73% recurring. Previous ventral hernia repair increases the complication profile of repair, creating a vicious cycle of repair, complications, reoperation, and re-repair. Furthermore, long-term outcomes for ventral hernia repair are poor. Future studies should focus on hernia prevention and improving long-term outcomes after hernia repair.

Mesh fixation techniques in primary ventral or incisional hernia repair

Mesh fixation techniques in primary ventral or incisional hernia repair

Factors affecting hernia recurrence after Strattice mesh repair: A retrospective study

Aim The aim of the present study was to explore the factors that affect hernia recurrence after Strattice mesh repair. Patients and Methods The present study is a retrospective study of the medical records of 42 patients who underwent Strattice mesh hernia repair at Ruby Memorial Hospital, West Virginia University. Strattice mesh was employed in a variety of ventral hernia procedures, including primary ventral hernia repair, recurrent ventral incisional hernia repair, component separation (abdominal wall reconstruction), parastomal hernia repair and infected inguinal hernia repair. The main collected variables were body mass index, intraoperative hernia defect size, diabetes, wound events and steroid use. Results For 42 patients, the overall recurrence rate was 21.43 per cent. The mean body mass index (BMI) was 36.4. BMI and sex were significant risk factors for recurrence (P = 0.036, P = 0.002), respectively. The mean defect size was 97 cm2. The hernia defect size was not significantly associated with the hernia recurrence rate (P = 0.166). Of the 10 diabetics, five developed recurrence. However, diabetes was not significantly associated with the hernia recurrence rate (P = 0.726). A total of four patients (9.52 per cent) were using steroids; one developed recurrence, which was not significantly associated with the hernia recurrence rate (P = 0.20). Wound infection also was not significantly associated with recurrence (P = 0.323). Conclusions Only sex and an increase in the BMI were significantly associated with the risk of hernia recurrence. In order to decrease the modifiable risk of hernia recurrence, surgeons should counsel obese patients regarding preoperative weight loss.

Outcomes of acute versus elective primary ventral hernia repair

The morbidity and mortality associated with acute primary ventral hernia repair have not been well described. We examined the rate of surgical site infection (SSI), hernia recurrence, and mortality in acute versus elective primary ventral hernia repair and identified predictors of morbidity and mortality after primary ventral hernia repair. A retrospective study on all patients undergoing open primary ventral hernia repair at a single institution (2000-2010) was performed. Primary outcomes were mortality at any time, SSI, and recurrence. Survival analysis for the entire, unmatched sample was conducted. We performed a risk-adjusted analysis of outcomes using two methods as follows: (1) case matching and (2) propensity score-adjusted regression model. We identified 497 patients; 57 (11%) underwent acute primary ventral hernia repair. For the entire cohort, survival was worse for patients undergoing acute repair (log rank, 0.03). Following case matching on age, body mass index, American Society of Anesthesiologists score, and hernia size, there was no difference in mortality, SSI, or recurrence. After propensity score adjustment, acute surgery was not a predictor for mortality or SSI; however, incarcerated hernias predicted recurrence. After risk adjustment, acute primary ventral hernia repair was not associated with higher mortality, infection, or recurrence compared with elective repair. Therapeutic study, level IV.