Risk Factors For Hernia Recurrence Research Articles

Hernia Recurrence and Complications After Abdominal Reconstruction With Reinforced Versus Nonreinforced Biologic Mesh.

Both biologic and permanent (synthetic) meshes are used for abdominal wall reconstruction. Biologic mesh has the advantage of eventual incorporation, which makes it generally preferred in contaminated patients compared with synthetic mesh (Ann Surg. 2013;257:991-996). However, synthetic mesh has been shown to have decreased long-term hernia recurrence despite increased complications (JAMA Surg. 2022;157:293-301). Ovitex (TelaBio, Ltd, Auckland, New Zealand) is a combined reinforced biologic mesh with a permanent Prolene suture weave that theoretically combines incorporation with a long-term strength component. We hypothesize that a reinforced biologic will have a similar complication profile but decreased long-term hernia recurrence. A single-center retrospective review was performed from January 2013 to January 2022. Baseline patient characteristics and outcomes including 90-day complications and recurrence were compared. Categorical and continuous variables were analyzed with χ2 and Wilcoxon rank sum tests, respectively. Predictors of postoperative complications and hernia recurrence were analyzed via univariate logistic regression and multivariate logistic regression with backward stepwise selection with a threshold of P < 0.2. Two hundred fifty-four patients underwent abdominal wall reconstruction biologic mesh (Strattice, Allergan; FlexHD, MTF Biologics; Alloderm, Allergan; Surgisis Gold, Cook Biotech; Ovitex, Telabio) with retrorectus (66.5%) or intraperitoneal (33.5%) mesh placement. Sixty-six of these used reinforced biologic mesh (Ovitex, TelaBio). Baseline characteristics were comparable including preoperative hernia size measured on CT. The mean follow-up time was 343 days. The majority of patients underwent component separation (80.3% bilateral, 11.4% unilateral, 8.3% none). On univariate analysis, reinforced biologic mesh did not impact 90-day complication rates (P = 0.391) or hernia recurrence rates (P = 0.349). On multivariate analysis, reinforced mesh had no impact on complication or recurrence rates (P > 0.2). A previous history of infected mesh was an independent risk factor for hernia recurrence (P = 0.019). Nonreinforced biologics were more likely to be used in instances of previous mesh infection (P = 0.025), bowel resection (P = 0.026), and concomitantly at the time of stoma takedown (P = 0.04). Reinforced biologics were more likely to be used with a history of previous hernia repair with recurrence not due to infection (P = 0.001). Body mass index >35 was an independent risk factor across both groups for 90-day complications (P = 0.028). Reinforced versus nonreinforced biologics have similar risk profile and recurrence rate when placed primary fascial repair achieved. In abdominal walls with history of infection, or abdominal wall reconstruction performed concomitantly at the time of stoma takedown or bowel resection/anastomosis, nonreinforced biologics were used more commonly with no difference in negative outcomes. This implies that they may have a role for use in contaminated surgical cases. Reinforced biologics were more commonly used as a mesh choice in the setting of previous hernia repair with recurrence with no difference in outcomes. This implies that the reinforced nature may be useful in situations where extra reinforcement of already traumatized abdominal wall tissue is needed. Retrorectus or intraperitoneal placement of any biologic mesh is acceptable and should be chosen based off surgeon comfort and anticipated cost saving of individual mesh brands. There may be a role for reinforced mesh in the setting of previous failed hernia repair with weakened fascia, as well as nonreinforced in contaminated cases.

Analysis of recurrence and risk factors in laparoscopic sandwich technique for parastomal hernia repair.

Parastomal hernias are frequent and highly recurrent. The sandwich technique is a combination of the keyhole and Sugarbaker techniques, using a double intraperitoneal mesh. The objective of this study was to assess the outcomes of the sandwich technique, specifically focusing on recurrence rates. Observational retrospective study conducted in two tertiary referral centers in Catalonia, Spain. All consecutive patients who underwent parastomal hernia repair using the sandwich technique between 1st January 2016 and 31st December 2021 were included. A total of 38 patients underwent the laparoscopic sandwich technique for parastomal hernia repair. The overall recurrence rate was 7.9% (3/38), with a median follow-up of 39months (IQR: 12.3-56.5). According to the EHS classification for parastomal hernia, there were 47.4% (18/38) type I defects, 10.5% (4/38) type II defects, 28.9% (11/38) type III defects, and 13.2% (5/38) type IV defects. The used mesh was predominantly TiMesh® (76.3%; 29/38), followed by DynaMesh® IPOM (23.7%; 9/38). Patients with recurrence exhibited higher rates of seroma, hematoma, surgical site infection, and one case of early recurrence attributed to mesh retraction. Consequently, postoperative complications emerged as the primary risk factor for hernia recurrence. The sandwich technique demonstrated recurrence rates consistent with those reported in the existing literature.

MP65-02 UROSTOMAL HERNIAS: REPAIR TECHNIQUES AND RECURRENCE RATES AMONG PATIENTS WITH URINARY DIVERSION

You have accessJournal of UrologyCME1 Apr 2023MP65-02 UROSTOMAL HERNIAS: REPAIR TECHNIQUES AND RECURRENCE RATES AMONG PATIENTS WITH URINARY DIVERSION Anna Faris, Zachary Eisner, Krishnan Raghavendran, and John Stoffel Anna FarisAnna Faris More articles by this author , Zachary EisnerZachary Eisner More articles by this author , Krishnan RaghavendranKrishnan Raghavendran More articles by this author , and John StoffelJohn Stoffel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003323.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Following urinary diversion, a challenging complication is parastomal hernia formation, termed here as urostomal hernia. We examine patients who underwent urostomal hernia repair and describe their outcomes. METHODS: For individuals who underwent urostomal hernia repair, we collected retrospective demographic data, perioperative variables, surgical technique, and tracked hernia recurrence events. Kaplan Meier methods were used to estimate time from hernia repair to hernia recurrence. Cox proportional hazards modeling assessed risk factors for hernia recurrence. RESULTS: Thirty patients had a urostomal hernia repair between 2009 and 2022. Urinary diversion was initially performed for benign (37%) or malignant (63%) pathologies. Median age was 68.5 [IQR: 57.5,73.8], 57% male, and a median Charleston comorbidity index of 8 [IQR: 6,10]. Primary indications for urostomal hernia repair were bowel obstruction or incarceration (n=10, 33%), obstructive uropathy (n=6, 20%), pain (n=5, 16%), pouching difficulty (n=5, 16%), and recurrent urinary tract infections (n=4, 13%). Follow up period was a median of 2.5 [IQR: 1,5] years. Repair techniques included primary repair (n=15, 50%), stomal relocation without mesh (n=5, 17%), mesh placement without stomal relocation (n=7, 23%), and mesh with stomal relocation (n=3, 10%). Nearly a third (30%) had a concurrent procedure at the time of hernia repair (eg, nephrectomy, ureteral reimplant, ventral hernia, new ileal loop). Urostomal hernia recurrence rate was 67%, occurring at a median of 13 [IQR: 8,26] months from initial repair. Kaplan Meier analysis of time to urostomal hernia recurrence is depicted in Figure 1. Twelve (40%) individuals had a second urostomal hernia repair and three (10%) had a third repair. No associations found within the Cox proportional hazards model which was limited by sample size. At last follow up, the primary urostomal hernia complications that prompted hernia repair had resolved in 22 individuals (73%). CONCLUSIONS: Recurrence following urostomal hernia repair is common (67%) even in the hands of experienced urology and general surgery teams. For these complex patients, perhaps a more important metric of success is resolution of primary hernia complications following repair, which is 73% in this cohort. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e890 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anna Faris More articles by this author Zachary Eisner More articles by this author Krishnan Raghavendran More articles by this author John Stoffel More articles by this author Expand All Advertisement PDF downloadLoading ...

Risk factors for recurrence in blunt traumatic abdominal wall hernias: A secondary analysis of a Western Trauma association multicenter study

BackgroundFew studies have investigated risk factors for recurrence of blunt traumatic abdominal wall hernias (TAWH). MethodsTwenty trauma centers identified repaired TAWH from January 2012 to December 2018. Logistic regression was used to investigate risk factors for recurrence. ResultsTAWH were repaired in 175 patients with 21 (12.0%) known recurrences. No difference was found in location, defect size, or median time to repair between the recurrence and non-recurrence groups. Mesh use was not protective of recurrence. Female sex, injury severity score (ISS), emergency laparotomy (EL), and bowel resection were associated with hernia recurrence. Bowel resection remained significant in a multivariable model. ConclusionFemale sex, ISS, EL, and bowel resection were identified as risk factors for hernia recurrence. Mesh use and time to repair were not associated with recurrence. Surgeons should be mindful of these risk factors but could attempt acute repair in the setting of appropriate physiologic parameters.

Robotic versus hybrid assisted ventral hernia repair: a prospective one-year comparative study of clinical outcomes

Background Laparoscopic ventral hernia repair (LVHR) may be associated with chronic pain, seroma formation, bulging and failure to restore abdominal wall function. These outcomes are risk factors for hernia recurrence and poor quality of life (QoL). Our study evaluates whether robotic-assisted ventral hernia repair (rVHR) diminishes these complications compared to LVHR with primary closure of the defect (hybrid). Methods Thirty-eight consecutive patients undergoing incisional ventral hernia operation with fascial defect size from 3 to 6 cm were recruited between November 2019 and October 2020. Nineteen patients underwent rVHR and nineteen underwent hybrid operation. The main outcome measure was postoperative pain, evaluated with a visual analogue scale (VAS: 0–10) at 1-month and at 1-year. Hernia recurrence was evaluated with ultrasound examination and QoL using the generic SF-36 short form questionnaire. Results At the 1-month control visit, VAS scores were significantly lower in the rVHR group; 2.5 in the hybrid group and 0.3 in the rVHR group (p < 0.001). At the 1-year control, the difference in VAS scores was still significant, 2.8 vs 0.1 (p = 0.023). There was one hernia recurrence in the hybrid group (p = 0.331). QoL did not differ significantly between the study groups when compared to preoperative physical status at 1-year follow-up (p = 0.121). However, emotional status (p = 0.049) and social functioning (p = 0.039) improved significantly in the rVHR group. Conclusions Robotic-assisted ventral hernia repair (rVHR) was less painful compared to hybrid repair at 1-month and at 1-year follow-up. In addition, improvement in social functioning status was reported with rVHR. Trial Registration ID 5200658.

Incisional hernia repair after kidney transplantation in a tertiary high-volume center: outcomes from a 10-year retrospective cohort study.

Incisional hernia (IH) after Kidney Transplantation (KT) is a challenging complication due to both technical reasons and patients' complexity. Data regarding outcomes of hernia repair in KT recipients are uncertain, since the biggest part of previous papers focused on risk factors for incisional hernia occurrence and not on its outcomes. Aim of the study was to focus on risk factors for incisional hernia recurrence after surgical repair in KT recipients. Data regarding all consecutive patients undergoing kidney transplantations from January 2011 until September 2020 in Montpellier University Hospital were retrospectively collected from a single institutional database. After a median follow-up of 48months (IQR25-75 31-59), data from 1546 consecutive KT were collected. 83 patients underwent 99 incisional hernia surgeries after KT, with 14 patients that had one recurrence (14.4%) and 2 patients that experienced two recurrences (2.4%). Total recurrence rate was 16.8%. At univariate analysis, the only factor associated with an incisional hernia recurrence was having undergone to at least one previous abdominal surgery other than KT (p value 0.002). Overall morbidity was 15% (n = 15), with most of complications classified as mild (59%). No mortality related to incisional hernia repair occurred. IHs after KT represent an important condition. Its surgical management is challenging due to its anatomical complexity and patient's status. This is the largest sample size in the literature of patients treated for IH after KT and it shows that a previous surgery other than the KT is a risk factor for hernia recurrence after surgical repair, without regarding surgical technique or other comorbidity and therapeutical factors.

Risk Factors for Surgical Site Occurrence or Infection and Recurrence After Incisional Hernia Repair in Abdominal Transplant Population

PurposeTo investigate risk factors for hernia recurrence, surgical site occurrence/infection (SSO/I) and those requiring procedural intervention (SSOPI) after incisional hernia repair (IHR) following abdominal transplantation. MethodsPatients undergoing IHR following abdominal transplant were retrospectively identified in the Americas Hernia Society Quality Collaborative database. Primary outcome measures were SSO/I, SSOPI and hernia recurrence. ResultsThere was a total of 166 patients. Seventeen patients (10%) had an SSO/I at 30 days. Overall complication rate was 26%, and there was 1 mortality (1%). Composite recurrence rate was 28% (21/75) over 2 years. In univariate analysis, history of diabetes (DM), body mass index (BMI) >35 kg/m2, and history of open abdomen were associated with SSO/I (P < .05). Immunosuppression had a negative correlation with SSO/Is and SSOPIs. BMI >35 kg/m2 was associated with 180-day recurrence, whereas history of hypertension remained significant for recurrence at 2 years (P < .05). ConclusionHistory of an open abdomen, DM, and obesity are risk factors for SSO/I, and obesity and hypertension are associated with short-term and long-term recurrence after IHR following abdominal organ transplantation. Immunosuppression had negative correlation with SSO/I. However, long-term outcomes and those related to immunosuppression should be interpreted cautiously in view of the small sample size and low follow-up rates. Baseline comorbidities seem to be the main drive for hernia outcomes for transplant population, similar to the general population. Larger cohorts and longer follow-up are necessary to delineate preventable risk factors for SSO/Is and hernia recurrences after organ transplantation.

Comorbid rectus abdominis diastasis is a risk factor for recurrence of umbilical hernia in Japanese patients.

Rectus abdominis diastasis (RAD) is characterized by thinning and widening of the linea alba and laxity of the ventral abdominal muscle. RAD, when coexistent with umbilical hernia, is considered a risk factor for hernia recurrence. We investigated the impact of comorbid RAD in patients with umbilical hernia who had undergone hernia repair. We enrolled 30 patients who had undergone umbilical hernia repair using either a laparoscopic or anterior approach between April 2006 and May 2018. We diagnosed RAD according to preoperative CT. The outcomes of patients with umbilical hernia, the RAD group, and the non-RAD group were compared, especially in terms of recurrence. Twenty-five patients (83%) presented with RAD, including three patients (12%) with postoperative recurrence who were allocated to the RAD group. The median BMI in the RAD group was 27.2kg/m2 . In the RAD group, a prosthesis mesh was used in 12 patients (48%), and nonabsorbable suture material was used in four patients (16%). There was no statistically significant difference between the two groups in terms of age, hernial orifice diameter, surgical technique, or operative time. The rate of comorbid umbilical hernia in Japanese patients with RAD was high, as was the recurrence rate of umbilical hernia. We strongly recommend preoperative detection of RAD. We also recommend mesh-based repair of the midline and nonabsorbable suture material to decrease the recurrence rate, irrespective of hernia size.

Operative outcome of hernia repair with synthetic mesh in immunocompromised patients.

The safety of synthetic mesh in elective hernia repair in the setting of immunosuppression lacks national and international consensus. The aim of our analysis was to explore the effects of immunosuppression on the rates of wound complications. Comparative analysis of immunocompetent and immunocompromised patients with elective mesh repair of inguinal, femoral, primary ventral, incisional or parastomal hernia between January 2001 and December 2013. Immunosuppression included glucocorticoids, biologicals, chemotherapy and chemoradiotherapy. Primary outcome parameter was mesh infection rate. Follow-up questionnaires were completed in written form or by telephone interview. Questionnaire response rate was 59.5% (n = 194) with a median follow-up of 33 (interquartile range: 28-41) months. There were no differences between immunocompromised (n = 40, 20.6%) and immunocompetent patients (n = 154, 79.4%) based on hernia and patient characteristics. Immunosuppression was not associated with the rates of mesh infection (P = 1.000), surgical site infection (SSI, P = 0.330) or re-operation for SSI (P = 0.365), but with higher rates (P = 0.007) and larger odds for hernia recurrence (odds ratio 3.264, 95% confidence interval 1.304-8.172; P = 0.012). Mesh infection also increased the odds for hernia recurrence (odds ratio 11.625; 95% confidence interval 1.754-77.057; P = 0.011). Only in the subset of ventral/incisional hernias, immunocompromised (n = 8, 40%) patients had higher recurrence rates than immunocompetent patients (n = 5, 11.6%; P = 0.017). Patients with SSI reported more frequently moderate to severe dysesthesia at the surgical site (P = 0.013) and would less frequently re-consent to surgery (P = 0.006). Immunosuppression does not increase the rate of wound infections after elective hernia repair with synthetic mesh. However, immunosuppression and mesh infection are risk factors for hernia recurrence.

How to Treat Hernias in Pregnant Women?

A hernia is a common surgical problem. Although hernias during pregnancy are uncommon, they can be challenging for both the surgeon and the patient if present. To date, there is no consensus in the medical community regarding the elective repair of hernias in pregnant women. The debate mainly concerns three areas: the timing, the approach, and the surgical technique. This study aims to offer a clear pathway in this field based on the best available data. In this study, we collected reviews written in English and published in PubMed from 2010 to 2020 (the exception being three articles that were published before 2010, which we retained since they contained relevant information). We used regular and Medical Subject Headings (MeSH) keywords. Two of the authors screened the collected studies to select the best articles that would fit our inclusion criteria for the review. The articles considered for this review can be classified into retrospective studies, case reports, and reviews. No randomized controlled trials were found.The lack of an agreement about the treatment of ventral hernias in fertile women makes the decision to treat and the process challenging. The treatment significantly depends on two factors: the symptoms and the pregnancy status at diagnosis. If the hernia is incarcerated or strangulated at presentation, an emergency repair is obligatory. If the hernia is symptomatic, but not complicated, elective surgery should be offered. The timing of repair will depend on whether the patient is already pregnant or non-pregnant. In pregnant patients, if the hernia is small and asymptomatic, it may be better to delay the surgery until after delivery or after the last pregnancy. If the hernia is symptomatic and seems to affect the patient's quality of life, it may be better to postpone the repair until the second trimester or after delivery if complications do not occur. Internal herniation (IH) should be suspected as a cause of the abdominal pain in pregnant women who have undergone laparoscopic Roux-en-Y gastric bypass (LRYGB).In pre-pregnancy patients, if the hernia is large and symptomatic, it may be better to do an elective repair and then wait for one or two years before the next pregnancy. However, if the hernia is small or minimally symptomatic, it may be better to hold the repair until after delivery or after the last pregnancy. Pregnancy may be considered a significant risk factor for hernia recurrence. The laparoscopic mesh repair should be offered whenever possible, whereas the open approach may be preferred in complicated cases. The suture repair may be suitable for both small hernias and in cases of gross contamination.

Refractory ascites is a major risk factor for hernia recurrence in cirrhotics

Presenter: Danny Lascano MD | Westchester Medical Center/New York Medical College Background: Elective and urgent surgery is fraught with risk for cirrhotics. Retrospective studies for umbilical hernia repairs show a mortality of 5% and morbidity of 13%. Few studies look at risk factors for recurrence, pre-operative optimization, intraoperative resuscitation, and causes of readmission. We decided to look at our experience repairing hernias in cirrhotics. Methods: A single surgeon’s experience was queried for cirrhotic patients from 2014-2018. Outcomes measured included pre-operative factors, intraoperative resuscitation and other factors, and post-operative outcomes. The use of mesh was and type of hernia was also included. Results: A total of 46 unique patients underwent 57 operations including 8 recurrences. Median age was 60 years old (Range 38-82 years old), 15.1% were female (7/46), and alcohol was the leading cause of cirrhosis at 34.8% (16/46). Median BMI was 25.95 (Range 18-44). Median MELD score was 13 (6-30), 64.9% (37/57) were either Child B or C, and 49% were emergent/urgent procedures (28/57). There were a total of 49 ventral/umbilical hernias and 8 inguinal hernias performed. A total of 41 cases (71.9%) underwent primary repair. In the 25 cases of refractory ascites, 18 of these cases had a paracentesis done while 7 had an intraperitoneal drain before hernia repair. There was one death within 90 days due to spontaneous bacterial peritonitis. On multivariate logistic regression controlling for mesh and Na-MELD score, pre-operative paracentesis/drain placement was associated with hernia recurrence. Of note, 22% of patients (8 / 36) had a transplant done after their surgical intervention. Conclusion: Refractory ascites requiring pre-operative paracentesis and /or drain placement was a major risk factor for hernia recurrence when controlling for Na-MELD score in this high-risk population. These patients may benefit from receiving their liver transplant first and then repair of their hernia. Moreover, elective surgeries for hernias prevented potential downstream complications with very low mortality allowing eligible patients to eventually receive a liver transplant. More research on the impact of elective surgery to prevent downstream complications and allowing more patients to make it to transplant is warranted to understand the benefit of elective surgery in this high-risk population.

Laparoscopic Abdominal Wall Hernia Repair.

Background and Objectives:The aim of this retrospective monocentric study was to evaluate results and recurrence rate with long-term follow-up after laparoscopic incisional/ventral hernia repair.Methods:This was a retrospective, single-center, observational trial, collecting data from patients who underwent laparoscopic incisional/ventral abdominal hernia repair using the open intraperitoneal onlay mesh technique and a single mesh type. All patients signed an informed consent form before surgery.Results:A total of 1,029 patients were included. The median surgery time was 40 min (range 30–55) and the median length of hospital stay was 2 d (range 2–3). Intraoperative complications occurred in two of 1,029 patients (0.19%), whereas early postoperative surgical complications (within 30 d) occurred in 50 patients (4.86%). Postoperative complications according to Clavien-Dindo classification were as follows: I, 3.30% (34 of 1,029); II, 0.97% (10 of 1,029); IIIB, 0.58% (six of 1,029); IV, 0.00% (none of 1,029); and V, 0.00% (none of 1,029). During follow-up, bulging mesh was diagnosed in 58 of 1,029 patients (5.6%), and hernia recurred in 40 of 1,029 patients (3.9%). A mesh overlap equal to or greater than 4 cm appeared to be a significant protective factor for hernia recurrence (P < .001); a mesh overlap equal or greater than 5 cm appeared to be a significant protective factor for bulging (P < .001), whereas the use of resorbable fixing devices was a significant risk factor for hernia recurrence (odds ratio, 111.53, P < .001, 95% confidence interval, 21.53–577.67).Conclusion:This study demonstrates that laparoscopic repair of ventral/incisional abdominal wall hernias is a safe, effective, and reproducible procedure. Identified risk factors for recurrence are an overlap of less than 4 cm and the use of resorbable fixation means.

Laparoscopic versus hybrid approach for treatment of incisional ventral hernia: a prospective randomised multicentre study, 1-year results

PurposeLaparoscopic incisional ventral hernia repair (LIVHR) is often followed by seroma formation, bulging and failure to restore abdominal wall function. These outcomes are risk factors for hernia recurrence, chronic pain and poor quality of life (QoL). We aimed to evaluate whether LIVHR combined with defect closure (hybrid) follows as a diminished seroma formation and thereby has a lower rate of hernia recurrence and chronic pain compared to standard LIVHR.MethodsThis study is a multicentre randomised controlled clinical trial. From November 2012 to May 2015, 193 patients undergoing LIVHR for primary incisional hernia with fascial defect size from 2 to 7 cm were recruited in 11 Finnish hospitals. Patients were randomised to either a laparoscopic (LG) or a hybrid (HG) repair group. The main outcome measure was hernia recurrence, evaluated clinically and radiologically at a 1-year follow-up visit. At the same time, chronic pain scores and QoL were also measured.ResultsAt the 1-year-control visit, we found no difference in hernia recurrence between the study groups. Altogether, 11 recurrent hernias were found in ultrasound examination, producing a recurrence rate of 6.4%. Of these recurrences, 6 (6.7%) were in the LG group and 5 (6.1%) were in the HG group (p > 0.90). The visual analogue scores for pain were low in both groups; the mean visual analogue scale (VAS) was 1.5 in LG and 1.4 in HG (p = 0.50). QoL improved significantly comparing preoperative status to 1 year after operation in both groups since the bodily pain score increased by 7.8 points (p < 0.001) and physical functioning by 4.3 points (p = 0.014).ConclusionLong-term follow-up is needed to demonstrate the potential advantage of a hybrid operation with fascial defect closure. Both techniques had low hernia recurrence rates 1 year after operation. LIVHR reduces chronic pain and physical impairment and improves QoL.Trial Registry: Clinical trial number NCT02542085.

Risk Factors for Hernia Recurrence in Women of Child-Bearing Age

Risk Factors for Hernia Recurrence in Women of Child-Bearing Age

Risk Factors for Hernia Recurrence: Preoperative Weight or Postoperative Complications?

Risk Factors for Hernia Recurrence: Preoperative Weight or Postoperative Complications?

Prospective Analysis of Epigastric, Umbilical, and Small Incisional Hernia Repair Using the Modified Kugel Oval Patch

The study was performed to determine the complication and recurrence rate using the modified Kugel oval patch for small ventral hernia repair. Another aim of the study was to find risk factors for recurrence in patients with this repair. Seventy-three patients underwent ventral hernia repair with the modified Kugel oval patch between April 2013 and February 2015. Prospective follow-up data (18 months postoperative) were collected and evaluated. A total of 58 primary (18 epigastric/40 umbilical) and 15 incisional ventral hernias were repaired with the modified Kugel oval patch (7.6/10.2 cm/8 × 12 cm). We found three patients suffered superficial wound infection and two participants got hernia recurrence. Placement of mesh was found to be a significant risk factor for hernia recurrence. Small ventral hernia repair using the modified Kugel oval patch is a novel and useful approach and we recommend placing the patch preperitoneally.

ANNULOPLASTY AS A METHOD TO PREVENT THE RECURRENCE OF THE LUMBAR INTERVERTEBRAL DISC HERNIATION: A LITERATURE REVIEW

The presented literature review highlights epidemiological aspects of the unfavorable outcome following surgical treatment of patients with herniated lumbar intervertebral discs, the risk factors for hernia recurrence, and the annuloplasty as one of the methods to prevent recurrent herniation. The concept of the annuloplasty is based on a number of favorable factors: maintaining the height of the intervertebral disc, preventing the hernia recurrence due to the barrier function, reducing lumbodynia due to limited microdiscectomy, and slowing down the degenerative cascade both in the intervertebral disc and facet joints. The study material included abstracts from the Scopus and PubMed databases, articles published in Spine, European Spine Journal, and in Russian periodicals over the past 10 years, as well as publications of the previous years, when required.

Risk Factors for Recurrent Herniation After Percutaneous Endoscopic Lumbar Discectomy.

Percutaneous endoscopic lumbar discectomy (PELD) has been widely used for treating lumbar disc herniation. Recurrence after PELD has been reported, but few studies have focused on the risk factors responsible for recurrence after PELD. This retrospective study enrolled 116 patients with recurrent herniation after successful PELD from March 2005 to March 2016. Kaplan-Meier method and Cox regression analysis were employed to identify significant risk factors predicting recurrence after PELD. Univariate analysis showed that older age (≥50 years old), obesity (body mass index ≥25), no smoking history, decreased reflexes, learning curve of the surgeon (<200 cases), treatment period (March 2005 to September 2010), Modic change, migrated herniation, and central herniation are potential risk factors for recurrence after PELD. Multivariate analysis suggested that older age (≥50 years old), obesity (body mass index ≥25), learning curve of the surgeon (<200 cases), treatment period (March 2005 to September 2010), and central location of herniation are independent significant risk factors for recurrence after PELD. Obesity (body mass index ≥25) was the most robust risk factor responsible for recurrence after PELD. Older age (≥50 years old), learning curve of the surgeon (<200 cases), treatment period (March 2005 to September 2010), and central location of herniation were also closely associated with recurrent herniation after successful PELD.

Patient profiles and outcomes following repair of irreducible and reducible Ventral Wall Hernias

The belief that irreducible hernias are repaired less successfully and with higher morbidity drives patients to seek elective repair. The aims of this study were threefold. First, this study sought to compare characteristics of patients undergoing irreducible and reducible ventral hernia repair. Second, to compare morbidity rates. Third, to determine which factors, including irreducibility, might be associated with recurrence. This observational study was a retrospective review of 252 consecutive ventral hernia patients divided into two cohorts: 101 patients who underwent repair of an irreducible ventral hernia, and 152 patients underwent repair of a reducible ventral hernia. The mean follow-up time was approximately 4 years in both groups. Patients undergoing repair of irreducible hernias had higher median BMI (31 vs. 27 kg/m2, p = 0.005), had their hernias longer (median 34 months compared to 12 months, p = 0.043), had more defects on average (mean 1.8 vs. 1.4, p < 0.001), and were more likely to be symptomatic (83 vs. 55%, p = 0.002). Interestingly, neither hernia size (p = 0.821), nor the location of hernia (p = 0.261) differed significantly between the two groups. Morbidity rates, including rates of surgical site infection, obstruction, and recurrence, did not differ significantly; nor did recurrence-free survival (RFS) distributions. Risk factors for hernia recurrence on multivariate analysis included the repaired hernia being itself recurrent (HR = 2.06, 95% CI = 1.07-3.99, p = 0.031), the occurrence of post-operative surgical site infection (HR = 5.10, 95% CI = 2.18-11.91, p < 0.001), and the occurrence of post-operative intestinal obstruction (HR = 5.18, 95% CI = 1.82-14.75, p = 0.002). Irreducibility was not a significant predictor of recurrence (p = 0.152). Despite differing profiles, patients with these two types of hernias did not have statistically significant differences in morbidity. Recurrence was not observed to be associated with irreducibility but was found to be associated with other post-operative complications.

Risk factors associated with early failure in complex abdominal wall reconstruction: A 5 year single surgeon experience

Complex abdominal wall reconstruction (AWR) is commonly performed, but with a significant rate of surgical complications and hernia recurrence. The aim of this experiential review is to assess risk factors for hernia recurrence after complex AWR. A retrospective review of AWR patients from 2007–2012 was performed. Rates of hernia recurrence were assessed. Univariate analyses and subsequent multivariate logistic regression analysis was used to assess independent predictors of early hernia recurrence. One hundred and thirty-four consecutive cases of AWR were performed over a 5-year period. Hernia recurrence developed in 14 (10.4%) patients. Hernias derived from trauma (OR = 19.76, p = 0.011) and those who experienced postoperative wound infections (OR = 18.81, p = 0.004) were at increased risk for hernia recurrence. In conclusion, increased vigilance must be paid to patients presenting after trauma with massive loss of domain and those who experience postoperative infection, as these cohorts are at added risk for failed reconstruction.