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Bhardwaj P, Huayllani MT, Olson MA, Janis JE. Year-Over-Year Ventral Hernia Recurrence Rates and Risk Factors. JAMA Surg 2024; 159:651-658. [PMID: 38536183 PMCID: PMC10974689 DOI: 10.1001/jamasurg.2024.0233] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/04/2023] [Indexed: 06/13/2024]
Abstract
Importance Recurrence is one of the most challenging adverse events after ventral hernia repair as it impacts quality of life, utilization of resources, and subsequent need for re-repair. Rates of recurrence range from 30% to 80% after ventral hernia repair. Objective To determine the contemporary ventral hernia recurrence rate over time in patients with previous hernia repair and to determine risk factors associated with recurrence. Design, Setting, and Participants This retrospective, population-based study used the Abdominal Core Health Quality Collaborative registry to evaluate year-over-year recurrence rates in patients with prior ventral hernia repair between January 2012 and August 2022. Patients who underwent at least 1 prior ventral hernia repair were included and categorized into 2 groups based on mesh or no-mesh use. There were 43 960 eligible patients; after exclusion criteria (patients with concurrent inguinal hernias as the primary diagnosis, nonstandard hernia procedure categories, American Society of Anesthesiologists class unassigned, or no follow-up), 29 834 patients were analyzed in the mesh group and 5599 in the no-mesh group. Main Outcomes and Measures Ventral hernia recurrence rates. Risk factors analyzed include age, body mass index, sex, race, insurance type, medical comorbidities, American Society of Anesthesiologists class, smoking, indication for surgery, concomitant procedure, hernia procedure type, myofascial release, fascial closure, fixation type, number of prior repairs, hernia width, hernia length, mesh width, mesh length, operative approach, prior mesh placement, prior mesh infection, mesh location, mesh type, postoperative surgical site occurrence, postoperative surgical site infection, postoperative seroma, use of drains, and reoperation. Results Among 29 834 patients with mesh, the mean (SD) age was 57.17 (13.36) years, and 14 331 participants (48.0%) were female. Among 5599 patients without mesh, the mean (SD) age was 51.9 (15.31) years, and 2458 participants (43.9%) were female. When comparing year-over-year hernia recurrence rates in patients with and without prior mesh repair, respectively, the Kaplan Meier analysis showed a recurrence rate of 201 cumulative events with 13 872 at risk (2.8%) vs 104 cumulative events with 1707 at risk (4.0%) at 6 months; 411 cumulative events with 4732 at risk (8.0%) vs 184 cumulative events with 427 at risk (32.6%) at 1 year; 640 cumulative events with 1518 at risk (19.7%) vs 243 cumulative events with 146 at risk (52.4%) at 2 years; 731 cumulative events with 670 at risk (29.3%) vs 258 cumulative events with 73 at risk (61.4%) at 3 years; 777 cumulative events with 337 at risk (38.5%) vs 267 cumulative events with 29 at risk (71.2%) at 4 years; and 798 cumulative events with 171 at risk (44.9%) vs 269 cumulative events with 19 at risk (73.7%) at 5 years. Higher body mass index; immunosuppressants; incisional and parastomal hernias; a robotic approach; greater hernia width; use of a biologic or resorbable synthetic mesh; and complications, such as surgical site infections and reoperation, were associated with higher odds of hernia recurrence. Conversely, greater mesh width, myofascial release, and fascial closure had lower odds of recurrence. Hernia type was the most important variable associated with recurrence. Conclusions and Relevance In this study, the 5-year recurrence rate after ventral hernia repair was greater than 40% and 70% in patients with and without mesh, respectively. Rates of ventral hernia recurrence increased over time, underscoring the importance of close, long-term follow up in this population.
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Affiliation(s)
- Priya Bhardwaj
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus
| | - Maria T. Huayllani
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus
| | - Molly A. Olson
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Jeffrey E. Janis
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus
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Sanders DL, Pawlak MM, Simons MP, Aufenacker T, Balla A, Berger C, Berrevoet F, de Beaux AC, East B, Henriksen NA, Klugar M, Langaufová A, Miserez M, Morales-Conde S, Montgomery A, Pettersson PK, Reinpold W, Renard Y, Slezáková S, Whitehead-Clarke T, Stabilini C. Midline incisional hernia guidelines: the European Hernia Society. Br J Surg 2023; 110:1732-1768. [PMID: 37727928 PMCID: PMC10638550 DOI: 10.1093/bjs/znad284] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/08/2023] [Accepted: 08/02/2023] [Indexed: 09/21/2023]
Affiliation(s)
- David L Sanders
- Academic Department of Abdominal Wall Surgery, Royal Devon University
Foundation Healthcare Trust, North Devon District Hospital,
Barnstaple, UK
- University of Exeter Medical School,
Exeter, UK
| | - Maciej M Pawlak
- Academic Department of Abdominal Wall Surgery, Royal Devon University
Foundation Healthcare Trust, North Devon District Hospital,
Barnstaple, UK
- University of Exeter Medical School,
Exeter, UK
| | - Maarten P Simons
- Department of Surgery, OLVG Hospital Amsterdam,
Amsterdam, The
Netherlands
| | - Theo Aufenacker
- Department of Surgery, Rijnstate Hospital Arnhem,
Arnhem, The Netherlands
| | - Andrea Balla
- IRCCS San Raffaele Scientific Institute,
Milan, Italy
| | - Cigdem Berger
- Hamburg Hernia Centre, Department of Hernia and Abdominal Wall Surgery,
Helios Mariahilf Hospital Hamburg, Teaching Hospital of the University of Hamburg,
Hamburg, Germany
| | - Frederik Berrevoet
- Department for General and HPB Surgery and Liver Transplantation, Ghent
University Hospital, Ghent, Belgium
| | | | - Barbora East
- 3rd Department of Surgery at 1st Medical Faculty of Charles University,
Motol University Hospital, Prague, Czech Republic
| | - Nadia A Henriksen
- Department of Gastrointestinal and Hepatic Diseases, University of
Copenhagen, Herlev Hospital, Copenhagen, Denmark
| | - Miloslav Klugar
- The Czech National Centre for Evidence-Based Healthcare and Knowledge
Translation (Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Masaryk
University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of
Medicine, Masaryk University, Brno, Czech Republic
| | - Alena Langaufová
- Department of Health Sciences, Faculty of Medicine, Masaryk
University, Brno, Czech
Republic
| | - Marc Miserez
- Department of Abdominal Surgery, University Hospital Gasthuisberg, KU
Leuven, Leuven, Belgium
| | - Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and
Digestive Surgery, University Hospital Virgen del Rocio, University of
Sevilla, Sevilla, Spain
| | - Agneta Montgomery
- Department of Surgery, Skåne University Hospital,
Malmö, Sweden
- Department of Clinical Sciences, Malmö Faculty of Medicine, Lund
University, Lund, Sweden
| | - Patrik K Pettersson
- Department of Surgery, Skåne University Hospital,
Malmö, Sweden
- Department of Clinical Sciences, Malmö Faculty of Medicine, Lund
University, Lund, Sweden
| | - Wolfgang Reinpold
- Hamburg Hernia Centre, Department of Hernia and Abdominal Wall Surgery,
Helios Mariahilf Hospital Hamburg, Teaching Hospital of the University of Hamburg,
Hamburg, Germany
| | - Yohann Renard
- Reims Champagne-Ardennes, Department of General, Digestive and Endocrine
Surgery, Robert Debré University Hospital, Reims,
France
| | - Simona Slezáková
- The Czech National Centre for Evidence-Based Healthcare and Knowledge
Translation (Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Masaryk
University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of
Medicine, Masaryk University, Brno, Czech Republic
| | - Thomas Whitehead-Clarke
- Centre for 3D Models of Health and Disease, Division of Surgery and
Interventional Science, University College London,
London, UK
| | - Cesare Stabilini
- Department of Surgery, University of Genoa,
Genoa, Italy
- Policlinico San Martino, IRCCS, Genoa,
Italy
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3
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Muacevic A, Adler JR. Onlay Versus Sublay Mesh Repair for Incisional Hernias: A Systematic Review. Cureus 2023; 15:e34156. [PMID: 36713818 PMCID: PMC9879281 DOI: 10.7759/cureus.34156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 01/25/2023] Open
Abstract
Incisional hernias are a common problem following major abdominal surgery. There are numerous surgical techniques described in the existing English scientific literature with different planes for mesh placement. The current review aims to compare onlay versus sublay repair in managing incisional hernias. A systematic literature search was conducted on Embase, the Cochrane Library, PubMed, and Medline to identify randomised controlled trials (RCTs) comparing onlay versus sublay mesh repair for incisional hernias. We identified six RCTs that included 986 patients, of whom 503 were in the onlay group and 485 were in the sublay group. There was no statistically significant difference in hernia recurrence between the onlay and sublay groups (odds ratio (OR): 1.3 (0.49-3.47), 95% confidence interval (CI), p=0.60). Seroma formation was significantly higher in the onlay group (OR: 2.85 (1.74-4.67), 95% CI, p<0.0001). There were 45 reported cases of surgical site infection (SSI). There was no significant difference between the two groups (OR: 1.46 (0.44-4.84), 95% CI, p=0.54). Haematomas were reported in 11 cases, and there was no significant difference between the two groups (OR: 2.13 (0.56-8.19), 95% CI, p=0.27). Four RCTs reported the length of the hospital stay. There was no significant difference between the two groups (mean difference (MD): 0.53 (-0.16-1.22), 95% CI, p=0.13). We failed to draw conclusive clinical recommendations due to the variability in the included RCTs. We recommend well-structured, large-volume RCTs to better compare these two surgical techniques.
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Kumar M, Kumar M, Jha A, Arora A, Sreepriya PP, Niroop BS, Ali M. Comparative analysis of onlay and sublay (retrorectus) mesh repair for incisional hernia (width ≤10 cm) of abdominal wall: A single-center experience. FORMOSAN JOURNAL OF SURGERY 2022. [DOI: 10.4103/fjs.fjs_89_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mathes T, Prediger B, Walgenbach M, Siegel R. Mesh fixation techniques in primary ventral or incisional hernia repair. Cochrane Database Syst Rev 2021; 5:CD011563. [PMID: 34046884 PMCID: PMC8160478 DOI: 10.1002/14651858.cd011563.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The use of a mesh in primary ventral or incisional hernia repair lowers the recurrence rate and is the accepted standard of care for larger defects. In laparoscopic primary ventral or incisional hernia repair the insertion of a mesh is indispensable. Different mesh fixation techniques have been used and refined over the years. The type of fixation technique is claimed to have a major impact on recurrence rates, chronic pain, health-related quality of life (HRQOL) and complication rates. OBJECTIVES To determine the impact of different mesh fixation techniques for primary and incisional ventral hernia repair on hernia recurrence, chronic pain, HRQOL and complications. SEARCH METHODS On 2 October 2020 we searched CENTRAL, MEDLINE (Ovid MEDLINE(R)) Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R)), Ovid Embase, and two trials registries. We also performed handsearches, and contacted experts from the European Hernia Society (EHS). SELECTION CRITERIA We included randomised controlled trials (RCTs) including adults with primary ventral or incisional hernia that compared different types of mesh fixation techniques (absorbable/nonabsorbable sutures, absorbable/nonabsorbable tacks, fibrin glue, and combinations of these techniques). DATA COLLECTION AND ANALYSIS We extracted data in standardised piloted tables, or if necessary, directly into Review Manager 5. We assessed risks of bias with the Cochrane 'Risk of bias' tool. Two review authors independently selected the publications, and extracted data on results. We calculated risk ratios (RRs) for binary outcomes and mean differences (MDs) for continuous outcomes. For pooling we used an inverse-variance random-effects meta-analysis or the Peto method in the case of rare events. We prepared GRADE 'Summary of findings' tables. For laparoscopic repair we considered absorbable tacks compared to nonabsorbable tacks, and nonabsorbable tacks compared to nonabsorbable sutures as key comparisons. MAIN RESULTS We included 10 trials with a total of 787 participants. The number of randomised participants ranged from 40 to 199 per comparison. Eight studies included participants with both primary and incisional ventral hernia. One study included only participants with umbilical hernia, and another only participants with incisional hernia. Hernia size varied between studies. We judged the risk of bias as moderate to high. Absorbable tacks compared to nonabsorbable tacks Recurrence rates in the groups were similar (RR 0.74, 95% confidence interval (CI) 0.17 to 3.22; 2 studies, 101 participants). It is uncertain whether there is a difference between absorbable tacks and nonabsorbable tacks in recurrence because the certainty of evidence was very low. Evidence suggests that the difference between groups in early postoperative, late follow-up, chronic pain and HRQOL is negligible. Nonabsorbable tacks compared to nonabsorbable sutures At six months there was one recurrence in each group (RR 1.00, 95% CI 0.07 to 14.79; 1 study, 36 participants). It is uncertain whether there is a difference between nonabsorbable tacks and nonabsorbable sutures in recurrence because the certainty of evidence was very low. Evidence suggests that the difference between groups in early postoperative, late follow-up and chronic pain is negligible. We found no study that assessed HRQOL. Absorbable tacks compared to absorbable sutures No recurrence was observed at one year (very low certainty of evidence). Early postoperative pain was higher in the tacks group (VAS 0 - 10: MD -2.70, 95% CI -6.67 to 1.27; 1 study, 48 participants). It is uncertain whether there is a difference between absorbable tacks compared to absorbable sutures in early postoperative pain because the certainty of evidence was very low. The MD for late follow-up pain was -0.30 (95% CI -0.74 to 0.14; 1 study, 48 participants). We found no study that assessed HRQOL. Combination of different fixation types (tacks and sutures) or materials (absorbable and nonabsorbable) There were mostly negligible or only small differences between combinations (e.g. tacks plus sutures) compared to a single technique (e.g. sutures only), as well as combinations compared to other combinations (e.g. absorbable sutures combined with nonabsorbable sutures compared to absorbable tacks combined with nonabsorbable tacks) in all outcomes. It is uncertain whether there is an advantage for combining different fixation types or materials for recurrence, chronic pain, HRQOL and complications, because the evidence certainty was very low or low, or we found no study on important outcomes. Nonabsorbable tacks compared to fibrin sealant The two studies showed different directions of effects: one showed higher rates for nonabsorbable tacks, and the other showed higher rates for fibrin sealant. Low-certainty evidence suggests that the difference between groups in early postoperative, late follow-up, chronic pain and HRQOL is negligible. Absorbable tacks compared to fibrin sealant One recurrence in the tacks group and none in the fibrin sealant group were noted after one year (low certainty of evidence). Early postoperative pain might be slightly lower using tacks (VAS 0 - 100; MD -12.40, 95% CI -27.60 to, 2.80;1 study, 50 participants; low-certainty evidence). The pattern of pain and HRQOL course over time (up to 1 year) was similar in the groups (low certainty of evidence). AUTHORS' CONCLUSIONS Currently none of the techniques can be considered superior to any other, because the certainty of evidence was low or very low for all outcomes.
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Affiliation(s)
- Tim Mathes
- Institute for Research in Operative Medicine (IFOM) - Department for Evidence-based Health Services Research, Witten/Herdecke University, Cologne, Germany
| | - Barbara Prediger
- Institute for Research in Operative Medicine (IFOM) - Department for Evidence-based Health Services Research, Witten/Herdecke University, Cologne, Germany
| | - Maren Walgenbach
- Institute for Research in Operative Medicine (IFOM) - Department for Evidence-based Health Services Research, Witten/Herdecke University, Cologne, Germany
| | - Robert Siegel
- Department of General, Visceral and Cancer Surgery, HELIOS Klinikum Berlin-Buch, Berlin-Buch, Germany
- Faculty of Health, Witten/Herdecke University, Witten, Germany
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Akalin C, Karagulle OO. The effects of onlay titanium-coated mesh on recurrence, foreign body sensation and chronic pain after ventral hernia repair. Asian J Surg 2021; 44:1158-1165. [PMID: 33771424 DOI: 10.1016/j.asjsur.2021.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/12/2021] [Accepted: 02/08/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE There are many complications of meshes in hernia repair. The aim of this study was to investigate the effects of onlay titanium-coated meshes (TCM) on recurrence, foreign body sensation and chronic pain in ventral hernia repair. METHODS In this retrospective study, 160 patients undergone TCM or polypropylene mesh (PM) surgery for onlay repair of ventral hernia were examined between May 2014 and January 2018 at our center. Patient characteristics, type of hernia, defect size, operative time, follow-up time, surgical site occurrence (infection, seroma and hematoma), recurrence, foreign body sensation and chronic pain were analyzed. Patients were divided into two groups according to mesh used: TCM (titanium group) or PM (polypropylene group). RESULTS Out of 160 patients, 63 (32.6%) had TCM and 97 (67.4%) had PM. There was no significant difference between groups in terms of recurrence (p = 0.757). Chronic pain and foreign body sensation were low in the titanium group (p = 0.047 and p = 0.029, respectively), a positive correlation was found between surgical site infection and recurrence (p = 0.020). In the polypropylene group, an increase in defect size was significantly associated with foreign body sensation and chronic pain (p < 0.001 for both comparisons). CONCLUSION In onlay repair of ventral hernia, TCM led to less foreign body sensation and chronic pain then PM. The surgical site infection was associated with recurrence for these meshes. Additionally, the increase in defect size causes a risk for foreign body sensation and chronic pain in repair using PM.
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Affiliation(s)
- Cagri Akalin
- Department of General Surgery, Ordu Training and Research Hospital, Ordu, Turkey
| | - Onur Olgac Karagulle
- Department of General Surgery, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
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Kaushik M, Glenesk N, Silapaswan S. Reviving Onlay Ventral Hernia Repair: a Novel Concept of Using a Hernia Stapler for Securing the Mesh. Indian J Surg 2019. [DOI: 10.1007/s12262-018-1765-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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8
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Köckerling F. Onlay Technique in Incisional Hernia Repair-A Systematic Review. Front Surg 2018; 5:71. [PMID: 30538992 PMCID: PMC6277585 DOI: 10.3389/fsurg.2018.00071] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/08/2018] [Indexed: 01/18/2023] Open
Abstract
Introduction: A meta-analysis that compared the onlay vs. sublay technique in open incisional hernia repair identified better outcomes for the sublay operation. Nonetheless, an Expert Consensus Guided by Systematic Review found the onlay mesh location useful in certain settings. Therefore, all studies on the onlay technique were once again collated and analyzed. Materials and Methods: A systematic search of the available literature was performed in August 2018 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library. For the present analysis 42 publications were identified as relevant. Results: In five prospective randomized trials and 17 observational studies the postoperative complication rates ranged between 5 and 76%, with a mean value of 33.5%. The recurrence rates in these studies also ranged between 0 and 32%, with a mean value of 9.9%. Hence, compared with the literature data on the sublay operation, more post-operative complications, in particular wound complications and seroma, with a comparable recurrence rate, were identified. Conclusion: When the onlay technique is used in certain settings for incisional hernia repair, a careful dissection technique and prophylactic measures (drainage, abdominal binders, fibrin sealant) should be employed to prevent wound complications and seroma formation.
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Affiliation(s)
- Ferdinand Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Berlin, Germany
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Köckerling F, Schug-Pass C, Scheuerlein H. What Is the Current Knowledge About Sublay/Retro-Rectus Repair of Incisional Hernias? Front Surg 2018; 5:47. [PMID: 30151365 PMCID: PMC6099094 DOI: 10.3389/fsurg.2018.00047] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/05/2018] [Indexed: 12/17/2022] Open
Abstract
Introduction: There continues to be very little agreement among experts on the precise treatment strategy for incisional hernias. That is the conclusion drawn from the very limited scientific evidence available on the repair of incisional hernias. The present review now aims to critically assess the data available on the sublay/retro-rectus technique for repair of incisional hernia. Materials and Methods: A systematic search of the literature was performed in May 2018 using Medline, PubMed, and the Cochrane Library. This article is based on 77 publications. Results: The number of available RCTs that permit evaluation of the role of the sublay/retro-rectus technique in the repair of only incisional hernia is very small. The existing data suggest that the sublay/retro-rectus technique has disadvantages compared with the laparoscopic IPOM technique for repair of incisional hernia, but in that respect has advantages over all other open techniques. However, the few existing studies provide only a limited level of evidence for assessment purposes. Conclusion: Further RCTs based on a standardized technique are urgently needed for evaluation of the role of the sublay/retro-rectus incisional hernia repair technique.
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Affiliation(s)
- Ferdinand Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Berlin, Germany
| | - Christine Schug-Pass
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Berlin, Germany
| | - Hubert Scheuerlein
- Department of General and Visceral Surgery, St. Vinzenz Hospital, Paderborn, Germany
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10
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López-Cano M, Martin-Dominguez LA, Pereira JA, Armengol-Carrasco M, García-Alamino JM. Balancing mesh-related complications and benefits in primary ventral and incisional hernia surgery. A meta-analysis and trial sequential analysis. PLoS One 2018; 13:e0197813. [PMID: 29874261 PMCID: PMC5991361 DOI: 10.1371/journal.pone.0197813] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 05/09/2018] [Indexed: 01/16/2023] Open
Abstract
Background Primary 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. Methods Five 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. Results 10 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. Conclusions Evidence 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.
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Affiliation(s)
- Manuel López-Cano
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- * E-mail:
| | - Lidia A. Martin-Dominguez
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Antonio Pereira
- Department of Surgery, Parc de Salut Mar, Experimental and Health Science, Universitat Pompeu Fabra, Barcelona, Spain
| | - Manuel Armengol-Carrasco
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Sevinç B, Okuş A, Ay S, Aksoy N, Karahan Ö. Randomized prospective comparison of long-term results of onlay and sublay mesh repair techniques for incisional hernia. Turk J Surg 2018; 34:17-20. [PMID: 29756100 DOI: 10.5152/turkjsurg.2017.3712] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 02/08/2017] [Indexed: 01/05/2023]
Abstract
Objective Incisional hernia is a significant problem after laparotomy, and there is still no consensus on an ideal treatment method. The aim of this study was to compare the results of onlay and sublay mesh repair techniques. Material and Methods In this randomized prospective trial, 100 patients were divided into two groups: onlay and sublay groups. Recurrences were evaluated by performing a physical examination. Results The median follow-up was 37.1 (26.6 to 46.5) months. In the onlay group, the mean operation time was significantly shorter. However, in terms of postoperative pain and wound complications, the sublay group had significantly better results. The recurrence rates were found to be similar in both groups (6% in the onlay group and 2% in the sublay group). Conclusion In the treatment of incisional hernia, sublay mesh repair is superior to onlay mesh repair in terms of postoperative pain and wound complications. Both techniques have similar recurrence rates.
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Affiliation(s)
- Barış Sevinç
- Department of General Surgery, Medical Park Uşak Hospital, Uşak, Turkey
| | - Ahmet Okuş
- Department of General Surgery, Karatay University School of Medicine, Konya, Turkey
| | - Serden Ay
- Department of General Surgery, Karatay University School of Medicine, Konya, Turkey
| | - Nergis Aksoy
- Department of General Surgery, Konya Training and Research Hospital, Konya, Turkey
| | - Ömer Karahan
- Department of General Surgery, Uşak University School of Medicine, Uşak, Turkey
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12
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Holihan JL, Hannon C, Goodenough C, Flores-Gonzalez JR, Itani KM, Olavarria O, Mo J, Ko TC, Kao LS, Liang MK. Ventral Hernia Repair: A Meta-Analysis of Randomized Controlled Trials. Surg Infect (Larchmt) 2017; 18:647-658. [DOI: 10.1089/sur.2017.029] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Julie L. Holihan
- Department of Surgery, University of Texas Health Science Center, Houston, Texas
| | - Craig Hannon
- Department of Surgery, University of Texas Health Science Center, Houston, Texas
| | | | | | - Kamal M. Itani
- Department of Surgery, Veterans Affairs Boston Healthcare System, Boston University and Harvard Medical School, Boston, Massachusetts
| | - Oscar Olavarria
- Department of Surgery, University of Texas Health Science Center, Houston, Texas
| | - Jiandi Mo
- Department of Surgery, University of Texas Health Science Center, Houston, Texas
| | - Tien C. Ko
- Department of Surgery, University of Texas Health Science Center, Houston, Texas
| | - Lillian S. Kao
- Department of Surgery, University of Texas Health Science Center, Houston, Texas
| | - Mike K. Liang
- Department of Surgery, University of Texas Health Science Center, Houston, Texas
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Denney B, De Latorre JI. Multipoint Suture Fixation Technique for Abdominal Wall Reconstruction with Component Separation and Onlay Biological Mesh Placement. Am Surg 2017. [DOI: 10.1177/000313481708300529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Component separation with mesh reinforcement has become the primary modality for complex abdominal wall reconstruction. However, many fundamental questions remain unanswered, such as whether underlay versus overlay mesh placement is superior, and what is the best means of suture fixation technique for mesh placement? This study presents the senior author's technique for onlay biologic mesh placement with multipoint suture fixation in combination with component separation and its subsequent low recurrence rates. This is a retrospective review of the senior author's cases of component separation with onlay biologic mesh placement during his tenure at the home institution of the University of Alabama at Birmingham. A total of 75 patients were included, all of whom underwent complex abdominal wall reconstruction from September 2002 to April 2012. Patients were excluded from the dataset if their surgery occurred less than two years before date of data collection to give a minimum 2-year follow-up. Patients were identified by Current Procedural Terminology codes for component separation and their charts reviewed by the home institution's electronic medical record. Data point entries included patient demographics and comorbidities, concomitant procedures such as bowel resection or panniculectomy, and characteristics of the reconstruction such as type of mesh used. Primary data endpoints were complications following surgery, particularly recurrence and laxity. A total of 75 patients were included in the study from September 2002 to April 2012 with a minimum 2-year follow-up period. The recurrence rate was 13 per cent and the rate of laxity 2.7 per cent. There was one death (1.35%). The most frequent complication was seromas at a rate of 17 per cent. Multipoint fixation suture technique for abdominal wall reconstruction with component separation and onlay biologic mesh is a reproducible technique with reliably low recurrence rates.
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Affiliation(s)
- Brad Denney
- Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jorge I. De Latorre
- Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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14
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A Randomised Prospective Study to Evaluate Preperitoneal Mesh Repair Versus Onlay Mesh Repair and Laparoscopic IPOM in Incisional Hernia Surgery. Indian J Surg 2017; 79:96-100. [PMID: 28442833 DOI: 10.1007/s12262-015-1430-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 12/23/2015] [Indexed: 10/22/2022] Open
Abstract
Incisional hernia remains a very common postoperative complication. These are encountered with an incidence of up to 20 % following laparotomy. These hernias enlarge over time, making the repair difficult, and serious complications like bowel obstruction, strangulation and enterocutaneous fistula can occur. Hence, elective repair is indicated to avoid these complications. Implantation of a prosthetic mesh is nowadays considered as the standard treatment due to low hernia recurrence. The most common mesh repair techniques used are the onlay repair, sublay repair and laparoscopic intraperitoneal onlay mesh (IPOM). However, it is still not clear which technique among the three is superior. A study consisting of 30 patients who underwent incisional hernia repair by onlay, laparoscopic and preperitoneal mesh repair with abdominoplasty was conducted in the Coimbatore Medical College and Hospital. Of the three groups, the preperitoneal repair with abdominoplasty was found to have better patient compliance and satisfaction with regard to occurrence of complications and appearance of the abdominal wall without laxity in a single sitting.
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15
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Mommers EHH, Leenders BJM, Leclercq WKG, de Vries Reilingh TS, Charbon JA. A modified Chevrel technique for ventral hernia repair: long-term results of a single centre cohort. Hernia 2017; 21:591-600. [PMID: 28409277 PMCID: PMC5517587 DOI: 10.1007/s10029-017-1602-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 03/30/2017] [Indexed: 11/15/2022]
Abstract
Purpose To evaluate the short- and long-term results after a modified Chevrel technique for midline incisional hernia repair, regarding surgical technique, hospital stay, wound complications, recurrence rate, and postoperative quality of life. These results will be compared to the literature derived reference values regarding the original and modified Chevrel techniques. Methods In this large retrospective, single surgeon, single centre cohort all modified Chevrel hernia repairs between 2000 and 2012 were identified. Results were obtained by reviewing patients’ medical charts. Postoperative quality of life was measured using the Carolina Comfort Scale. A multi-database literature search was conducted to compare the results of our series to the literature based reference values. Results One hundred and fifty-five patients (84 male, 71 female) were included. Eighty patients (52%) had a large incisional hernia (width ≥ 10 cm) according the definition of the European Hernia Society. Fourteen patients (9%) underwent a concomitant procedure. Median length-of-stay was 5 days. Within 30 days postoperative 36 patients (23.2%) had 39 postoperative complications of which 30 were mild (CDC I–II), and nine severe (CDC III–IV). Thirty-one surgical site occurrences were observed in thirty patients (19.4%) of which the majority were seroma (16 patients 10.3%). There was no hernia-related mortality during follow-up. Recurrence rate was 1.8% after a median follow-up of 52 months (12–128 months). Postoperative quality of life was rated excellent. Conclusions The modified Chevrel technique for midline ventral hernias results in a moderate complication rate, low recurrence rate and high rated postoperative quality of life.
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Affiliation(s)
- E H H Mommers
- Department of Surgery, Elkerliek Hospital, Helmond, The Netherlands. .,Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - B J M Leenders
- Department of Surgery, Máxima Medical Centre, Eindhoven, The Netherlands
| | - W K G Leclercq
- Department of Surgery, Máxima Medical Centre, Eindhoven, The Netherlands
| | | | - J A Charbon
- Department of Surgery, Máxima Medical Centre, Eindhoven, The Netherlands
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16
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Mathes T, Walgenbach M, Siegel R. Suture Versus Mesh Repair in Primary and Incisional Ventral Hernias: A Systematic Review and Meta-Analysis. World J Surg 2015; 40:826-35. [DOI: 10.1007/s00268-015-3311-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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17
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Holihan JL, Nguyen DH, Nguyen MT, Mo J, Kao LS, Liang MK. Mesh Location in Open Ventral Hernia Repair: A Systematic Review and Network Meta-analysis. World J Surg 2015; 40:89-99. [DOI: 10.1007/s00268-015-3252-9] [Citation(s) in RCA: 191] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Which mesh is appropriate for laparoscopic use? Prevention of adhesions to macroporous mesh, a rabbit model. Eur Surg 2012. [DOI: 10.1007/s10353-012-0154-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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A randomised, multi-centre, prospective, observer and patient blind study to evaluate a non-absorbable polypropylene mesh vs. a partly absorbable mesh in incisional hernia repair. Langenbecks Arch Surg 2012; 397:1225-34. [PMID: 23053458 PMCID: PMC3510400 DOI: 10.1007/s00423-012-1009-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 09/18/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The implantation of a polymer mesh is considered as the standard treatment for incisional hernia. It leads to lower recurrence rates compared to suture techniques without mesh implantation; however, there are also some drawbacks to mesh repair. The operation is more complex and peri-operative infectious complications are increased. Yet it is not clear to what extent a mesh implantation influences quality of life or leads to chronic pain or discomfort. The influence of the material, textile structure and size of the mesh remain unclear. The aim of this study was to evaluate if a non-absorbable, large pore-sized, lightweight polypropylene (PP) mesh leads to a better health outcome compared to a partly absorbable mesh. METHODS/DESIGN In this randomised, double-blinded study, 80 patients with incisional hernia after a median laparotomy received in sublay technique either a non-absorbable mesh (Optilene® Mesh Elastic) or a partly absorbable mesh (Ultrapro® Mesh). Primary endpoint was the physical health score from the SF-36 questionnaire 21 days post-operatively. Secondary variables were patients' daily activity score, pain score, wound assessment and post-surgical complications until 6 months post-operatively. RESULTS SF-36, daily activity and pain scores were similar in both groups after 21 days and 6 months, respectively. No hernia recurrence was observed during the observation period. Post-operative complication rates also showed no difference between the groups. CONCLUSION The implantation of a non-absorbable, large pore-sized, lightweight PP mesh for incisional hernia leads to similar patient-related outcome parameters, recurrence and complication rates as a partly absorbable mesh.
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