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Expectant Management of Patients with Ventral Hernias: 3 Years of Follow-up

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Abstract

Background

The safety and effectiveness of expectant management (e.g., watchful waiting or initially managing non-operatively) for patients with a ventral hernia is unknown. We report our 3-year results of a prospective cohort of patients with ventral hernias who underwent expectant management.

Methods

A hernia clinic at an academic safety-net hospital was used to recruit patients. Any patient undergoing expectant management with symptoms and high-risk comorbidities, as determined by a surgeon based on institutional criteria, would be included in the study. Patients unlikely to complete follow-up assessments were excluded from the study. Patient-reported outcomes were collected by phone and mailed surveys. A modified activities assessment scale normalized to a 1–100 scale was used to measure results. The rate of operative repair was the primary outcome, while secondary outcomes include rate of emergency room (ER) visits and both emergent and elective hernia repairs.

Results

Among 128 patients initially enrolled, 84 (65.6%) completed the follow-up at a median (interquartile range) of 34.1 (31, 36.2) months. Overall, 28 (33.3%) patients visited the ER at least once because of their hernia and 31 (36.9%) patients underwent operative management. Seven patients (8.3%) required emergent operative repair. There was no significant change in quality of life for those managed non-operatively; however, substantial improvements in quality of life were observed for patients who underwent operative management.

Conclusions

Expectant management is an effective strategy for patients with ventral hernias and significant comorbid medical conditions. Since the short-term risk of needing emergency hernia repair is moderate, there could be a safe period of time for preoperative optimization and risk-reduction for patients deemed high risk.

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Funding

No external funding was used to perform this study.

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Authors and Affiliations

  1. Department of Surgery, Lyndon B. Johnson Hospital, The University of Texas Health Science Center At Houston McGovern Medical School, 5656 Kelley St, Houston, TX, 77026, USA

    Alexander C. Martin, Nicole B. Lyons, Karla Bernardi, Julie L. Holihan, Deepa V. Cherla, Juan R. Flores, Lillian Huang, Alexis Milton, Puja Shah, Lillian S. Kao, Tien C. Ko & Mike K. Liang

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  1. Alexander C. Martin
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  2. Nicole B. Lyons
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  3. Karla Bernardi
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  4. Julie L. Holihan
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  5. Deepa V. Cherla
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  6. Juan R. Flores
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  7. Lillian Huang
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Correspondence to Nicole B. Lyons.

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Martin, A.C., Lyons, N.B., Bernardi, K. et al. Expectant Management of Patients with Ventral Hernias: 3 Years of Follow-up. World J Surg 44, 2572–2579 (2020). https://doi.org/10.1007/s00268-020-05505-2

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  • DOI: https://doi.org/10.1007/s00268-020-05505-2

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