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Ten-year outcomes following ventral hernia repair: making the case for better post-market surveillance in the USA

  • 2022 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

We sought to identify the 10-year complication and recurrence rates and associated sociodemographic and operative characteristics associated with non-mesh versus mesh-based ventral hernia repairs (VHRs).

Methods

This was an IRB-approved (2020H0317) retrospective longitudinal study of patients undergoing mesh or non-mesh VHR from 2009–2019 at a single tertiary-care institution. The electronic medical record was used to collect sociodemographic, clinical, and intraoperative details, and early (≤ 30 days) and long-term (> 30-day) postoperative complications. Up to ten-year follow-up was obtained for long-term complications, categorized as: hernia recurrence reoperation (HRR), major complications requiring emergency surgery (MCES) (defined as non-elective operations related to the abdominal wall), and non-recurrence procedural intervention (NRPI) (defined as any procedures related to the abdominal wall, bowel, or mesh). Kaplan–Meier survival curves were obtained for each long-term complication.

Results

Of the 645 patients identified, the mean age at index operation was 52.51 ± 13.57 years with 50.70% female. Of the index operations, 21.24% were for a recurrence. Procedure categories included: 57.36% incisional, 37.21% non-incisional umbilical, 8.22% non-incisional epigastric, 3.88% parastomal, 0.93% diastasis recti, and 0.47% Spigelian hernias. Operative approaches included open (n = 383), laparoscopic (n = 267), and robotic (n = 21). Fascial closure (81.55%) and mesh use (66.2%) were performed in the majority of cases. Median follow-up time was 2098 days (interquartile range 1320–2806). The rate of short-term complications was 4.81% for surgical site infections, 15.04% for surgical site occurrences, and 13.64% for other complications. At 10 years, the HRR-free survival probability was 85.26%, MCES-free survival probability was 94.44%, and NRPI-free survival probability was 78.11%.

Conclusions

A high proportion of patients experienced long-term recurrence and complications requiring intervention after index VHR. For many patients, a ventral hernia develops into a chronic medical condition. Improved efforts at post-market surveillance of operative approaches and mesh location and type should be undertaken to help optimize outcomes.

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Funding

This research was supported by the National Institutes of Health under the Ruth L. Kirschstein National Research Service Award, from the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under Award Number NIH T32AI106704. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Center for Abdominal Core Health, The Ohio State University Wexner Medical Center, 395 W. 12th Ave, #670, Columbus, OH, 43210, USA

    Dahlia M. Kenawy, Jennifer M. Underhill, Ayanna G. Jacobs, Savannah M. Renshaw, Benjamin T. Gabanic, Marlene I. Garcia-Neuer, Parviz Kanga, Aysenur Gunacar & Benjamin K. Poulose

  2. Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA

    Molly A. Olson

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  1. Dahlia M. Kenawy
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Correspondence to Dahlia M. Kenawy.

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Disclosures

Dr. Benjamin K. Poulose has the following disclosures: salary support from the ACHQC, research support from BD Interventional and Advanced Medical Solutions, consulting fees from Ethicon. Dr. Dahlia M. Kenawy, Dr. Jennifer M. Underhill, Dr. Ayanna G. Jacobs, Molly A. Olson, Savannah M. Renshaw, Benjamin T. Gabanic, Dr. Marlene I. Garcia-Neuer, Parviz Kanga, and Aysenur Gunacar have no financial conflicts of interest to disclose.

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This research was supported by the National Institutes of Health under the Ruth L. Kirschstein National Research Service Award, from the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under Award Number NIH T32AI106704. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Kenawy, D.M., Underhill, J.M., Jacobs, A.G. et al. Ten-year outcomes following ventral hernia repair: making the case for better post-market surveillance in the USA. Surg Endosc 37, 5612–5622 (2023). https://doi.org/10.1007/s00464-022-09725-6

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