Surgical treatment for giant incisional hernia: a qualitative systematic review
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Repair for giant incisional hernias is a challenge due to unacceptable high morbidity and recurrence rates. Several surgical techniques are available, but all are poorly documented. This systematic review was undertaken to evaluate the existing literature on repair for giant incisional hernia.
Literature was identified through a systematic search on PubMed, EMBASE, and CINAHL. We only included studies with clearly defined surgical techniques and defect size of at least 15 cm. The heterogeneity of the studies precluded a meta-analysis. The analysis was based on the premises of a systematic review of the literature.
We identified 14 studies (1,198 patients) including one randomised trial. Studies were mainly small and retrospective and highly heterogenic regarding design, outcome, inclusion, and exclusion criteria. The overall morbidity rate was median 32 % with a wide range between studies of 4–100 %. The mortality ranged from 0 to 5 % (median 0 %) and recurrence rate ranged from 0 to 53 % (median 5 %). Study follow-up ranged from 15 to 97 months (median 36 months). Mesh repair should always be used for patients undergoing repair for a giant hernia, and the sublay position may have advantages over onlay positioning. To avoid tension, it may be advisable to use a mesh in combination with a component separation technique. Inlay positioning of the mesh and repair without a mesh should be avoided.
Evidence to optimise repair for giant hernias is weak due to the heterogeneity and the poor quality of studies. However, sublay positioning of the mesh perhaps in combination with a component separation technique may be advantageous compared with other surgical techniques for giant hernia repair. Giant hernia repair is a challenging surgical procedure and severely lack evidence-based research from high-quality, large-scaled randomised studies.
KeywordsVentral hernia Incisional hernia Giant hernia Hernia repair
Conflict of interest
AE declares no conflicts of interest. TB and JR declares consultancy outside submitted work, payment for lectures outside submitted work, grant support outside the submitted work, support for travelling outside the submitted work, and no other conflict of interest that directly relates to this study.
- 5.Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. BMJ 339:b2700. doi: 10.1371/journal.pmed.1000100 PubMedCentralPubMedCrossRefGoogle Scholar
- 13.Ferrari GC, Miranda A, Di Lernia S, Sansonna F, Magistro C, Maggioni D, Scandroglio I, Constanzi A, Franzetti M, Pugliese R (2008) Laparoscopic repair of incisional hernia: outcomes of 100 consecutive cases comprising 25 wall defects larger than 15 cm. Surg Endosc 22:1173–1179. doi: 10.1007/s00464-007-9707-9 PubMedCrossRefGoogle Scholar
- 24.den Hartog D, Dur AH, Tuinebreijer WE, Kreis RW (2008) Open surgical procedures for incisional hernias. Cochrane Database Syst Rev. CD006438. doi: 10.1002/14651858.CD006438.pub2
- 25.Sauerland S, Walgenbach M, Habermalz B, Seiler CM, Miserez M (2011) Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev CD007781. doi: 10.1002/14651858.CD007781.pub2
- 26.Wassenaar E, Schoenmaeckers E, Raymakers J, van der Palen J, Rakic S (2010) Mesh-fixation method and pain and quality of life after laparoscopic ventral or incisional hernia repair: a randomized trial of three fixation techniques. Surg Endosc 24:1296–1302. doi: 10.1007/s00464-009-0763-1 PubMedCentralPubMedCrossRefGoogle Scholar
- 28.Müller-Riemenschneider F, Roll S, Friedrich M, Zieren J, Reinhold T, von der Schulenburg JM, Greiner W, Willich SN (2007) Medical effectiveness and safety of conventional compared to laparoscopic incisional hernia repair: a systematic review. Surg Endosc 21:2127–2136. doi: 10.1007/s00464-007-9513-4 PubMedCrossRefGoogle Scholar