, Volume 20, Issue 2, pp 249–256 | Cite as

Enhanced recovery after giant ventral hernia repair

  • K. K. Jensen
  • T. L. Brondum
  • H. Harling
  • H. Kehlet
  • L. N. Jorgensen
Original Article



Giant ventral hernia repair is associated with a high risk of postoperative morbidity and prolonged length of stay (LOS). Enhanced recovery (ERAS) measures have proved to lead to decreased morbidity and LOS after various surgical procedures, but never after giant hernia repair. The current study prospectively examined the results of implementation of an ERAS pathway including high-dose preoperative glucocorticoid, and compared the outcome with patients previously treated according to standard care (SC).


Consecutive patients who underwent giant ventral hernia repair were included. Pain, nausea and fatigue were registered prospectively in all patients treated according to ERAS, as well as continuous measurement of transcutaneous capillary oxygen saturation. Postoperative morbidity and LOS were compared between patients treated according to ERAS and a historic group treated with SC.


A total of 32 patients were included. Postoperative LOS was decreased after the introduction of the ERAS pathway compared with SC (median 3.0 vs. 5.5 days, P = 0.003). Scores of pain, nausea and fatigue were low, while mean oxygen saturation during the first three postoperative days was 0.92. There were no differences when comparing readmission (5 vs. 2, P = 0.394), postoperative complications (7 vs. 4, P = 0. 458), or reoperation (5 vs. 1, P = 0.172) in ERAS versus controls.


The current study suggests that an ERAS pathway including preoperative high-dose glucocorticoid may lead to low scores of pain, fatigue and nausea after giant ventral hernia repair with reduced LOS compared with patients treated according to SC.


Hernia Enhanced recovery Glucocorticoid Recovery 


Compliance with ethical standards

Conflict of interest

KJ declares no conflict of interest. TB declares no conflict of interest. HH declares no conflict of interest. HK declares no conflict of interest. LJ declares no conflict of interest.


  1. 1.
    Fischer JP, Wes AM, Wink JD, Nelson JA, Braslow BM, Kovach SJ (2014) Analysis of risk factors, morbidity, and cost associated with respiratory complications following abdominal wall reconstruction. Plast Reconstr Surg 133:147–156CrossRefPubMedGoogle Scholar
  2. 2.
    Blatnik JA, Krpata DM, Pesa NL, Will P, Harth KC, Novitsky YW, Rowbottom JR, Rosen MJ (2012) Predicting severe postoperative respiratory complications following abdominal wall reconstruction. Plast Reconstr Surg 130:836–841CrossRefPubMedGoogle Scholar
  3. 3.
    Fox M, Cannon RM, Egger M, Spate K, Kehdy FJ (2013) Laparoscopic component separation reduces postoperative wound complications but does not alter recurrence rates in complex hernia repairs. Am J Surg 206:869–875CrossRefPubMedGoogle Scholar
  4. 4.
    Bisgaard T, Kehlet H, Bay-Nielsen MB, Iversen MG, Wara P, Rosenberg J, Friis-Andersen HF, Jorgensen LN (2009) Nationwide study of early outcomes after incisional hernia repair. Br J Surg 96:1452–1457CrossRefPubMedGoogle Scholar
  5. 5.
    Harth KC, Rose J, Delaney CP, Blatnik JA, Halaweish I, Rosen MJ (2011) Open versus endoscopic component separation: a cost comparison. Surg Endosc 25:2865–2870CrossRefPubMedGoogle Scholar
  6. 6.
    Husted H, Lunn TH, Troelsen A, Gaarn-Larsen L, Kristensen BB, Kehlet H (2011) Why still in hospital after fast-track hip and knee arthroplasty? Acta Orthopaedica 82:679–684CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Kehlet H (2008) Fast-track colorectal surgery. Lancet 371:791–793CrossRefPubMedGoogle Scholar
  8. 8.
    Fayezizadeh M, Petro CC, Rosen MJ, Novitsky YW (2014) Enhanced recovery after surgery pathway for abdominal wall reconstruction: pilot study and preliminary outcomes. Plast Reconstr Surg 134:151S–159SCrossRefPubMedGoogle Scholar
  9. 9.
    de la Motte L, Kehlet H, Vogt K, Nielsen CH, Groenvall JB, Nielsen HB, Andersen A, Schroeder TV, Lonn L (2014) Preoperative methylprednisolone enhances recovery after endovascular aortic repair: a randomized, double-blind, placebo-controlled clinical trial. Ann Surg 260:540–548CrossRefPubMedGoogle Scholar
  10. 10.
    Srinivasa S, Kahokehr AA, Yu TC, Hill AG (2011) Preoperative glucocorticoid use in major abdominal surgery: systematic review and meta-analysis of randomized trials. Ann Surg 254:183–191CrossRefPubMedGoogle Scholar
  11. 11.
    Nagelschmidt M, Fu ZX, Saad S, Dimmeler S, Neugebauer E (1999) Preoperative high dose methylprednisolone improves patients outcome after abdominal surgery. Eur J Surg 165:971–978CrossRefPubMedGoogle Scholar
  12. 12.
    Lunn TH, Andersen LO, Kristensen BB, Husted H, Gaarn-Larsen L, Bandholm T, Ladelund S, Kehlet H (2013) Effect of high-dose preoperative methylprednisolone on recovery after total hip arthroplasty: a randomized, double-blind, placebo-controlled trial. Br J Anaesth 110:66–73CrossRefPubMedGoogle Scholar
  13. 13.
    Rosen MJ, Jin J, McGee MF, Williams C, Marks J, Ponsky JL (2007) Laparoscopic component separation in the single-stage treatment of infected abdominal wall prosthetic removal. Hernia 11:435–440CrossRefPubMedGoogle Scholar
  14. 14.
    Stoppa R, Moungar F, Verhaeghe P (1992) Surgical treatment of supraumbilical eventrations. J Chir (Paris) 129:335–343Google Scholar
  15. 15.
    Romundstad L, Breivik H, Roald H, Skolleborg K, Haugen T, Narum J, Stubhaug A (2006) Methylprednisolone reduces pain, emesis, and fatigue after breast augmentation surgery: a single-dose, randomized, parallel-group study with methylprednisolone 125 mg, parecoxib 40 mg, and placebo. Anesth Analg 102:418–425CrossRefPubMedGoogle Scholar
  16. 16.
    Lunn TH, Kristensen BB, Andersen LO, Husted H, Otte KS, Gaarn-Larsen L, Kehlet H (2011) Effect of high-dose preoperative methylprednisolone on pain and recovery after total knee arthroplasty: a randomized, placebo-controlled trial. Br J Anaesth 106:230–238CrossRefPubMedGoogle Scholar
  17. 17.
    Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ (2011) Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev 2:Cd007635Google Scholar
  18. 18.
    Fischer JP, Shang EK, Butler CE, Nelson JA, Braslow BM, Serletti JM, Kovach SJ (2013) Validated model for predicting postoperative respiratory failure: analysis of 1706 abdominal wall reconstructions. Plast Reconstr Surg 132:826e–835eCrossRefPubMedGoogle Scholar
  19. 19.
    Schulze S, Andersen J, Overgaard H, Norgard P, Nielsen HJ, Aasen A, Gottrup F, Kehlet H (1997) Effect of prednisolone on the systemic response and wound healing after colonic surgery. Arch Surg 132:129–135CrossRefPubMedGoogle Scholar
  20. 20.
    Dieleman JM, Nierich AP, Rosseel PM, van der Maaten JM, Hofland J, Diephuis JC, Schepp RM, Boer C, Moons KG, van Herwerden LA, Tijssen JG, Numan SC, Kalkman CJ, van Dijk D (2012) Intraoperative high-dose dexamethasone for cardiac surgery: a randomized controlled trial. JAMA 308:1761–1767CrossRefPubMedGoogle Scholar
  21. 21.
    Wink JD, Wes AM, Fischer JP, Nelson JA, Stranksy C, Kovach SJ 3rd (2015) Risk factors associated with early failure in complex abdominal wall reconstruction: a 5 year single surgeon experience. J Plast Surg Hand Surg 49:77–82CrossRefPubMedGoogle Scholar
  22. 22.
    Rothman JP, Gunnarsson U, Bisgaard T (2014) Abdominal binders may reduce pain and improve physical function after major abdominal surgery—a systematic review. Dan Med J 61:A4941PubMedGoogle Scholar
  23. 23.
    Gurusamy KS, Allen VB (2013) Wound drains after incisional hernia repair. Cochrane Database Syst Rev 12:CD005570Google Scholar

Copyright information

© Springer-Verlag France 2016

Authors and Affiliations

  • K. K. Jensen
    • 1
  • T. L. Brondum
    • 1
  • H. Harling
    • 1
  • H. Kehlet
    • 2
  • L. N. Jorgensen
    • 1
  1. 1.Digestive Disease Center, Bispebjerg HospitalUniversity of CopenhagenCopenhagen NVDenmark
  2. 2.Section of Surgical Pathophysiology, RigshospitaletUniversity of CopenhagenCopenhagen ØDenmark

Personalised recommendations