Advertisement

Hernia

pp 1–11 | Cite as

Primary uncomplicated midline ventral hernias: factors that influence and guide the surgical approach

  • H. AlkhatibEmail author
  • A. Fafaj
  • M. Olson
  • T. Stewart
  • D. M. Krpata
Original Article
  • 23 Downloads
Part of the following topical collections:
  1. Forum on primary midline uncomplicated ventral hernia

Abstract

Background

Considering recently published high-level evidence on the management of primary midline ventral hernias, we set out to review current practices and reevaluate the literature surrounding this topic.

Methods

The Americas Hernia Society Quality Collaborative (AHSQC) was used to abstract all uncomplicated primary midline ventral hernias. The primary outcomes of interest were surgical approaches, including the use of mesh, the type and position of mesh, and the use of minimally invasive surgery (MIS).

Results

A total of 7030 met inclusion criteria; mean age of 52 ± 14, 71% male, with a median hernia width of 2 [1, 2]. A total 69% underwent mesh repair, while 31% underwent suture repair. The most commonly used mesh was permanent synthetic (98%), placed in either the intraperitoneal (46%) or preperitoneal (42%) spaces. The majority of repairs were performed through an open approach (72%). When mesh was used through an open approach (58%), the majority were patches (70%) placed in the preperitoneal space (50%). Through an MIS approach (95%), the majority were flat meshes (53%) placed in the intraperitoneal space (58%).

Conclusion

Recent high-level literature recommends the use of mesh repair (flat mesh) in all patients with hernia width ≥ 1 cm. This evidence is limited to the use of flat mesh through an open approach. While AHSQC surgeons do offer mesh repair in the majority of cases, this is most commonly using a mesh patch, and is selective towards larger hernias and obese patients. Further research is required to evaluate the safety of mesh patches, and a mesh repair should be offered to a young non-obese healthy patient, as they benefit similarly from the use of mesh.

Keywords

Primary Ventral Hernia Epigastric Umbilical Mesh 

Notes

Compliance with ethical standards

Conflict of interest

Dr. Stewart and Ms. Olsen report that the AHSQC contracts Vanderbilt Biostatistics to provide support for AHSQC projects. The work provided was performed under the umbrella of the AHSQC-Vanderbilt Biostatistics collaboration plan. Dr. Krpata reports grants from Gore for education, outside of submitted work. Dr. Alkhatib reports no conflicts of interest.

Ethical approval

This study did not need approval from the local ethical committee.

Human and animal rights

This study does not contain any studies with participants or animals performed by any of the authors.

Informed consent

For this type of study, consent was not required.

References

  1. 1.
    Witherspoon P, O’Dwyer PJ (2005) Surgeon perspectives on options for ventral abdominal wall hernia repair: results of a postal questionnaire. Hernia 9(3):259–262CrossRefGoogle Scholar
  2. 2.
    Appleby PW, Martin TA, Hope WW (2018) Umbilical hernia repair: overview of approaches and review of literature. Surg Clin N Am 98(3):561–576CrossRefGoogle Scholar
  3. 3.
    Halm JA et al (2005) Long-term follow-up after umbilical hernia repair: are there risk factors for recurrence after simple and mesh repair. Hernia 9(4):334–337CrossRefGoogle Scholar
  4. 4.
    Stabilini C et al (2009) Mesh versus direct suture for the repair of umbilical and epigastric hernias. Ten-year experience. Ann Ital Chir 80(3):183–187PubMedGoogle Scholar
  5. 5.
    Christoffersen MW et al (2013) Lower reoperation rate for recurrence after mesh versus sutured elective repair in small umbilical and epigastric hernias. A nationwide register study. World J Surg 37(11):2548–2552CrossRefGoogle Scholar
  6. 6.
    Aslani N, Brown CJ (2010) Does mesh offer an advantage over tissue in the open repair of umbilical hernias? A systematic review and meta-analysis. Hernia 14(5):455–462CrossRefGoogle Scholar
  7. 7.
    Nguyen MT et al (2014) Comparison of outcomes of synthetic mesh vs suture repair of elective primary ventral herniorrhaphy: a systematic review and meta-analysis. JAMA Surg 149(5):415–421CrossRefGoogle Scholar
  8. 8.
    Kaufmann R et al (2018) Mesh versus suture repair of umbilical hernia in adults: a randomised, double-blind, controlled, multicentre trial. Lancet 391(10123):860–869CrossRefGoogle Scholar
  9. 9.
    Bisgaard T et al (2018) Lower risk of recurrence after mesh repair versus non-mesh sutured repair in open umbilical hernia repair: a systematic review and meta-analysis of randomized controlled trials. Scand J Surg 108(3):187–193CrossRefGoogle Scholar
  10. 10.
    Poulose BK et al (2016) Design and implementation of the Americas Hernia Society Quality Collaborative (AHSQC): improving value in hernia care. Hernia 20(2):177–189CrossRefGoogle Scholar
  11. 11.
    Haskins IN et al (2018) A call for standardization of wound events reporting following ventral hernia repair. Hernia 22(5):729–736CrossRefGoogle Scholar
  12. 12.
    Centers for Disease Control and Prevention web site (2018) Surgical site infection (SSI) event. [cited 2018 5 April]. https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Accessed 5 Apr 2018
  13. 13.
    Arroyo A et al (2001) Randomized clinical trial comparing suture and mesh repair of umbilical hernia in adults. Br J Surg 88(10):1321–1323CrossRefGoogle Scholar
  14. 14.
    Shankar DA et al (2017) Factors associated with long-term outcomes of umbilical hernia repair. JAMA Surg 152(5):461–466CrossRefGoogle Scholar
  15. 15.
    Oma E, Jensen KK, Jorgensen LN (2017) Increased risk of ventral hernia recurrence after pregnancy: a nationwide register-based study. Am J Surg 214(3):474–478CrossRefGoogle Scholar
  16. 16.
    Lappen JR, Sheyn D, Hackney DN (2016) Does pregnancy increase the risk of abdominal hernia recurrence after prepregnancy surgical repair? Am J Obstet Gynecol 215(3):390.e1–390.e5CrossRefGoogle Scholar
  17. 17.
    Oma E et al (2019) Nationwide propensity-score matched study of mesh versus suture repair of primary ventral hernias in women with a subsequent pregnancy. World J Surg 43(6):1497–1504CrossRefGoogle Scholar
  18. 18.
    Vychnevskaia K et al (2010) Intraperitoneal mesh repair of small ventral abdominal wall hernias with a ventralex hernia patch. Dig Surg 27(5):433–435CrossRefGoogle Scholar
  19. 19.
    Zarmpis N, Wassenberg D, Ambe PC (2015) Repair of small and medium size umbilical hernias with the “proceed ventral patch” in the preperitoneal position. Am Surg 81(11):1144–1148PubMedGoogle Scholar
  20. 20.
    Tollens T et al (2011) Retrospective analysis of umbilical, epigastric, and small incisional hernia repair using the Ventralex hernia patch. Hernia 15(5):531–540CrossRefGoogle Scholar
  21. 21.
    Martin DF et al (2008) Ventralex mesh in umbilical/epigastric hernia repairs: clinical outcomes and complications. Hernia 12(4):379–383CrossRefGoogle Scholar
  22. 22.
    Ponten JEH et al (2018) Mesh versus patch repair for epigastric and umbilical hernia (MORPHEUS trial); one-year results of a randomized controlled trial. World J Surg 42(5):1312–1320CrossRefGoogle Scholar
  23. 23.
    Khera G, Berstock DA (2006) Incisional, epigastric and umbilical hernia repair using the Prolene Hernia System: describing a novel technique. Hernia 10(4):367–369CrossRefGoogle Scholar
  24. 24.
    Xie Y et al (2016) Effectiveness of preperitoneal herniorrhaphy with Ultrapro Plug mesh for umbilical hernia repair in adults. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 30(6):739–741PubMedGoogle Scholar
  25. 25.
    Polat C et al (2005) Umbilical hernia repair with the prolene hernia system. Am J Surg 190(1):61–64CrossRefGoogle Scholar
  26. 26.
    Liang MK et al (2013) Outcomes of laparoscopic vs open repair of primary ventral herniaslaparoscopic vs open repair of PVHs laparoscopic vs open repair of PVHs. JAMA Surg 148(11):1043–1048CrossRefGoogle Scholar
  27. 27.
    Hajibandeh S et al (2017) Laparoscopic versus open umbilical or paraumbilical hernia repair: a systematic review and meta-analysis. Hernia 21(6):905–916CrossRefGoogle Scholar
  28. 28.
    Prabhu AS et al (2017) Laparoscopic vs robotic intraperitoneal mesh repair for incisional hernia: an Americas Hernia Society Quality Collaborative Analysis. J Am Coll Surg 225(2):285–293CrossRefGoogle Scholar
  29. 29.
    Chen YJ et al (2017) Outcomes of robot-assisted versus laparoscopic repair of small-sized ventral hernias. Surg Endosc 31(3):1275–1279CrossRefGoogle Scholar
  30. 30.
    Belyansky I et al (2018) A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair. Surg Endosc 32(3):1525–1532CrossRefGoogle Scholar
  31. 31.
    Schwarz J, Reinpold W, Bittner R (2017) Endoscopic mini/less open sublay technique (EMILOS)-a new technique for ventral hernia repair. Langenbecks Arch Surg 402(1):173–180CrossRefGoogle Scholar
  32. 32.
    Cassie S et al (2014) Laparoscopic versus open elective repair of primary umbilical hernias: short-term outcomes from the American College of Surgeons National Surgery Quality Improvement Program. Surg Endosc 28(3):741–746CrossRefGoogle Scholar
  33. 33.
    Savitch SL, Shah PC (2016) Closing the gap between the laparoscopic and open approaches to abdominal wall hernia repair: a trend and outcomes analysis of the ACS-NSQIP database. Surg Endosc 30(8):3267–3278CrossRefGoogle Scholar
  34. 34.
    Lee J et al (2013) Laparoscopic vs open ventral hernia repair in the era of obesity. JAMA Surg 148(8):723–726CrossRefGoogle Scholar
  35. 35.
    Novitsky YW et al (2006) Laparoscopic ventral hernia repair in obese patients: a new standard of care. JAMA Surg 141(1):57–61Google Scholar
  36. 36.
    Earle D et al (2016) SAGES guidelines for laparoscopic ventral hernia repair. Surg Endosc 30(8):3163–3183CrossRefGoogle Scholar
  37. 37.
    Kohler G, Luketina RR, Emmanuel K (2015) Sutured repair of primary small umbilical and epigastric hernias: concomitant rectus diastasis is a significant risk factor for recurrence. World J Surg 39(1):121–126 (discussion 127) CrossRefGoogle Scholar
  38. 38.
    Privett BJ, Ghusn M (2016) Proposed technique for open repair of a small umbilical hernia and rectus divarication with self-gripping mesh. Hernia 20(4):527–530CrossRefGoogle Scholar
  39. 39.
    Kockerling F et al (2016) Endoscopic-assisted linea alba reconstruction plus mesh augmentation for treatment of umbilical and/or epigastric hernias and rectus abdominis diastasis—early results. Front Surg 3:27PubMedPubMedCentralGoogle Scholar
  40. 40.
    Emanuelsson P et al (2016) Operative correction of abdominal rectus diastasis (ARD) reduces pain and improves abdominal wall muscle strength: a randomized, prospective trial comparing retromuscular mesh repair to double-row, self-retaining sutures. Surgery 160(5):1367–1375CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Center for Abdominal Core Health, Digestive Disease and Surgery InstituteThe Cleveland Clinic FoundationClevelandUSA
  2. 2.Department of BiostatisticsVanderbilt University Medical CenterNashvilleUSA

Personalised recommendations