Primary uncomplicated midline ventral hernias: factors that influence and guide the surgical approach
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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.
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).
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%).
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.
KeywordsPrimary Ventral Hernia Epigastric Umbilical Mesh
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.
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.
For this type of study, consent was not required.
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