Abstract
Background
The decision for emergent and urgent ventral hernia repair (VHR) is driven by acute symptomatology, concern for incarceration and strangulation, and perforation. Although mesh has been established to reduce hernia recurrences, the potential for mesh complications may impact the decision for utilization in emergent repairs. This study evaluates hernia repair outcomes in the emergent setting with/without mesh.
Methods
An IRB-approved review of NSQIP and retrospective chart review data of emergent/urgent VHRs performed between 2013 and 2017 was conducted at a single academic institution. Six-month postoperative emergency department and surgery clinic visits, hospital readmissions, and hernia recurrences were recorded. Patients were grouped based on mesh utilization. Perioperative and outcome variables were compared using Chi-square, Fisher’s exact, and t-tests.
Results
Among 94 patients, 41 (44%) received mesh; 53 (56%) did not. Synthetic mesh was used in 27 cases (65.9%); bioresorbable or biologic mesh was used in 14 cases (34.1%). ASA class (p = 0.016) was higher in the no-mesh group, as were emergent vs. urgent cases (p ≤ 0.001). Preoperative SIRS/Sepsis, COPD, and diabetes were increased in the no-mesh group. Hernia recurrence was significantly higher in the no-mesh group vs. the mesh group (24.5% vs. 7.3%, p = 0.03). No difference was found in wound complications between groups. ED visits occurred almost twice as often in the mesh group (42% vs. 23%, p = 0.071). Postoperative surgery clinic visits were more frequent among the mesh group (> 1 visit 61% vs. 24%, p = 0.004).
Conclusions
Mesh-based hernia repairs in the urgent/emergent patient population are performed in fewer than half of patients in our tertiary care referral center. Repairs without mesh were associated with over a three-fold increase in recurrence without a difference in the risk of infectious complications. Efforts to understand the rationale for suture-based repair compared to mesh repair are needed to reduce hernia recurrences in the emergent population.
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Acknowledgements
We acknowledge and thank the University of Kentucky College of Medicine Professional Student Mentored Research Fellowship Program for their contributions to this project.
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Rachel Whittaker has nothing to disclose. Zachary Lewis has nothing to disclose. Margaret A. Plymale has nothing to disclose. Michael Nisiewicz has nothing to disclose. Ajadi Ebunoluwa has nothing to disclose. Daniel Davenport has nothing to disclose. Jessica Reynolds has nothing to disclose. John Scott Roth discloses the following: research grant and consulting honoraria from Becton Dickenson, a research grant from Advanced Medical Solutions, and he holds stock in Miromatrix.
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Whittaker, R., Lewis, Z., Plymale, M.A. et al. Emergent and urgent ventral hernia repair: comparing recurrence rates amongst procedures utilizing mesh versus no mesh. Surg Endosc 36, 7731–7737 (2022). https://doi.org/10.1007/s00464-022-09101-4
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DOI: https://doi.org/10.1007/s00464-022-09101-4