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

Hernia volume 23, pages 873–883 (2019)Cite this article

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.

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Fig. 1

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Author information

Affiliations

  1. Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    H. Alkhatib, A. Fafaj & D. M. Krpata

  2. Department of Biostatistics, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA

    M. Olson & T. Stewart

Authors
  1. H. Alkhatib
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  2. A. Fafaj
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  3. M. Olson
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  4. T. Stewart
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  5. D. M. Krpata
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Corresponding author

Correspondence to H. Alkhatib.

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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.

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Alkhatib, H., Fafaj, A., Olson, M. et al. Primary uncomplicated midline ventral hernias: factors that influence and guide the surgical approach. Hernia 23, 873–883 (2019). https://doi.org/10.1007/s10029-019-02051-2

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  • DOI: https://doi.org/10.1007/s10029-019-02051-2

Keywords

  • Primary
  • Ventral
  • Hernia
  • Epigastric
  • Umbilical
  • Mesh