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What is the reality in epigastric hernia repair?–a trend analysis from the Herniamed Registry

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Abstract

Introduction

The proportion of epigastric hernias in the total collective of all operated abdominal wall hernias is 3.6–6.9%. The recently published guidelines for treatment of epigastric hernias of the European Hernia Society and the Americas Hernia Society recommend the use of a mesh for defect size of ≥ 1 cm, i.e., a preperitoneal flat mesh technique for sizes 1–4 cm, and laparoscopic IPOM technique for defects > 4 cm and/or obesity. Against that background, this analysis of data from the Herniamed Registry now aims to explore trends in epigastric hernia repair.

Methods

To detect trends, the perioperative outcome was calculated separately for the years 2010 to 2019 and the 1-year follow-up for the years 2010 to 2018 and significant differences were identified. Analysis was based on 25,518 primary elective epigastric hernia repairs. The rates of postoperative surgical complications, pain at rest, pain on exertion, chronic pain requiring treatment and recurrence associated with the various surgical techniques were calculated separately for each year. Fisher’s exact test for unadjusted analysis between years was applied with Bonferroni adjustment for multiple testing.

Results

The proportion of laparoscopic IPOM repairs declined from 26.0% in 2013 to 18.2% in 2019 (p < 0.001). Instead, the proportion of open sublay repairs rose from 16.5% to 21.8% (p < 0.001). That was also true for innovative techniques such as the EMILOS, MILOS, eTEP and preperitoneal flat mesh technique (8.3% vs 15.3%; p < 0.001). This change in indication for the various surgical techniques led to a significant improvement in the postoperative surgical complication rate (3.8% vs 1.9%; p < 0.001).

Conclusion

The trend is for epigastric hernia repair to be performed less often in laparoscopic IPOM technique and instead more often in open sublay technique or the new innovative techniques.

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References

  1. Fitzgibbons, Jr. RJ (2002) Greenburg AG 35B Epigastric Hernia; Page 398–404 in: Nyhus & Condon’s-Hernia, Fifth Edition by Lippincott Williams & Wilkins

  2. Ponten JEH, Thomassen I (2014) Nienhuijs SW A Collective Review on Mesh-Based Repair of Umbilical and Epigastric Hernias. Indian J Surg 76:371–377. https://doi.org/10.1007/s12262-013-0920-6

    Article  PubMed  Google Scholar 

  3. Statistisches Bundesamt (Destatis) (2019) Artikelnummer: 5231401197014

  4. Rutkow IM (2003) Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surg Clin North Am. 83:1045–1051. https://doi.org/10.1016/S0039-6109(03)00132-4

    Article  PubMed  Google Scholar 

  5. Helgstrand F, Rosenberg J, Kehlet H, Bisgaard T (2013) Outcomes after emergency versus elective ventral hernia repair: a prospective nationwide study. World J Surg 37:2273–2279. https://doi.org/10.1007/s00268-013-2123-5

    Article  PubMed  Google Scholar 

  6. Ponten JE, Somers KY, Nienhuijs SW (2012) Pathogenesis of the epigastric hernia. Hernia 16:627–633. https://doi.org/10.1007/s10029-012-0964-8

    Article  CAS  PubMed  Google Scholar 

  7. Blonk L, Civil YA, Kaufmann R, Ket JC, van der Velde S (2019) A systematic review on surgical treatment of primary epigastric hernias. Hernia 23:847–857. https://doi.org/10.1007/s10029-019-02017-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Ponten JE, Leenders BJ, Leclercq WK, Lettinga T, Heemskerk J, Konsten JL, Castelijns PS, Nienhuijs SW (2018) Mesh versus patch repair for epigastric and Umbilical Hernia (MORPHEUS Trial); one-year results of a randomized controlled trial. World J Surg. 42:1312–1320. https://doi.org/10.1007/s00268-017-4297-8

    Article  CAS  PubMed  Google Scholar 

  9. Ponten JEH, Leclercq WKG, Lettinga T, Heemskerk J, Konsten JLM, Bouvy ND, Nienhuijs SW (2019) Mesh OR patch for hernia on epigastric and Umbilical sites (MORPHEUS-Trial): the complete two-year follow-up. Ann Surg. 270:33–37. https://doi.org/10.1097/SLA.0000000000003086

    Article  PubMed  Google Scholar 

  10. Bernardi K, Olavarria OA, Holihan JL, Kao LS, Ko TC, Roth JS, Tsuda S, Vaziri K, Liang MK (2020) Primary fascial closure during laparoscopic ventral hernia repair improves patient quality of life: a multicentre, blinded randomized controlled trial. Ann Surg 271:434–439. https://doi.org/10.1097/SLA.0000000000003505

    Article  PubMed  Google Scholar 

  11. Henriksen NA, Montgomery A, Kaufmann R, Berrevoet E, East B, Fischer J et al (2020) Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society. BJs 107:171–190. https://doi.org/10.1002/bjs.11489

    Article  CAS  Google Scholar 

  12. Stechemesser B, Jacob DA, Schug-Pass C (2012) Köckerling Herniamed: an internet-based registry for outcome research in hernia surgery. Hernia 16:269–276. https://doi.org/10.1007/s10029-012-0908.3

    Article  CAS  PubMed  Google Scholar 

  13. Kyle-Leinhase I, Köckerling F, Jorgensen LN, Montgomery A, Gillion JF, Rodriguez JAP, Hope W, Muysoms F (2018) Comparison of hernia registries: the CORE project. Hernia 22:561–575. https://doi.org/10.1007/s10029-017-1724-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Köckerling F, Brunner W, Fortelny R, Mayer F, Adolf D, Niebuhr H, Lorenz R, Reinpold W, Zarras K, Weyhe D (2020) Treatment of small (< 2 cm) umbilical hernias: guidelines and current trends from the Herniamed Registry. Hernia. https://doi.org/10.1007/s10029-020-02345-w

    Article  PubMed  PubMed Central  Google Scholar 

  15. Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault DD, Chelala E et al (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13:407–414. https://doi.org/10.1007/s10029-009-0518-x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Ponten JE, Leenders BJ, Charbon JA, Nienhuijs SW (2015) A consecutive series of 235 epigastric hernias. Hernia 19:821–825. https://doi.org/10.1007/s10029-014-1227-7

    Article  CAS  PubMed  Google Scholar 

  17. Köckerling F, Hoffmann H, Mayer F, Zarras K, Reinpold W, Fortelny R, Weyhe D, Lammers B, Adolf D, Schug-Pass C (2020) What are the trends in incisional hernia repair?–Real-world data over 10 years from the Herniamed Registry. Hernia. https://doi.org/10.1007/s10029-020-02319-y

    Article  PubMed  PubMed Central  Google Scholar 

  18. Sharma A (2018) Berger D The current role of laparoscopic IPOM repair in abdominal wall reconstruction. Hernia 22:739–741. https://doi.org/10.1007/s10029-018-1820-2

    Article  CAS  PubMed  Google Scholar 

  19. Muysoms F (2018) IPOM: history of an acronym. Hernia 22:743–746. https://doi.org/10.1007/s10029-018-1804-2

    Article  CAS  PubMed  Google Scholar 

  20. Christoffersen MW, Helgstrand F, Rosenberg J, Kehlet H, Bisgaard T (2013) Lower reoperation rate for recurrence after mesh versus sutured elective repair in small Umbilical and Epigastric Hernias A Nationwide Registry Study. World J Surg 37:2548–2552. https://doi.org/10.1007/s00268-013-2160-0

    Article  CAS  PubMed  Google Scholar 

  21. Christoffersen MW, Helgstrand F, Rosenberg J, Kehlet H, Strandfelt P (2015) Bisgaard T Long-term recurrence and chronic pain after repair for small umbilical or epigastric hernias: a regional cohort study. Am J Surgery 209:725–732. https://doi.org/10.1016/j.amjsurg.2014.05.021

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany

    F. Köckerling & C. Schug-Pass

  2. StatConsult GmbH, Halberstädter Strasse 40 a, 9112, Magdeburg, Germany

    D. Adolf

  3. Department of Visceral, Minimally Invasive and Oncologic Surgery, Academic Teaching Hospital of University of Düsseldorf, Marien Hospital, Rochusstrasse 2, 40479, Düsseldorf, Germany

    K. Zarras

  4. Department of General Surgery, Wilhelminenhospital, Sigmund Freud University, Medical Faculty, Montleartstrasse 37, 1160, Vienna, Austria

    R. Fortelny

  5. 3+Chirurgen, Klosterstrasse 34/35, Spandau, 13581, Berlin, Germany

    R. Lorenz

  6. Department of Surgery I–Section Coloproctology and Hernia Surgery, Lukas Hospital, Preussenstrasse 84, 41464, Neuss, Germany

    B. Lammers

  7. Department of Surgery, Wilhelmsburger Hospital Gross Sand, Academic Teaching Hospital of University Hamburg, Gross Sand 32, 1107, Hamburg, Germany

    W. Reinpold

  8. Pan Hospital, Hernia Center, Zeppelinstrasse 1, 50667, Cologne, Germany

    B. Stechemesser

  9. Pius Hospital, Department of General and Visceral Surgery, University Hospital of Visceral Surgery, Georgstrasse 12, 26121, Oldenburg, Germany

    D. Weyhe

Authors
  1. F. Köckerling
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  2. D. Adolf
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  3. K. Zarras
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  4. R. Fortelny
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  5. R. Lorenz
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  6. B. Lammers
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  7. W. Reinpold
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  8. B. Stechemesser
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  9. C. Schug-Pass
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  10. D. Weyhe
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Corresponding author

Correspondence to F. Köckerling.

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Conflict of interest

Dr. Köckerling reports grants from Johnson & Johnson, Norderstedt, grants from Karl Storz, Tuttlingen, grants from pfm medical, Cologne, grants from Dahlhausen, Cologne, grants from B Braun, Tuttlingen, grants from MenkeMed, Munich, grants from Bard, Karlsruhe, during the conduct of the study; personal fees from Bard, Karlsruhe, outside the submitted work. All other authors have nothing to disclose.

Ethical approval

As only cases of routine hernia surgery are documented in the Herniamed Registry, an ethical approval was not neccessary.

Human and animal rights

This article does not contain any study with animals performed by any of the authors.

Informed consent

All patients with routine hernia surgery documented in the Herniamed Registry have signed an informed consent declaration agreeing to participate.

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Köckerling, F., Adolf, D., Zarras, K. et al. What is the reality in epigastric hernia repair?–a trend analysis from the Herniamed Registry. Hernia 25, 1083–1094 (2021). https://doi.org/10.1007/s10029-021-02408-6

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  • DOI: https://doi.org/10.1007/s10029-021-02408-6

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