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

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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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

Keywords

  • Epigastric hernia
  • Guidelines
  • Perioperative complications
  • Recurrence
  • Chronic pain