Skip to main content

Advertisement

SpringerLink
Log in

Long-term follow-up (at 5 years) of midline incisional hernia repairs using a primary closure and prosthetic onlay technique: recurrence and quality of life

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Introduction and objectives

The recurrence rate of incisional hernia (IH) repair is usually underestimated due to a lack of long-term follow-up. The objective of this study was to evaluate recurrence rate for patients operated on midline IH surgery, using a primary closure and prosthetic onlay technique, 5 years after the procedure.

Materials and methods

From January 2009 to January 2011, all 92 patients operated on elective midline IH repair by primary closure and prosthetic onlay technique in a General Surgery Department were retrospectively included in the study. Exclusion criteria were absence of follow-up or death. Recurrence rate and quality of life were assessed. Demographic, surgical data and quality of life in patients with and without 5-year recurrence were compared.

Results

Mean follow-up was 64 months. Ultimately, 76 patients were included in the study, representing 82% of the selected patients during the study period (76/92), of whom 24 presented a recurrence (32%). Half (12) were diagnosed for recurrence more than 3 years after the surgery. Patients who developed a recurrence had more percentage of obesity (64 vs. 29%, p = 0.016), which denoted an odds ratio (OR) for recurrence of 4.4 (1.2–15.7; p = 0.01) and they punctuated lower in quality of life (6.0 ± 2.9 vs. 7.6 ± 2.6, p = 0.006).

Conclusions

Recurrence rate on midline IH repair is still a concern (32% at 5 years). It is advisable to look for other strategies and more efficient surgical techniques for IH surgery, especially in obese patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Sugerman HJ, Kellum JM Jr, Reines HD et al (1996) Greater risk of incisional hernia with morbidly obese than steroid-dependent patients and low recurrence with prefascial polypropylene mesh. Am J Surg 171:80–84

    Article  CAS  PubMed  Google Scholar 

  2. Hodgson NC, Malthaner RA, Ostbye T et al (2000) The search for an ideal method of abdominal fascial closure: a meta-analysis. Ann Surg 231:436–442

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Hoer J, Lawong G, Klinge U et al (2002) Factors influencing the development of incisional hernia: a retrospective study of 2,983 laparotomy patients over a period of 10 years. Chirurg 73:474–480

    Article  CAS  PubMed  Google Scholar 

  4. Andersen LP, Klein M, Gögenur I et al (2009) Long-term recurrence and complication rates after incisional hernia repair with the open onlay technique. BMC Surg. 28(9):6

    Article  Google Scholar 

  5. Burger JW, Luijendijk RW, Hop WC et al (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240(4):578–583

    PubMed  PubMed Central  Google Scholar 

  6. Fink C, Baumann P, Wente MN et al (2014) Incisional hernia rate 3 years after midline laparotomy. Br J Surg 101(2):51–54

    Article  CAS  PubMed  Google Scholar 

  7. Gillion JF, Sanders D, Miserez M, et al (2016) The economic burden of incisional ventral hernia repair: a multicentric cost analysis. Hernia (Epub ahead of print)

  8. Oprea V, Matei O, Leucã D et al (2013) Late results and quality of life after Rives-Stoppa repair for incisional hernias: a prospective clinical study. Chirurgia 108:679–683 (No. 5)

    CAS  PubMed  Google Scholar 

  9. Gysel C (1974) Adolphe Quetelet. The statistics and biometry of growth. Orthod Fr 45(1):643–677

    CAS  PubMed  Google Scholar 

  10. World Health Organization (WHO): obesity and overweight. Fact Sheet No 311. Updated January 2015

  11. Langer S, Christiansen J (1985) Long-term results after incisional hernia repair. Acta Chirst Scand 151(3):217–219

    CAS  Google Scholar 

  12. Klinge U, Fiebeler A (2010) Two controversial concepts: standard Procedure in a standard patient versus tailored surgery with procedures adjusted to individual patients. In: Volker S, Fitzgibbons RJ (eds) Hernia repair sequelae. Springer, Berlin, pp 467–472

    Chapter  Google Scholar 

  13. Flum DR, Horvath K, Koepsell T (2003) Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg 237(1):129–135

    Article  PubMed  PubMed Central  Google Scholar 

  14. Cobb WS, Warren JA, Ewing JA et al (2015) Open retromuscular mesh repair of complex incisional hernia: predictors of wound events and recurrence. J Am Coll Surg 220(4):606–613

    Article  PubMed  Google Scholar 

  15. Carter SA, Hicks SC, Brahmbhatt R et al (2014) Recurrence and pseudorecurrence after laparoscopic ventral hernia repair: predictors and patient-focused outcomes. Am Surg 80(2):138–148

    PubMed  Google Scholar 

  16. Vilallonga R, Fort JM, Gonzalez O et al (2011) Management of patients with hernia or incisional hernia undergoing surgery for morbid obesity. J Obes 2011:860942

    Article  PubMed  Google Scholar 

  17. Raziel A, Sakran N, Szold A et al (2014) Concomitant bariatric and ventral/incisional hernia surgery in morbidly obese patients. Surg Endosc 16(4):1209–1212

    Article  Google Scholar 

  18. Langer C, Schaper A, Liersch T et al (2005) Prognosis factors in incisional hernia surgery: 25 years of experience. Hernia 9(1):16–21

    Article  CAS  PubMed  Google Scholar 

  19. Froylich D, Segal M, Weinstein A et al (2016) Laparoscopic versus open ventral hernia repair in obese patients: a long-term follow-up. Surg Endosc 30(2):670–675

    Article  PubMed  Google Scholar 

  20. Den Hartog D, Dur AH, Tuinebreijer WE et al (2008) Open surgical procedures for incisional hernias. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD006438.pub2

    PubMed  Google Scholar 

  21. Timmermans L, de Goede B, van Dijk SM et al (2014) Meta-analysis of sublay versus onlay mesh repair in incisional hernia surgery. Am J Surg 207(6):980–988

    Article  PubMed  Google Scholar 

  22. Hernandez-Granados P, Pereira JA, Feliu X, Lopez-Cano M, Fernandez F, Delgado I (2014) Spanish registry of incisional hernia. Preliminary results after 1 year of implementation. Hernia 18(suppl. 2):S31

    Google Scholar 

  23. Kokotovic D, Gögenur I, Helgstrand F (2017) Substantial variation among hernia experts in the decision for treatment of patients with incisional hernia: a descriptive study on agreement. Hernia 21(2):271–278

    Article  CAS  PubMed  Google Scholar 

  24. Ramirez OM, Ruas E, Dellon AL (1990) “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 86(3):519–526

    Article  CAS  PubMed  Google Scholar 

  25. Cornette B, De Bacquer D, Berrevoet F (2017) Component separation technique for giant incisional hernia: a systematic review. Am J Surg. https://doi.org/10.1016/j.amsurg.2017.07.032

    PubMed  Google Scholar 

  26. Pauli EM, Rosen MJ (2013) Open ventral hernia repair with component separation. Surg Clin North Am 93(5):1111–1133

    Article  PubMed  Google Scholar 

  27. Novitsky YW, Fayezizadeh M, Majumder A, Neupane R, Elliott HL, Orenstein SB (2016) Outcomes of posterior component separation with transversus abdominis muscle release and synthetic mesh sublay reinforcement. Ann Surg 264(2):226–232

    Article  PubMed  Google Scholar 

  28. Sauerland S, Walgenbach M, Habermalz B et al (2011) Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD007781.pub2

    Google Scholar 

  29. Al Chalabi H, Larkin J, Mehigan B et al (2015) A systematic review of laparoscopic versus open abdominal incisional hernia repair, with meta-analysis of randomized controlled trials. Int J Surg 20:65–74

    Article  PubMed  Google Scholar 

  30. López-Cano M (2013) Evidence-based surgery. Rev Hispanoam Hernia 1(1):18–26

    Article  Google Scholar 

  31. Hoyuela C, Trias M, Juvany M et al (2015) Preoperative progressive pneumoperitoneum and anterior component separation techniques for the treatment of a huge incisional hernia with loss of domain. Cir Esp 93(Special Congress):919

    Google Scholar 

  32. Bueno-Lledó J, Torregrosa A, Ballester N, Carreño O, Carbonell F, Pastor PG, Pamies J, Cortés V, Bonafé S, Iserte J (2017) Preoperative progressive pneumoperitoneum and botulinum toxin type A in patients with large incisional hernia. Hernia 21(2):233–243

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General and Digestive Surgery, Hospital Plató Barcelona, Universitat Autònoma Barcelona, Plató 21, 08006, Barcelona, Spain

    M. Juvany, C. Hoyuela, F. Carvajal, M. Trias, A. Martrat & J. Ardid

Authors
  1. M. Juvany
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Hoyuela
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. Carvajal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Trias
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Martrat
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Ardid
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Juvany.

Ethics declarations

Conflict of interest

None of the authors (MJ, CH, FC, MT, AM, JA) have any conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Human and animal rights

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

Informed consent

For this type of study formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Juvany, M., Hoyuela, C., Carvajal, F. et al. Long-term follow-up (at 5 years) of midline incisional hernia repairs using a primary closure and prosthetic onlay technique: recurrence and quality of life. Hernia 22, 319–324 (2018). https://doi.org/10.1007/s10029-018-1730-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-018-1730-3

Keywords

Search

Navigation