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Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh
Published on: September 11, 2021
Ventral incisional hernia recurrence
1Surgery Service, Department of Veterans Affairs, Minneapolis Veterans Administration Medical Center, One Veterans Drive, Minneapolis, Minnesota 55417, USA.
Abstract:
During the period October 1993 to December 1996, 31 patients were operated on by the author for primary or recurrent ventral incisional hernia (VIH). Three patients were excluded from analysis because their records were unavailable for review. The median age of the 28 remaining patients at their initial procedure was 57.5 years (range, 37-78 years). The repair was performed with interrupted O-Ethibond sutures in all but 3 cases where Prolene suture was used secondary to noniatrogenic contamination or recurrent hernia. There were no unplanned enterotomies in the entire series and prophylactic intravenous antibiotics were used in all cases. The only significant complications were skin hyperemia after five repairs in 3 patients who were treated empirically with intravenous antibiotics, and 1 patient who had an antibiotic-associated rash. There were no 30-day mortalities. Prolene mesh was used exclusively in all repairs performed with mesh. Seven of these repairs (25%) were for recurrent VIH. Three of these seven patients had previous mesh repairs. Six of these seven patients who presented with recurrent VIH had a mesh repair and four developed a recurrence. Five of seven were active smokers, with one having severe obstructive lung disease. Four of seven related significant occupational lifting. Of the 21 patients having initial repair of VIH, mesh was used in 8 (38%). After a median follow-up of 13 months, there were 2 recurrent hernias (25%). The remaining 13 patients had primary closure of their hernias. After median follow-up of 25 months, there were 5 recurrences (38%). A total of 34 VIH repairs were performed on these 28 patients, of which 13 were for recurrent hernias. Five of thirteen (38%) of the mesh repairs for recurrent VIH failed. The median body mass index (BMI) for the 13 patients having primary repair was 26.4, and that for all 21 cases having mesh repair was 28.8. Patients with recurrent VIH frequently recur despite use of mesh, avoidance of contamination, and consistent technique. No difference in BMI was apparent in those who recurred. Continued smoking and occupational lifting may be important risk factors for recurrent VIH.
Insights
Ventral incisional hernia (VIH) repair outcomes show high recurrence rates, especially for recurrent cases, even with mesh. Smoking and heavy lifting are identified as key risk factors for ventral incisional hernia recurrence.
Area of Science:
- Surgical outcomes research
- Hernia repair analysis
- Abdominal wall reconstruction
Background:
- Ventral incisional hernia (VIH) is a common surgical complication.
- Recurrence rates and risk factors for VIH require further investigation.
- Optimal surgical techniques for primary and recurrent VIH are debated.
Purpose of the Study:
- To evaluate the outcomes of ventral incisional hernia (VIH) repairs.
- To identify risk factors associated with recurrent ventral incisional hernias.
- To assess the efficacy of mesh versus primary closure in VIH repair.
Main Methods:
- Retrospective analysis of 31 patients undergoing ventral incisional hernia (VIH) repair between October 1993 and December 1996.
- Sutures used included O-Ethibond and Prolene; mesh (Prolene) was employed in select cases.
- Data collected on patient demographics, hernia type, repair method, complications, and recurrence rates.
Main Results:
- 28 patients were analyzed, with a median age of 57.5 years.
- Recurrence rates were 25% for initial mesh repairs and 38% for primary closures.
- For recurrent VIH repairs (n=13), 38% of mesh repairs failed; smoking and occupational lifting were identified as significant risk factors.
Conclusions:
- Ventral incisional hernia (VIH) recurrence is frequent, even with mesh and meticulous technique.
- Continued smoking and significant occupational lifting appear to be important risk factors for recurrent VIH.
- Further research into preventative strategies and management of recurrent ventral incisional hernias is warranted.
