Identifying predictors of ventral hernia recurrence: systematic review and meta-analysis

Area of Science:

• General Surgery
• Surgical Outcomes Research

Background:

• Ventral hernias have a high recurrence rate after surgical repair.
• Existing literature on recurrence predictors is often underpowered and lacks consensus.
• High-quality evidence is needed to guide surgeons on perioperative factors influencing ventral hernia recurrence.

Purpose of the Study:

• To systematically review and identify prognostic variables associated with ventral hernia recurrence.
• To synthesize current evidence to inform surgical practice and future research directions.

Main Methods:

• A systematic literature search of PubMed was conducted for studies published between January 1995 and January 2018.
• Data on hernia characteristics, recurrence definitions, detection methods, follow-up duration, and comorbidities were extracted.
• Random-effects meta-analysis was employed, with bias assessed using a modified PROBAST tool.

Main Results:

• 274 studies were included, with significant heterogeneity in recurrence definitions.
• Key predictors identified include patient factors (female sex, younger age, higher BMI), comorbidities (smoking, diabetes, COPD, high ASA grade, steroid use), hernia type (incisional), and surgical factors (biological mesh, bridged repair, open surgery, suture repair, specific mesh placements).
• Numerous intraoperative and postoperative variables, including complications like wound infection and seroma, were also significant prognostic factors.

Conclusions:

• This systematic review consolidates evidence on predictors of ventral hernia recurrence.
• The findings provide a basis for improving surgical decision-making and patient counseling.
• Further research should focus on standardizing definitions and validating predictive models for ventral hernia recurrence.