Joost Verhelst1, Lucas Timmermans2, Maurits van de Velde2, An Jairam2, Konstantinos A Vakalopoulos2, Johannes Jeekel3, Johan F Lange2. 1. Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands. Electronic address: j.verhelst@erasmusmc.nl. 2. Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands. 3. Department of Neuroscience, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
Abstract
BACKGROUND: Incisional hernia (IH) is among the most common postoperative complications after abdominal surgery. Operative treatment (OT) using mesh is the treatment of choice. A strategy of watchful waiting (WW) might be a considered in some patients. This retrospective study compares the outcomes of WW and OT. METHODS: All patients presenting with IH in an academic surgery department between January 2004 and December 2009 were analyzed according to whether they were treated by WW or OT. Crossovers between both groups were also analyzed. Patient characteristics, information about the initial abdominal operative procedure, symptoms at presentation, and characteristics of the hernia were collected retrospectively. In case of OT, postoperative complications were analyzed. RESULT: In total, 255 patients were included; 151 (59%) in the OT group and 104 (41%) in WW group. The median follow-up was 68 months (interquartile range [IQR], 52-93). The reasons for WW were the absence of symptoms in 34 patients (33%), comorbidities in 24 (23%), and obesity in 23 (22%). During follow-up, 34 patients (33%) crossed over from WW to OT. Eight of the crossovers (24%) were emergency repairs owing to incarceration at a median of 1 month (IQR, 1-5) after the start of WW. The incidence of unexpected intraoperative intestinal perforation was greater in the crossover group (13%) compared with the OT group (2%; P = .002). Postoperative fistulas were seen in 7% of patients who crossed over from WW to OT versus 0% in primary OT (P = .002). Postoperatively, 3 patients died, 2 of whom were treated operatively after belonging initially to the WW group. CONCLUSION: WW for IH leads to high crossover rates with significantly greater incidence of intraoperative perforations, fistulas, and mortality, than in the OT group, particularly in patients who require emergency repair of IH owing to incarceration.
BACKGROUND: Incisional hernia (IH) is among the most common postoperative complications after abdominal surgery. Operative treatment (OT) using mesh is the treatment of choice. A strategy of watchful waiting (WW) might be a considered in some patients. This retrospective study compares the outcomes of WW and OT. METHODS: All patients presenting with IH in an academic surgery department between January 2004 and December 2009 were analyzed according to whether they were treated by WW or OT. Crossovers between both groups were also analyzed. Patient characteristics, information about the initial abdominal operative procedure, symptoms at presentation, and characteristics of the hernia were collected retrospectively. In case of OT, postoperative complications were analyzed. RESULT: In total, 255 patients were included; 151 (59%) in the OT group and 104 (41%) in WW group. The median follow-up was 68 months (interquartile range [IQR], 52-93). The reasons for WW were the absence of symptoms in 34 patients (33%), comorbidities in 24 (23%), and obesity in 23 (22%). During follow-up, 34 patients (33%) crossed over from WW to OT. Eight of the crossovers (24%) were emergency repairs owing to incarceration at a median of 1 month (IQR, 1-5) after the start of WW. The incidence of unexpected intraoperative intestinal perforation was greater in the crossover group (13%) compared with the OT group (2%; P = .002). Postoperative fistulas were seen in 7% of patients who crossed over from WW to OT versus 0% in primary OT (P = .002). Postoperatively, 3 patients died, 2 of whom were treated operatively after belonging initially to the WW group. CONCLUSION: WW for IH leads to high crossover rates with significantly greater incidence of intraoperative perforations, fistulas, and mortality, than in the OT group, particularly in patients who require emergency repair of IH owing to incarceration.
Authors: Esmaeel R Dadashzadeh; Lauren V Huckaby; Robert Handzel; M Shanaz Hossain; Gloria D Sanin; Vincent P Anto; Patrick Bou-Samra; J B Moses; Stephen Cai; Heather M Phelos; Richard L Simmons; Matthew R Rosengart; Dirk J van der Windt Journal: Ann Surg Date: 2022-02-01 Impact factor: 12.969
Authors: J Nigh; D J Wade; G T Rives; S A Karim; A Bhavaraju; M K Kimbrough; R J Reif; K W Sexton; H K Jensen Journal: Hernia Date: 2022-06-28 Impact factor: 4.739
Authors: Lauren V Huckaby; Esmaeel Reza Dadashzadeh; Robert Handzel; Alexa Kacin; Matthew R Rosengart; Dirk J van der Windt Journal: J Am Coll Surg Date: 2020-08-19 Impact factor: 6.532
Authors: F Köckerling; H Hoffmann; D Adolf; W Reinpold; P Kirchhoff; F Mayer; D Weyhe; B Lammers; K Emmanuel Journal: Hernia Date: 2020-04-10 Impact factor: 4.739
Authors: Lia D Delaney; Ryan Howard; Krisinda Palazzolo; Anne P Ehlers; Shawna Smith; Michael Englesbe; Justin B Dimick; Dana A Telem Journal: JAMA Netw Open Date: 2021-11-01