H Hoffmann1,2,3, F Köckerling4, D Adolf5, F Mayer6, D Weyhe7, W Reinpold8, R Fortelny9, P Kirchhoff1,2,3. 1. ZweiChirurgen GmbH-Center for Hernia Surgery and Proctology, St. Johanns-Vorstadt 44, 4056, Basel, Switzerland. 2. Hirslanden Clinic Birshof, Hernia Center, Reinacherstrasse 28, 4142, Münchenstein, Switzerland. 3. University Basel, Spitalstrasse 21, 4031, Basel, Switzerland. 4. Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany. ferdinand.koeckerling@vivantes.de. 5. StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany. 6. Department of Surgery, Paracelsus Medical University Salzburg, University Hospital of Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria. 7. Department of General and Visceral Surgery Pius Hospital, University Hospital of Visceral Surgery, Georgstraße 12, 26121, Oldenburg, Germany. 8. Department of Surgery, Wilhelmsburger Hospital Groß Sand, Academic Teaching Hospital of University Hamburg, Groß Sand 3, 21107, Hamburg, Germany. 9. Department of General Surgery, Medical Faculty, Wilhelminen Hospital, Sigmund Freud University Vienna, Freudplatz 3, 1020, Vienna, Austria.
Abstract
INTRODUCTION: The proportion of recurrences in the total collective of all incisional hernias has been reported to be around 25%. In the European Hernia Society (EHS) classification, recurrent incisional hernias are assigned to a unique prognostic group and considered as complex abdominal wall hernias. Surgical repairs are characterized by dense adhesions, flawed anatomical planes caused by previous dissection or mesh use, and device-related complications. To date, only relatively small case series have been published focusing on outcomes following recurrent incisional hernia repair. This cohort study now analyzes the outcome of recurrent incisional hernia repair assessing potential risk factors based on data from the Herniamed registry. Special attention is paid to the technique used during the primary incisional hernia repair, since laparoscopic IPOM was recently deemed to cause more complications during subsequent repairs. METHODS: In the multicenter Internet-based Herniamed registry, patients with recurrent incisional hernia repair between September 2009 and January 2018 were enrolled. In a confirmatory multivariable analysis, factors potentially associated with the outcome parameters (intraoperative, postoperative and general complications, complication-related reoperations, re-recurrences, pain at rest and on exertion, and chronic pain requiring treatment at one-year follow-up) were evaluated. RESULTS: In total, 4015 patients from 712 participating hospitals were included. Postoperative complications and complication-related reoperations were significantly associated with larger recurrent hernia defect size, open recurrent incisional hernia repair and the use of larger meshes. General complications were more frequent in female sex patients and when larger meshes were used. Higher re-recurrence rate was observed with lateral defect localization, present risk factors, and time interval ≤ 1 year between primary and recurrent incisional hernia repair. Pain rates at 1-year follow-up were unfavorably related with pre-existing preoperative pain, female sex, lateral defect localization, larger mesh, presence of risk factors, and postoperative complications. As regards the primary incisional hernia repair technique, laparoscopic IPOM was found to show no effect versus open mesh techniques on the subsequent recurrence repair, despite a trend toward higher rates of complication-related reoperations. CONCLUSION: The outcomes of recurrent incisional hernia repair were significantly associated with potential influencing factors, which are very similar to the factors seen in primary incisional hernia repair. The impact of the primary incisional hernia repair technique, namely laparoscopic IPOM versus open mesh techniques, on the outcome of recurrent incisional hernia repair seems less pronounced than anticipated.
INTRODUCTION: The proportion of recurrences in the total collective of all incisional hernias has been reported to be around 25%. In the European Hernia Society (EHS) classification, recurrent incisional hernias are assigned to a unique prognostic group and considered as complex abdominal wall hernias. Surgical repairs are characterized by dense adhesions, flawed anatomical planes caused by previous dissection or mesh use, and device-related complications. To date, only relatively small case series have been published focusing on outcomes following recurrent incisional hernia repair. This cohort study now analyzes the outcome of recurrent incisional hernia repair assessing potential risk factors based on data from the Herniamed registry. Special attention is paid to the technique used during the primary incisional hernia repair, since laparoscopic IPOM was recently deemed to cause more complications during subsequent repairs. METHODS: In the multicenter Internet-based Herniamed registry, patients with recurrent incisional hernia repair between September 2009 and January 2018 were enrolled. In a confirmatory multivariable analysis, factors potentially associated with the outcome parameters (intraoperative, postoperative and general complications, complication-related reoperations, re-recurrences, pain at rest and on exertion, and chronic pain requiring treatment at one-year follow-up) were evaluated. RESULTS: In total, 4015 patients from 712 participating hospitals were included. Postoperative complications and complication-related reoperations were significantly associated with larger recurrent hernia defect size, open recurrent incisional hernia repair and the use of larger meshes. General complications were more frequent in female sex patients and when larger meshes were used. Higher re-recurrence rate was observed with lateral defect localization, present risk factors, and time interval ≤ 1 year between primary and recurrent incisional hernia repair. Pain rates at 1-year follow-up were unfavorably related with pre-existing preoperative pain, female sex, lateral defect localization, larger mesh, presence of risk factors, and postoperative complications. As regards the primary incisional hernia repair technique, laparoscopic IPOM was found to show no effect versus open mesh techniques on the subsequent recurrence repair, despite a trend toward higher rates of complication-related reoperations. CONCLUSION: The outcomes of recurrent incisional hernia repair were significantly associated with potential influencing factors, which are very similar to the factors seen in primary incisional hernia repair. The impact of the primary incisional hernia repair technique, namely laparoscopic IPOM versus open mesh techniques, on the outcome of recurrent incisional hernia repair seems less pronounced than anticipated.
Authors: R Bittner; K Bain; V K Bansal; F Berrevoet; J Bingener-Casey; D Chen; J Chen; P Chowbey; U A Dietz; A de Beaux; G Ferzli; R Fortelny; H Hoffmann; M Iskander; Z Ji; L N Jorgensen; R Khullar; P Kirchhoff; F Köckerling; J Kukleta; K LeBlanc; J Li; D Lomanto; F Mayer; V Meytes; M Misra; S Morales-Conde; H Niebuhr; D Radvinsky; B Ramshaw; D Ranev; W Reinpold; A Sharma; R Schrittwieser; B Stechemesser; B Sutedja; J Tang; J Warren; D Weyhe; A Wiegering; G Woeste; Q Yao Journal: Surg Endosc Date: 2019-06-27 Impact factor: 4.584
Authors: Mike K Liang; Julie L Holihan; Kamal Itani; Zeinab M Alawadi; Juan R Flores Gonzalez; Erik P Askenasy; Conrad Ballecer; Hui Sen Chong; Matthew I Goldblatt; Jacob A Greenberg; John A Harvin; Jerrod N Keith; Robert G Martindale; Sean Orenstein; Bryan Richmond; John Scott Roth; Paul Szotek; Shirin Towfigh; Shawn Tsuda; Khashayar Vaziri; David H Berger Journal: Ann Surg Date: 2017-01 Impact factor: 12.969
Authors: Jacobus W A Burger; Roland W Luijendijk; Wim C J Hop; Jens A Halm; Emiel G G Verdaasdonk; Johannes Jeekel Journal: Ann Surg Date: 2004-10 Impact factor: 12.969
Authors: Ferdinand Köckerling; Andreas Koch; Ralph Lorenz; Christine Schug-Pass; Bernd Stechemesser; Wolfgang Reinpold Journal: Front Surg Date: 2015-06-16
Authors: R Bittner; J Bingener-Casey; U Dietz; M Fabian; G S Ferzli; R H Fortelny; F Köckerling; J Kukleta; K Leblanc; D Lomanto; M C Misra; V K Bansal; S Morales-Conde; B Ramshaw; W Reinpold; S Rim; M Rohr; R Schrittwieser; Th Simon; M Smietanski; B Stechemesser; M Timoney; P Chowbey Journal: Surg Endosc Date: 2013-10-11 Impact factor: 4.584
Authors: R Bittner; J Bingener-Casey; U Dietz; M Fabian; G S Ferzli; R H Fortelny; F Köckerling; J Kukleta; K LeBlanc; D Lomanto; M C Misra; S Morales-Conde; B Ramshaw; W Reinpold; S Rim; M Rohr; R Schrittwieser; Th Simon; M Smietanski; B Stechemesser; M Timoney; P Chowbey Journal: Surg Endosc Date: 2014-02 Impact factor: 4.584
Authors: R Bittner; K Bain; V K Bansal; F Berrevoet; J Bingener-Casey; D Chen; J Chen; P Chowbey; U A Dietz; A de Beaux; G Ferzli; R Fortelny; H Hoffmann; M Iskander; Z Ji; L N Jorgensen; R Khullar; P Kirchhoff; F Köckerling; J Kukleta; K LeBlanc; J Li; D Lomanto; F Mayer; V Meytes; M Misra; S Morales-Conde; H Niebuhr; D Radvinsky; B Ramshaw; D Ranev; W Reinpold; A Sharma; R Schrittwieser; B Stechemesser; B Sutedja; J Tang; J Warren; D Weyhe; A Wiegering; G Woeste; Q Yao Journal: Surg Endosc Date: 2019-07-10 Impact factor: 4.584
Authors: R Bittner; J Bingener-Casey; U Dietz; M Fabian; G Ferzli; R Fortelny; F Köckerling; J Kukleta; K LeBlanc; D Lomanto; M Misra; S Morales-Conde; B Ramshaw; W Reinpold; S Rim; M Rohr; R Schrittwieser; Th Simon; M Smietanski; B Stechemesser; M Timoney; P Chowbey Journal: Surg Endosc Date: 2013-09-17 Impact factor: 4.584