Hernia width explains differences in outcomes between primary and incisional hernias: a prospective cohort study of 9159
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ORIGINAL ARTICLE
Hernia width explains differences in outcomes between primary and incisional hernias: a prospective cohort study of 9159 patients L. Verstoep1 · G. H. J. de Smet1,6 · D. Sneiders1 · L. F. Kroese2 · G.‑J. Kleinrensink3 · J. F. Lange1,4 · J.‑F. Gillion5 · The Hernia-Club Members Received: 14 September 2020 / Accepted: 4 November 2020 © The Author(s) 2020
Abstract Purpose Data on primary (PH) and incisional hernias (IH) are often pooled, even though several studies have illustrated that these are different entities with worse outcomes for IHs. The aim of this study is to validate previous research comparing PHs and IHs and to examine whether hernia width is an important contributor to the differences between these hernia types. Methods A registry-based, prospective cohort study was performed, utilizing the French Hernia Club database. All patients undergoing PH or IH repair between September 8th 2011 and May 22nd 2019 were included. Baseline, hernia and surgical characteristics, and postoperative outcomes were collected. Outcomes were analyzed per width category (≤ 2 cm, 3–4 cm, 5–10 cm and > 10 cm). Results A total of 9159 patients were included, of whom 4965 (54%) had PH and 4194 (46%) had IH. PHs and IHs differed significantly in 12/15 baseline characteristics, 9/10 hernia and surgical characteristics, and all outcomes. Overall, complications and re-interventions were more common in patients with IH. After correcting for width, the differences between PH and IH were no longer significant, except for medical complications, which were more common after IH repair compared to PH. Conclusion After correcting for hernia width, most outcomes do not significantly differ between PH and IH, indicating that not hernia type, but hernia width is an important factor contributing to the differences between PH and IH. Keywords Incisional hernia · Primary ventral hernia · Hernia surgery · Postoperative outcomes
Members of the Hernia-Club are listed in the acknowledgments. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10029-020-02340-1) contains supplementary material, which is available to authorized users. * G. H. J. de Smet [email protected] 1
Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
2
Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
3
Department of Neuroscience, Erasmus University Medical Center, Rotterdam, The Netherlands
4
Department of Surgery, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands
5
Unité de Chirurgie Viscérale et Digestive, Hôpital Prive d’Antony, Antony, France
6
Department of Surgery, Erasmus University Medical Center, PO BOX 2040, Room Ee‑173, Dr. Molewaterplein, 3000 CA Rotterdam, The Netherlands
Introduction In 2009 the European Hernia Society (EHS) formulated separate classifications for primary (PH) and incisional abdominal wall hernias (IH), as these were considered to be two different entities [1]. However, in hern
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