Recurrent incisional hernia repair: surgical outcomes in correlation with body-mass index
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ORIGINAL ARTICLE
Recurrent incisional hernia repair: surgical outcomes in correlation with body‑mass index L. van Silfhout1 · L. A. M. Leenders1 · J. Heisterkamp1 · M. S. Ibelings1 on behalf of the Ventral Hernia Group Tilburg Received: 20 July 2020 / Accepted: 7 October 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Background Hernia recurrence rates after incisional hernia repair vary between 8.7 and 32%, depending on multiple factors such as patient characteristics, the use of meshes, surgical technique and the degree of experience of the treating surgeon. Recurrent hernias are considered complex wall hernias, and 20% of all incisional hernia repairs involve a recurrent hernia. The aim of this study was to investigate the outcomes after recurrent incisional hernia repair, in association with surgical technique and body-mass index (BMI). Methods All patients who had incisional hernia repair between 2013 and 2018 were included. Primary outcome was rate of recurrent incisional hernia after initial hernia repair. Secondary outcomes were complication rate and recurrence rate in association with BMI. Results A number of 269 patients were included, of which 75 patients (27.9%) with a recurrent incisional hernia. Recurrent hernia repair was performed in 49 patients, 83.7% underwent open repair. Complication rate for recurrent hernia repair was higher than for the initial incisional hernia repair. Of the 49 patients with recurrent hernia repair, patients with a BMI above 30 had higher complication and recurrence rates compared to patients with BMI below 30. Especially infectious complications were more common in patients with a higher BMI: 23.1% vs. 0% wound infections. Conclusion The results from this study show that complication and recurrence rates are increased after recurrent incisional hernia repair, which are further increased by obesity. Only a limited amount of literature is available on this topic, further larger multicenter studies are necessary, until then a patient-specific surgical approach based on the surgeon’s expertise is recommended. Keywords Incisional hernia · Surgical repair · Recurrent (incisional) hernia · Body-mass index · Open repair · Laparoscopic repair · Complications
Introduction Incisional hernia is a common complication after abdominal surgery, and the literature suggests that 4–10% of all patients undergoing abdominal surgery develop an incisional hernia [1, 2]. Incisional hernia repair can be done open or laparoscopically, and use of meshes is widely recommended to reduce the risk of hernia recurrence [1–3]. Despite the use of meshes, recurrence rates of 25% and 32% have been observed after 5 and 10 years. It has been shown that the recurrence rate may depend on the surgical technique used
* L. van Silfhout [email protected] 1
Department of Surgery, ETZ, Tilburg, The Netherlands
for the initial incisional hernia repair [4, 5]. The literature shows a larger variety in reported recurrence rates after laparoscopic hernia repair compared to
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