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Analysis of 4,015 recurrent incisional hernia repairs from the Herniamed registry: risk factors and outcomes

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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.

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Author notes

  1. H. Hoffmann and F. Köckerling contributed equally to this publication.

Authors and Affiliations

  1. ZweiChirurgen GmbH-Center for Hernia Surgery and Proctology, St. Johanns-Vorstadt 44, 4056, Basel, Switzerland

    H. Hoffmann & P. Kirchhoff

  2. Hirslanden Clinic Birshof, Hernia Center, Reinacherstrasse 28, 4142, Münchenstein, Switzerland

    H. Hoffmann & P. Kirchhoff

  3. University Basel, Spitalstrasse 21, 4031, Basel, Switzerland

    H. Hoffmann & P. Kirchhoff

  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

    F. Köckerling

  5. StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany

    D. Adolf

  6. Department of Surgery, Paracelsus Medical University Salzburg, University Hospital of Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria

    F. Mayer

  7. Department of General and Visceral Surgery Pius Hospital, University Hospital of Visceral Surgery, Georgstraße 12, 26121, Oldenburg, Germany

    D. Weyhe

  8. Department of Surgery, Wilhelmsburger Hospital Groß Sand, Academic Teaching Hospital of University Hamburg, Groß Sand 3, 21107, Hamburg, Germany

    W. Reinpold

  9. Department of General Surgery, Medical Faculty, Wilhelminen Hospital, Sigmund Freud University Vienna, Freudplatz 3, 1020, Vienna, Austria

    R. Fortelny

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  1. H. Hoffmann
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Corresponding author

Correspondence to F. Köckerling.

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Conflict of interest

Dr. Köckerling reports grants from Johnson & Johnson, Norderstedt, grants from Karl Storz, Tuttlingen, grants from pfm medical, Cologne, grants from Dahlhausen, Cologne, grants from B Braun, Tuttlingen, grants from MenkeMed, Munich, grants from Bard, Karlsruhe, during the conduct of the study; personal fees from Bard, Karlsruhe, outside the submitted work. All other authors have nothing to disclose.

Ethical approval

As only cases of routine hernia surgery are documented in the Herniamed Registry, an ethical approval was not neccessary.

Human and animal rights

This article does not contain any study with animals performed by any of the authors.

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All patients with routine hernia surgery documented in the Herniamed Registry have signed an informed consent declaration agreeing to participate.

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Hoffmann, H., Köckerling, F., Adolf, D. et al. Analysis of 4,015 recurrent incisional hernia repairs from the Herniamed registry: risk factors and outcomes. Hernia 25, 61–75 (2021). https://doi.org/10.1007/s10029-020-02263-x

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