Recurrent Ventral Hernia Repair: Are Outcomes Really Inferior To Primary Repair?
*Jenny M Shao, *Eva B Deerenberg, *Sharbel A Elhage, Bradley R Davis, *Kent W Kercher, *Paul D Colavita, *Vedra A Augenstein, *B Todd Heniford
Carolinas Medical Center, Charlotte, NC
Introduction: Recurrent hernia repairs are reported to have higher recurrence and complication rates than primary hernia repairs. This is the largest analysis of outcomes for recurrent vs primary open ventral hernia repairs (OVHR) reported in the literature.
Methods: A prospective, institutional database at a tertiary hernia center was queried for patients undergoing recurrent and primary OVHR with complete fascial closure and synthetic mesh placement between 2008-2019.
Results: A total of 1,717 OVHR patients were identified, including 753(43.9%) recurrent vs 964(56.1%) primary repairs. Patients had a mean age of 58.1±12.1vs56.4±13.5, p=0.005 years, BMI of 33.1±6.8vs32.8±8.3, p=0.18 kg/m2, and hernia defect size of 213.1±192.2vs138.2±174.1cm2, p<0.0001 for recurrent vs primary, respectively. Recurrent hernia patients had increasing number of comorbidities (6.1±36.5vs3.5±2.4,p<0.0001), higher percentage of diabetes (26.2%vs20.1%,p=0.003), and similar smoking history (20.3%vs20.2%,p=0.97).
Mesh was placed preperitoneally more in recurrent hernias (91.7%vs89.1%,p=0.2). As expected, recurrent hernias were more complex, demonstrated by longer mean operative time (187.3±66.7vs166.2±83.3 minutes, p<0.0001), higher estimated blood loss (117.6±105.6vs115.4±126.3 mL, p=0.003), need for preoperative Botox (12.8%vs7.3%,p<0.06), and components separation (53.1%vs26.9%,p<0.0001). Recurrent hernias had larger meshes placed (932.4±436.6vs696.3±446.8 cm2, p<0.0001), and 39.6% of recurrent cases required excision of prior mesh. Mean mesh-to-defect ratio (M:DR) was 9.7±20.2vs14.3±32.8,p=0.0002 for recurrent vs primary.
Overall hernia recurrence rate was 4.4% for both groups (mean follow-up 26.5±37.3 months), with no significant difference between recurrent or primary repair (4.3%vs4.5%,p=0.86). Recurrent vs primary cohorts had comparable post-operative surgical site outcomes with no significant differences in: post-operative wound complication (24.8%vs23.9%,p=0.66), post-operative cellulitis (9.0%vs10.0%,p=0.49), seroma (17.8%vs17.0%,p=0.70), hematoma (3.0%vs2.6%,p=0.57), mesh infection (1.8%vs1.8%,p=0.97), or mesh infection requiring excision (0.3%vs0.2%,p=0.80), rates of small bowel obstruction (2.3%vs1.9%,p=0.54), reoperations (8.5%vs6.7%,p=0.17), 30-day readmissions (7.5%vs6.6%,p=0.52), and long-term readmission (13.9%vs13.2%,p=0.65). Recurrent hernia repairs had longer mean length of stay (LOS)(6.2±3.5vs5.5±5.7,p<0.0001).
Conclusion: Despite higher-risk patients, larger hernia defects, and increased need for components separation in the recurrent OVHR group, recurrence rates and wound complications are comparable to primary OVHR at an experienced tertiary care hernia center. The increased size of mesh and equivalent percentage of complications may be responsible for equalization of recurrence rates.
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