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Long-term outcomes of ventral hernia repair: Effect of patient, hernia, and technical characteristics on recurrence
Aymen H. Sadaka
1,
2, William J. O’Brien
3, Kamal M.F. Itani
1,
2,
4
1VA Boston Dept. of Surgery, Boston, MA, 2Boston University School of Medicine, Boston, MA, 3VA Boston CHOIR, Boston, MA, 4Harvard Medical School, Boston, MA
Background: There is no consensus on the best ventral hernia repair (VHR). This study aims to determine which patient, hernia, and technical factors are associated with long-term recurrence.
Methods: Since 2011, the New England VA Hernia Registry (NEVAHR) prospectively collected operative details of VHRs from 5 VA medical centers. Records and imaging were reviewed from operation to March 2024 for recurrence, skin and soft tissue infections (SSTI), mesh infections, and surgical site occurrences (SSO – hematoma, seroma, wound dehiscence). Logistical regression of NEVAHR data, alongside patient characteristics from VASQIP, was used to determine the factors associated with recurrence.
Results: There were 681 VHRs, with a median follow-up of 7 years, consisting of 407 (49.8%) midline incisional, 182 (26.7%) epigastric, 38 (5.6%) lower quadrants, 26 (3.8%) subcostal, 16 (2.3%) parastomal, and 12 (1.8%) Spigelian hernias. Mesh was used in 589 (86.5%) repairs and was associated with larger average horizontal (5.8cm vs 2.5cm) and vertical (6.9cm vs 2.6cm) defect sizes (p<0.001). There were 117 (19.9%) recurrences among mesh repairs and 22 (23.9%) recurrences among suture repairs (p=0.033). Post-op complications, including 61 SSTIs and 111 SSOs, were associated with increased recurrences (p=0.008). Among mesh repairs, recurrence was associated with higher BMI (p=0.009), smoking history (p=0.012), biologic mesh (p=0.003), parastomal and subcostal hernias (p=0.003; p=0.042), post-op complications including 13 mesh infections (p=0.009), and laparoscopy (p=0.042). Among suture repairs, no factors were associated with recurrence.
Conclusion: Suture repair was associated with increased recurrence. Recurrence among mesh repairs was associated with BMI, smoking, hernia type, biologic mesh, post-op complications, and laparoscopy.
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