Comparison of hernia registries: the CORE project

Initial report of "HERNIACLINIC-QoL": The first abdominal wall hernia surgery registry from a single center in Brazil

PURPOSE

Currently, Brazil does not have a registry of abdominal wall hernia surgeries. In this paper we describe the creation of HERNIACLINIC-QoL, that aims to fill this gap, and its preliminary results.

METHODS

A RedCap form was developed to collect data on patients and surgeries for abdominal hernia repair in a private practice hospital. Data input errors were checked every 30 days, and a preliminary analysis of the database as a whole was carried out in 2024.

RESULTS

We registered 554 patients (201 ventral, 227 inguinal and 103 for both hernias). The form needed corrections in the fields: preoperative data, hernia sizes and classifications, rectum diastasis and anesthesia type, ensuring completeness of data and simplifying the creation of statistical reports.

CONCLUSION

HERNIACLINIC-QoL may become a valuable tool for hernia care and research, as its use is expanded to include more surgeons and more patients.

CLINICAL TRIALS

Protocol Register at Brazilian Registry of Clinical Trials (ReBEC), ID: RBR-5vmhdfs https://ensaiosclinicos.gov.br/rg/RBR-5vmhdfs.

Emergency umbilical and epigastric hernia repair: nationwide registry-based study of long-term recurrence, mesh-related, and other complications

BACKGROUND

Emergency umbilical and epigastric hernia repairs (EUEHR) are common but understudied procedures. The role of different mesh positions in emergency settings is a topic of significant interest.

METHODS

A retrospective nationwide Danish cohort study of patients who underwent EUEHR from 2015 to 2020. A complete follow-up was obtained on December 31, 2023, through linkage of nationwide registries and full scrutiny of medical files for those patients who underwent a reoperation. The primary outcome was operation for recurrence. Secondary outcomes were non-recurrence reoperations, early (< 90 days) reoperations, and operations for severe complications. Multivariable analyses were performed using Fine-and-Gray competing risk models.

RESULTS

639 patients were registered in the database, and 70.6% underwent mesh repair (open onlay: 44.1%, open sublay: 15.3%, or laparoscopic intraperitoneal (lap-IPOM): 11.1%. The median follow-up time was 4.3 years. The 5-year risk of operations for recurrence was lower after mesh use compared to suture (n = 6 (1.7%) vs. n = 8 (4.7%); p = 0.023), with a hazard ratio (HR) 0.32 (95% CI (0.11-0,92); p = 0.034). The 5-year risk of operation for other complications was similar between the suture and mesh group (n = 28 (6.2%) vs. n = 9 (4.8%); p = 0.40, HR 1.12 (0.51-2.48; p = 0.77)). Surgical site infection occurred in 1.1%, 4.3%, 2.0%, and 2.8% of suture, onlay, sublay, and Lap-IPOM repairs, respectively. Few complications were directly mesh related: onlay n = 3 (1.1%), sublay n = 2 (2.0%), and Lap-IPOM n = 1 (1.4%). Early (< 90 days) operation for other complications was more frequent after onlay than suture repair (Odds-ratio 2.95 (0.094-12.2): p = 0.066). In sub-group analysis, lap-IPOM showed a trend towards more severe complications than suture repair (HR 7.85 (0.82-75.5); p = 0.074).

CONCLUSION

Mesh repair significantly reduced operation for recurrence after EUEHR compared to suture repair with a similar risk of operation for other complications. Onlay may cause more early reoperations compared to suture repair and lap-IPOM may be associated with more severe complications.

Effect of mesh fixation in incisional hernia repair using the open sublay technique: results from the herniamed-registry

PURPOSE

Incisional hernias reflect a common complication after abdominal surgery. Main treatment consists of defect closure and mesh insertion using the sublay method. The aim of the present study was to assess the association of mesh fixation to patients' outcome.

METHODS

Using the Herniamed registry, data from 13'452 incisional hernia repairs were analyzed retrospectively. Three groups of patients were compared: those with mesh fixation (n = 9'986), those with self-fixing meshes (n = 2'725), and those without mesh fixation (n = 741). Postoperative complications, recurrence and postoperative pain scores were assessed over a follow-up period of one year postoperatively.

RESULTS

Taking into account that patients without mesh fixation had smaller defects and were treated with smaller meshes indicating non-equivalent groups, postoperative complications (general, intra- and postoperative complications, as well as complication-related reoperations), were similar among groups except that self-fixing meshes showed a lower general complication rate compared to fixed meshes (OR = 0.733 [0.579; 0.929]; p = 0.010). Mesh fixation had no relation to recurrence rate. Self-fixating meshes were associated with increased pain at rest rate (OR = 1.325 [1.156; 1.518]; p < 0.001), pain on exertion rate (OR = 1.255 [1.125; 1.400], p < 0.001) and chronic pain requiring treatment (OR = 1.271 [1.086; 1.488], p = 0.003) compared to fixed meshes. Self-fixating (OR = 1.675 [1.322; 2.120], p < 0.001) and fixed meshes (OR = 1.334 [1.069; 1.666], p = 0.011) were associated to increased pain on exertion rate compared to non-fixed meshes.

CONCLUSION

It appears that mesh fixation can be omitted during sublay incisional hernia repair.

Protocol for the AFTERHERNIA Project: patient-reported outcomes of groin and ventral hernia repair

PURPOSE

The AFTERHERNIA Project aims to shift the focus of hernia surgery towards patient-reported outcomes by examining the impact of surgical methods and long-term complications on a national level. Groin and ventral hernia repairs are common surgical procedures with significant impact on patient quality of life and healthcare costs. Most large-scale studies focus on clinical outcomes like reoperation and readmission rates, rather than patient-reported outcomes.

METHODS

This nationwide survey involves Danish patients who have undergone groin or ventral hernia repair over a ten-year period. Patients will be identified in the Danish National Patient Registry, and they will receive either the Abdominal Hernia-Q or Groin Hernia-Q questionnaire to collect data on patient-reported outcomes. Data from the questionnaire will be linked with clinical and patient-related data from the Danish Hernia Database. The Danish National Patient Registry also contains information on long-term surgical complications. Thereby, it will be possible to link specific perioperative details with patient-reported outcomes and long-term surgical complications.

CONCLUSION

The AFTERHERNIA Project aims to redefine the understanding of hernia surgery outcomes by emphasizing patient-reported outcomes on a nationwide basis. By capturing a broad spectrum of patient experiences and outcomes, the project expects to inform and possibly transform clinical guidelines and patient care practices.

Improved outcomes after groin hernia surgery in Sweden between 1992 and 2021: Swedish Hernia Register

PURPOSE

Surgery for groin hernia is one of the most common operations in the world. Therefore, research concerning the outcomes of groin hernia surgery is extremely important both for the individual patient as well as for those providing the healthcare funding. The aim of this study is to evaluate the outcomes of hernia surgery in Sweden over a 30 year time period, from 1992 to 2021.

METHODS

All groin hernia repairs in the Swedish Hernia Register between 1992 to 2021 were analyzed with emphasis on the surgical method, reoperation rate for recurrence and date of surgery, specifically 1992-2001, 2002-2011 and 2012-2021. By using personal identification numbers, a cumulative reoperation rate has been deduced for males and females separately.

RESULTS

A total of 368,502 groin hernia operations identified in the Swedish Hernia Register between 1992 to 2021 were eligible for analysis. Since the register was begun, there have been significant changes in the choice of operative techniques, from suture repair in 1992 to open anterior mesh repair around the year 2000, until today, where an increasing proportion of hernias are repaired using laparo-endoscopic techniques. There has been a reduction in the reoperation rate for recurrence in both males and females, with the most pronounced improvement being seen in females. The laparo-endoscopic technique is associated with a reduced incidence of reoperation for recurrence in females.

CONCLUSION

Groin hernia surgery in Sweden has undergone substantial changes over the past 30 years. Reoperation for recurrence has decreased significantly during recent years, especially in females.

Is mesh pore size associated with the outcome in laparo-endoscopic inguinal hernia repair? - a registry-based multivariable analysis

INTRODUCTION

In inguinal hernia repair, mesh weight and pore size are used to describe the mesh characteristics. One meta-analysis of laparo-endoscopic inguinal hernia repairs identified 12 prospective randomized controlled trials (RCTs) with 2,909 patients who had all been treated with lightweight (≤ 50 g/m²) or heavyweight (> 70 g/m²) meshes. None of the 12 RCTs gave details of the pore size. There were more recurrences when using lightweight meshes, in particular in the case of medial defects without mesh fixation and/or large defects. In terms of pain, no significant differences were seen. This retrospective analysis of data from the Herniamed Registry now aims to analyze whether mesh pore size is related to the outcome in laparo-endoscopic inguinal repair.

MATERIALS AND METHODS

To analyze the association between mesh pore size and the outcome in laparo-endoscopic inguinal repair, it was necessary to select meshes with comparable properties. Polyester meshes and PTFE meshes had to be excluded and polypropylene and polyvinylidene fluoride meshes (PVDF) were included. 83,768 included patients were retrospectively analyzed. The meshes analyzed were eight small-pore and 13 large-pore meshes. Using a binary logistic regression model, it is possible to simultaneously analyze several factors being potentially associated with the outcome.

RESULTS

Higher BMI, lower weight meshes, higher ASA score and medial EHS classification were associated with a higher risk of recurrence. It was not possible to find any significant association between pore size and recurrences at one-year follow-up. This also applied for pain on exertion and pain requiring treatment.

CONCLUSION

No association was identified between the pore size of the meshes used in laparo-endoscopic inguinal repair and the recurrence rate, pain on exertion rate or the rate of chronic pain requiring treatment at one-year follow-up.

Laparoscopic totally extraperitoneal hernia repair in patients with a history of previous abdominopelvic surgery

A retrospective cohort study of patients undergoing laparoscopic inguinal hernia repair compared short- and long-term outcomes between individuals with or without history of previous abdominopelvic surgery, aiming to determine the feasibility of totally extraperitoneal (TEP) repair within this population. All patients who underwent elective TEP inguinal hernia repair by one consultant surgeon across three London hospitals from January 2017 to May 2023 were retrospectively analysed to assess perioperative outcomes. Two hundred sixty-two patients were identified, of whom two hundred forty-three (93%) underwent laparoscopic TEP repair. The most frequent complications were haematoma (6.2%) and seroma (4.1%). Recurrence occurred in four cases (1.6% of operations, 1.1% of hernias). One hundred eighty-four patients (76%) underwent day-case surgery. There were no mesh infections or explanations, vascular or visceral injuries, port-site hernias, damage to testicle, or persisting numbness. There were no requirements for blood transfusion, returns to theatre, or readmissions within 30 days. There was one conversion to open and one death within 60 days of surgery. Eighty-three (34%) had a history of previous AP surgery. There was no significant difference in perioperative outcomes between the AP and non-AP arms. This finding carried true for subgroup analysis of 44 patients whose AP surgical history did not include previous inguinal hernia repair and for those undergoing repair of recurrent hernia. In expert hands, laparoscopic TEP repair is associated with excellent outcomes and low rates of long-term complications, and thus should be considered as standard for patients regardless of a history of AP surgery.

Is surgeon annual case volume related with intra and postoperative complications after ventral hernia repair? Uni- and multivariate analysis of prospective registry-based data

BACKGROUND

Literature on a potential relationship between surgeon case volume and intra- or postoperative complications after ventral hernia repair remains scarce.

METHODS

Patients who underwent ventral hernia repair between 2011 and 2023 were selected from the prospectively maintained French Hernia-Club Registry. Outcome variables were: intraoperative events, postoperative general complications, surgical site occurrences, surgical site infections, length of intensive care unit (ICU), and patient-reported scar bulging during follow-up. Surgeons' annual case volume was categorized as 1-5, 6-50, 51-100, 101-125, and > 125 cases, and its association with outcome volume was evaluated using uni- and multivariable analyses.

RESULTS

Over the study period, 199 titular or temporary members registered 15,332 ventral hernia repairs, including 7869 primary, 6173 incisional, and 212 parastomal hernia repairs. In univariate analysis, surgeons' annual case volume was significantly related with all the postoperative studied outcomes. After multivariate regression analysis, annual case volume remained significantly associated with intra-operative complications, postoperative general complications and length of ICU stay. A primary repair was independently associated with fewer intra- and post-operative complications.

CONCLUSION

In the present multivariable analysis of a large registry on ventral hernia repairs, higher surgeon annual case volume was significantly related with fewer postoperative general complications and a shorter length of stay, but not with fewer surgical site occurrences, nor with less patient-reported scar bulging. Factors in the surgeons' case mix such as the type of hernia have significant impact on complication rates.

State of the Art: Advances in Hernia Care

The field of hernia surgery has seen many recent advances and continues to evolve. Care of the hernia patient begins preoperatively by ensuring adequate preparation for surgery with surgeons now having the opportunity to accurately predict risk which can aid with informed consent. Imaging studies can now help surgeons diagnose and plan hernia surgery on an individual level based on hernia characteristics as well as abdominal wall musculature. In the operating room, new technology and surgical techniques have allowed surgeons to become increasingly sophisticated with goals of reducing tension on midline closures, utilizing minimally invasive and robotic techniques, and availability of new and varied mesh prosthetics. While modest improvements in outcomes have been witnessed by these advances, there is still opportunity for improvement which will be realized by continued research, use of registries, and education and training. Hernia prevention strategies focusing on minimally invasive surgery, laparotomy closure, and the use of prophylactic mesh will also help with the burden of incisional hernias. These advances in hernia surgery have led to the new field of Abdominal Core Health which helps represent this evolving and growing new subspecialty of general surgery.

Lessons learnt from the construction and implementation of a prospective ventral hernia database

PURPOSE

The New England VA Hernia Registry was created in 2011 to prospectively collect relevant details of ventral hernia repairs, with the intention to assess and improve long term outcomes. The goal of this study is to assess registry compliance.

METHODS

All ventral hernia operations performed in five VA hospitals between 2011-2022 were obtained. We assessed compliance at the hospital and surgeon level.

RESULTS

3,516 cases were performed. Overall compliance with registry entry was 37.5%, ranging from 10.8% to 67.2% across hospitals. At the hospital level, there was a negative correlation between average yearly hernia volume per surgeon and registry compliance (r2 = 0.53). Surgeon compliance varied within hospitals and over time.

CONCLUSION

Registry compliance was low and highly variable. Lack of interest, incentives, oversight, and surgeon turnover are possible factors for noncompliance. Building a registry with these factors in mind, providing timely feedback, and conducting frequent audits may improve compliance.

Is mesh pore size in polypropylene meshes associated with the outcome in Lichtenstein inguinal hernia repair: a registry-based analysis of 22,141 patients

INTRODUCTION

Experimental data show that large-pored meshes reduce foreign body reaction, inflammation and scar bridging and thus improve mesh integration. However, clinical data on the effect of mesh porosity on the outcome of hernioplasty are limited. This study investigated the relation of pore size in polypropylene meshes to the outcome of Lichtenstein inguinal hernioplasty using data from the Herniamed registry.

METHODS

This analysis of data from the Herniamed registry evaluated perioperative and 1-year follow-up outcomes in patients undergoing elective, primary, unilateral Lichtenstein inguinal hernia repair using polypropylene meshes. Patients operated with a non-polypropylene mesh or a polypropylene mesh with absorbable components were excluded. Polypropylene meshes with a pore size of 1.0 × 1.0 mm or less were defined as small-pored meshes, while a pore size of more than 1.0 × 1.0 mm was considered large-pored. Unadjusted analyses and multivariable analyses were performed to investigate the relation of pore size of polypropylene meshes, patient and surgical characteristics to the outcome parameters.

RESULTS

Data from 22,141 patients were analyzed, of which 6853 (31%) were operated on with a small-pore polypropylene mesh and 15,288 (69%) with a large-pore polypropylene mesh. No association of mesh pore size with intraoperative, general or postoperative complications, recurrence rate or pain requiring treatment was found at 1-year follow-up. A lower risk of complication-related reoperation tended to be associated with small-pore size (p = 0.086). Furthermore, small-pore mesh repair was associated with a lower risk of pain at rest and pain on exertion at 1-year follow-up.

CONCLUSION

The present study could not demonstrate an advantage of large-pore polypropylene meshes for the outcome of Lichtenstein inguinal hernioplasty.

Open IPOMs for medium/large incisional ventral hernia repairs in the French Hernia Registry: factors associated with their use and mesh-related outcomes

PURPOSE

The use of open intra-peritoneal onlay mesh repairs (O-IPOMs) for treating medium/large incisional ventral hernias has come into question due to the development of minimally invasive and sublay procedures. This study aimed to identify factors that are associated with the use of O-IPOMs in France.

METHODS

We analysed prospectively collected data from the French Hernia Registry on incisional ventral hernia repairs (IVHR) for hernias ≥ 4 cm in width.

RESULTS

We obtained data for 2261 IVHR (from 11/09/2011 to 30/03/2020): 733 O-IPOMs and 1,528 other techniques. We found that the O-IPOMs were performed on patients with more patient-related risk factors compared with the other techniques. Specifically, there was a higher proportion of patients with ASA III/IV (40.47% vs. 28.02%; p < 0.00001) and at least one patient-related risk factor (66.17% vs. 58.51%; p = 0.0005). Of the 733 O-IPOMs, 195 used Ventrio ST™ (VST), the most commonly used mesh for such IPOMs in our database; the other 538 O-IPOMs used other meshes (OM). The VST subgroup had a higher proportion of patients with ASA III/IV (52.58% vs. 36.07%; p < 0.0001) and on anticoagulants (26.04% vs. 18.41%; p = 0.0229) compared with the OM subgroup; they also had a lower recurrence rate after 2 years (5.83% vs. 15.41%; p = 0.008). However, large (≥ 10 cm) or lateral defects were more common in the OM subgroup, and their mesh/defect area ratio was lower.

CONCLUSION

O-IPOMs were performed on patients with more comorbidities and/or complex incisional hernias compared with other techniques.

Parastomal hernia repairs: A nationwide cohort study in the Republic of Ireland

BACKGROUND

In the context of improving colorectal cancer outcomes, post-survivorship quality of life has become an important outcome measure. Parastomal hernias and their associated morbidity remain largely under-reported and under-appreciated. Despite their burden, conservative management is common. This study aims to provide a national overview on the current trends in parastomal hernia repairs (PHRs).

METHODS

All PHRs performed in public hospitals across the country between 1/2017 to 7/2022 were identified retrospectively from the National Quality Assurance and Improvement System (NQAIS) database. Anonymised patient characteristics and quality indices were extracted for statistical analysis.

RESULTS

A total of 565 PHRs, 64.1 % elective and the remainder emergent, were identified across 27 hospitals. The 8 national colorectal units performed 67.3 % of all repairs. While 42.3 % of PHRs were standalone procedures, reversal of Hartmann's procedure was the commonest simultaneous procedure in the remainder. The median age, ASA and Charlson Co-Morbidity Index were 64 years (19), 3(1) and 3(10) respectively. Mean length of stay (LOS) was 16.25 days (SD = 29.84). Linear regression analysis associated ASA (95 % CI 0.58-16.08, p < 0.035) and emergency admissions (95 % CI 5.86-25.55, P < 0.002) with a significantly longer LOS, with the latter also associated with more frequent emergency re-admissions (95 % CI 0.18-0.82, p < 0.002).

CONCLUSION

Patients undergoing emergency PHR were older and significantly more comorbid. Consequently, these patients were subjected to longer hospital stays, more frequent readmissions and overall higher hospital costs. Multidisciplinary perioperative optimisation and standardised referral pathways should underpin the shift towards elective PHRs.

Use of statewide financial incentives to improve documentation of hernia and mesh characteristics in ventral hernia repair

BACKGROUND

Documentation of intraoperative details is critical for understanding and advancing hernia care, but is inconsistent in practice. Therefore, to improve data capture on a statewide level, we implemented a financial incentive targeting documentation of hernia defect size and mesh use.

METHODS

The Abdominal Hernia Care Pathway (AHCP), a voluntary pay for performance (P4P) initiative, was introduced in 2021 within the statewide Michigan Surgical Quality Collaborative (MSQC). This consisted of an organizational-level financial incentive for achieving 80% performance on eight specific process measures for ventral hernia surgery, including complete documentation of hernia defect size and location, as well as mesh characteristics and fixation technique. Comparisons were made between AHCP and non-AHCP sites in 2021.

RESULTS

Of 69 eligible sites, 47 participated in the AHCP in 2021. There were N = 5362 operations (4169 at AHCP sites; 1193 at non-AHCP sites). At AHCP sites, 69.8% of operations had complete hernia documentation, compared to 50.5% at non-AHCP sites (p < 0.0001). At AHCP sites, 91.4% of operations had complete mesh documentation, compared to 86.5% at non-AHCP sites (p < 0.0001). The site-level hernia documentation goal of 80% was reached by 14 of 47 sites (range 14-100%). The mesh documentation goal was reached by 41 of 47 sites (range 4-100%).

CONCLUSIONS

Addition of an organizational-level financial incentive produced marked gains in documentation of intra-operative details across a statewide surgical collaborative. The relatively large effect size-19.3% for hernia-is remarkable among P4P initiatives. This result may have been facilitated by surgeons' direct role in documenting hernia size and mesh use. These improvements in data capture will foster understanding of current hernia practices on a large scale and may serve as a model for improvement in collaboratives nationally.

Risk factors for reoperation following inguinal hernia repair: results from a cohort of patients from an integrated healthcare system

PURPOSE

Inguinal hernia repair is one of the most common operations performed globally. Identification of risk factors that contribute to hernia recurrence following an index inguinal hernia repair, especially those that are modifiable, is of paramount importance. Therefore, we sought to investigate risk factors for reoperation following index inguinal hernia repair.

METHODS

125,133 patients aged ≥ 18 years who underwent their first inguinal hernia repair with mesh within a large US integrated healthcare system were identified for a cohort study (2010-2020). Laparoscopic, robotic, and open procedures were included. The system's integrated electronic health record was used to obtain data on demographics, patient characteristics, surgical characteristics, and reoperations. The association of these characteristics with ipsilateral reoperation during follow-up was modeled using Cox proportional-hazards regression. Risk factors were selected into the final model by stepwise regression with Akaike Information Criteria, which quantifies the amount of information lost if a factor is left out of the model. Factors associated with reoperation with p < 0.05 were considered statistically significant.

RESULTS

The cumulative incidence of reoperation at 5-year follow-up was 2.4% (95% CI 2.3-2.5). Increasing age, female gender, increasing body mass index, White race, chronic pulmonary disease, diabetes, drug abuse, peripheral vascular disease, and bilateral procedures all associated with a higher risk for reoperation during follow-up.

CONCLUSION

This study identifies several risk factors associated with reoperation following inguinal hernia repair. These risk factors may serve as targets for optimization protocols prior to elective inguinal hernia repair, with the goal of reducing reoperation risk.

Lichtenstein versus TIPP versus TAPP versus TEP for primary inguinal hernia, a matched propensity score study on the French Club Hernie Registry

PURPOSE

Groin hernia repair is one of the most frequent operation performed worldwide. Chronic postoperative inguinal pain (CPIP) is the most common and challenging complication after surgical repair with subsequent high socio-economic impact. The aim of this study was to compare the one-year CPIP rates between Lichtenstein, trans-inguinal pre-peritoneal (TIPP), trans-abdominal pre-peritoneal (TAPP) and totally extra-peritoneal (TEP) repair techniques on the French Hernia Registry.

METHODS

Between 2011 and 2021, 15,161 primary groin hernia repairs with 1-year follow-up were available on the register. Using propensity score (PS) matching, matched pairs were formed. Each group was compared in pairs independently; Lichtenstein versus TIPP, TEP and TAPP, TIPP versus TEP and TAPP and finally TEP versus TAPP.

RESULTS

After PS matching analysis, Lichtenstein group showed disadvantage over TIPP, TAPP and TEP groups with significantly more CPIP at one year (15.2% vs 9.6%, p < 0.0001; 15.9% vs. 10.0%, p < 0.0001 and 16.1% vs. 12.4%, p = 0.002, respectively). The 1-year CPIP rates were similar comparing TIPP versus TAPP and TEP groups (9.3% vs 10.5%, p = 0.19 and 9.8% vs 11.8%, p = 0.05, respectively). There was significantly less CPIP rate after TAPP versus TEP repair (1.00% vs 11.9%, p = 0.02).

CONCLUSION

This register-based study confirms the higher CPIP risk after Lichtenstein repair compared to the pre-peritoneal repair techniques. TIPP leads to comparable CPIP rates than TAPP and TEP repairs.

Mesh-based inguinal hernia repairs in an integrated healthcare system and surgeon and hospital volume: a cohort study of 110,808 patients from over a decade

PURPOSE

The aim of this study was to describe a cohort of patients who underwent inguinal hernia repair within a United States-based integrated healthcare system (IHS) and evaluate the risk for postoperative events by surgeon and hospital volume within each surgical approach, open, laparoscopic, and robotic.

METHODS

Patients aged ≥ 18 years who underwent their first inguinal hernia repair were identified for a cohort study (2010-2020). Average annual surgeon and hospital volume were broken into quartiles with the lowest volume quartile as the reference group. Multiple Cox regression evaluated risk for ipsilateral reoperation following repair by volume. All analyses were stratified by surgical approach (open, laparoscopic, and robotic).

RESULTS

110,808 patients underwent 131,629 inguinal hernia repairs during the study years; procedures were performed by 897 surgeons at 36 hospitals. Most repairs were open (65.4%), followed by laparoscopic (33.5%) and robotic (1.1%). Reoperation rates at 5 and 10 years of follow-up were 2.4% and 3.4%, respectively; rates were similar across surgical groups. In adjusted analysis, surgeons with higher laparoscopic volumes had a lower reoperation risk (27-46 average annual repairs: hazard ratio [HR] = 0.63, 95% confidence interval [CI] 0.53-0.74; ≥ 47 repairs: HR 0.53, 95% CI 0.44-0.64) compared to those in the lowest volume quartile (< 14 average annual repairs). No differences in reoperation rates were observed in reference to surgeon or hospital volume following open or robotic inguinal hernia repair.

CONCLUSION

High-volume surgeons may reduce reoperation risk following laparoscopic inguinal hernia repair. We hope to better identify additional risk factors for inguinal hernia repair complications and improve patient outcomes with future studies.

Suture versus open mesh repair for small umbilical hernia: Results of a propensity-matched cohort study

BACKGROUND

The objective was to compare the outcomes of open mesh repair versus suture repair for small (≤1 cm in diameter) umbilical hernia. The primary endpoint was the 30-day outcomes including pain, and secondary endpoints were the 2-year outcomes including recurrences and patient-reported outcomes.

METHODS

This propensity-matched, multicenter study was carried out on data collected prospectively in the Hernia-Club database between 2011 and 2021. A total of 590 mesh repairs and 590 suture repairs were propensity score matched (age, sex, body mass index) at a ratio of 1:1. Postoperative pain was assessed using the Verbal Rating Scale-4 and 0‒10 Numerical Rating Scale-11.

RESULTS

Mesh insertion was intraperitoneal in 331 patients (56.1%), extraperitoneal in 249 (42.2%), and onlay in 10 (1.7%). The rate of 30-day complications and Numerical Rating Scale-11 pain scores on postoperative days 8 and 30 were similar between the groups, including surgical site occurrences (2.2 vs 1.4% after suture repair). At 1 month, postoperative discomfort (sensation of something different from before) was significantly (P < .0001) more frequent after mesh repair, whereas the rate of relevant (moderate or severe) pain (mesh repair: 1.1% vs suture repair: 2.6%) and the distribution of Numerical Rating Scale-11 scores did not differ between the groups. At the 2-year follow-up, mesh repair patients had fewer reoperated recurrences (0.2% vs 1.7%; P = .035) and no more pain or discomfort than suture repair patients.

CONCLUSION

Both techniques are effective and safe. Mesh repair is likely to reduce the rate of recurrences. Concerns about postoperative pain and infection might not prevent the use of mesh in smallest umbilical hernias.

Groin Hernia Repair during the COVID-19 Pandemic-A Romanian Nationwide Analysis

Background and Objectives: Groin hernia repair surgery (GHRS) is among the most common elective interventions. The aim of this three-year nationwide study on GHRS is to provide a thorough analysis of the impact that the COVID-19 pandemic had on the Romanian Health System in regard to elective procedures. Materials and Methods: 46,795 groin hernia cases obtained between 2019 and 2021 from the DRG database using ICD-10 diagnostic codes. The data were collected from all 261 GHRS performing hospitals nationwide, including 227 public hospitals (PbH) and 34 private hospitals (PvH). The 42 variables taken into account were processed using Microsoft Excel 2021, applying Chi square, F-Test Two-Sample for variances, and Two Sample t-Test. The significance threshold considered was p < 0.001. Results: Of the grand total of cases, 96.2% were inguinal hernias, 86.8% were performed on men, 15.2% were laparoscopic procedures, and 6.88% were in PvH. Overall, due to the pandemic, the total number of GHRS decreased with 44.45% in 2020 and with 29.72% in 2021 compared to pre-pandemic year 2019. April 2020 shows the steepest decrease in GHRS (91 procedures nationwide). In the private sector, there was an opposite trend with increases in the number of cases by 12.21% and a 70.22% in both pandemic years. The mean admission period (MAP) for all procedures was 5.5 days. There was a significant difference between PbH and PvH (5.75 vs. 2.8 days, p < 0.0001). During the pandemic, the MAP in PbH decreased (6.02 in 2019, 5.82 in 2020 and 5.3 in 2021), remaining stable for PvH (2.9 days in 2019, 2.85 days in 2020 and 2.74 days in 2021). Conclusions: The COVID-19 pandemic significantly reduced the overall number of GHRS performed in Romania in 2020 and 2021, compared to 2019. However, the private sector thrived with an actual increase in the number of cases. There was a significant lower MAP in the PvH compared to PbH throughout the three-year period.

What are the influencing factors on the outcome in lateral incisional hernia repair? A registry-based multivariable analysis

INTRODUCTION

Incisional hernias following lateral abdominal wall incisions with an incidence of 1-4% are less common than following medial incisions at 14-19%. The proportion of lateral incisional hernias in the total collective of all incisional hernias is around 17%. Compared to midline defects, lateral incisional hernias are more difficult to repair because of the more complex anatomy and localization. A recent systematic review identified only 11 publications with a total of 345 patients reporting on lateral incisional hernia repair. Therefore, further studies are urgently needed.

METHODS

Multivariable analysis of the data available for 6,306 patients with primary elective lateral incisional hernia repair was performed to assess the confirmatory pre-defined potential influence factors and their association with the perioperative and one-year follow-up outcomes.

RESULTS

In primary elective lateral incisional hernia repair, open onlay, open IPOM and suture procedures were found to have an unfavorable effect on the recurrence rate. This was also true for larger defect sizes and higher BMI. A particularly unfavorable relationship was identified between larger defect sizes and perioperative complications. Laparoscopic-IPOM presented a higher risk of intraoperative, and open sublay of postoperative, complications. The chronic pain rates were especially unfavorably influenced by the postoperative complications, preoperative pain and female gender.

CONCLUSION

Open-onlay, open IPOM and suture procedures, larger defect sizes, female gender, higher BMI, preoperative pain and postoperative complications are associated with unfavorable outcomes following primary elective lateral incisional hernia repair.

Feasibility of a smartphone application for inguinal hernia care: a prospective pilot study

The Inguinal Hernia Application (IHAPP) is designed to overcome current limitations of regular follow-up after inguinal hernia surgery. It has two goals: Minimizing unnecessary healthcare consumption by supplying patient information and facilitating registration of patient-reported outcome measures (PROMs) by offering simple questionnaires. In this study we evaluated the usability and validity of the app. Patients (≥18 years) scheduled for elective hernia repair were assessed for eligibility. Feasibility of the app was evaluated by measuring patient satisfaction about utilization. Validity (internal consistency and convergent validity) was tested by comparing answers in the app to the scores of the standardized EuraHS-Quality of Life instrument. Furthermore, test-retest reliability was analyzed correlating scores obtained at 6 weeks to outcomes after 44 days (6 weeks and 2 days). During a 3-month period, a total of 100 patients were included. Median age was 56 years and 98% were male. Most respondents (68%) valued the application as a supplementary tool to their treatment. The pre-operative information was reported as useful by 77% and the app was regarded user-friendly by 71%. Patient adherence was mediocre, 47% completed all questionnaires during follow-up. Reliability of the app was considered excellent (α > 0.90) and convergent validity was significant (p = 0.01). The same applies to test-retest reliability (p = 0.01). Our results demonstrate the IHAPP is a useful tool for reliable data registration and serves as patient information platform. However, further improvements are necessary to increase patient compliance in recording PROMs.

Mesh versus non-mesh repair of groin hernias: a rapid review

BACKGROUND

Mesh is frequently utilized intraoperatively for the repair of groin hernias. However, patients may request non-mesh hernia repairs owing to adverse events reported in other mesh procedures. To inform surgical safety, this study aimed to compare postoperative complications between mesh and non-mesh groin hernia repairs and identify other operative and patient-related risk factors associated with poor postoperative outcomes.

METHODS

Ovid MEDLINE and grey literature were searched to 9 June 2021 for studies comparing mesh to non-mesh techniques for primary groin hernia repair. Outcomes of interest were postoperative complications, recurrence of hernia, pain and risk factors associated with poorer surgical outcomes. Methodological quality was appraised using the AMSTAR 2 tool.

RESULTS

The systematic search returned 4268 results, which included seven systematic reviews and five registry analyses. Mesh repair techniques resulted in lower hernia recurrence rates, with no difference in chronic pain, seroma, haematoma or wound infection, compared to non-mesh techniques. Risk factors associated with increased risk of hernia recurrence were increased body mass index (BMI), positive smoking status and direct hernia. These were independent of surgical technique. Patients under 40 years of age were at increased risk of postoperative pain.

CONCLUSIONS

Surgical repair of primary groin hernias using mesh achieves lower recurrence rates, with no difference in safety outcomes, compared with non-mesh repairs. Additional risk factors associated with increased recurrence include increased BMI, history of smoking and hernia subtype.

Significant factors influencing chronic postoperative inguinal pain: A conditional time-dependent observational cohort study

BACKGROUND

Inguinal hernia (IH) repair is a common surgical procedure. Focus has shifted from recurrences to chronic postoperative inguinal pain (CPIP). To assess the natural course of CPIP and identify patient factors influencing the onset of CPIP, an observational registry-based study was performed.

MATERIALS AND METHODS

Data prospectively collected from the Club-Hernie national database was retrieved from 2011 until 2021. Patients who underwent elective surgery for inguinal hernia were divided in an irrelevant pain group and relevant pain group. Relevant pain at one year and two years were compared with patients with irrelevant pain at all-time points (preoperatively, one month, one year and two years). Quality of life questions were compared between relevant pain at one year and two years.

RESULTS

4.016 patients were included in the analysis. Mean age was 65.1 years, 90.3% of patients was male. Factors correlated with CPIP onset were age, gender, ASA, recurrent surgery, surgical technique, nerve handling and fixation type. Relevant pain at one month was a greater risk for CPIP than preoperative pain (12.3% vs 3.6%). In the majority of patients (83.2%) CPIP was ameliorated at two years. Hernia related complaints differed significantly between CPIP at one year and two years.

CONCLUSION

Postoperative pain after one month was a greater risk factor for CPIP development than preoperative pain. CPIP at one year seems to have a different pain etiology than CPIP at two years. Patient and surgical factors influence the onset of CPIP at one year, however the natural course of these complaints shows great decline at two years, largely without reinterventions.

Robotic versus laparoscopic inguinal hernia repair: an updated systematic review and meta-analysis

The aim of this study was to review the latest evidence on the robotic approach (RHR) for inguinal hernia repair comparing the pooled outcome of this technique with those of the standard laparoscopic procedure (LHR). A systematic literature search was performed in PubMed, Web of Science and Scopus for studies published between 2010 and 2021 concerning the comparison between RHR versus LHR. After screening 582 articles, 9 articles with a total of 64,426 patients (7589 RHRs) were eligible for inclusion. Among preoperative variables, a pooled higher ratio of ASA > 2 patients was found in the robotic group (12.4 vs 8.6%, p < 0.001). Unilateral hernia repair was more common in the laparoscopic group (79.9 vs 68.1, p < 0.001). Overall, operative time was longer in the robotic group (160 vs 90 min, p < 0.001); this was confirmed also in the sub-analysis on unilateral procedures (88 vs 68 min, p = 0.040). The operative time for robotic bilateral repair was similar to the laparoscopic one (111 vs 100, p = 0.797). Conversion to open surgery was 0% in the robotic group. The pooled rate of chronic pain and postoperative complications was similar between the groups. The standardized mean difference MD of the costs between LHR versus RHR was - 3270$ (95% CI - 4757 to - 1782, p < 0.001). In conclusion, laparoscopic and robotic inguinal hernia repair have similar safety parameters and postoperative outcomes. Robotic approach may require longer operative time if the unilateral repair is performed. Costs are higher in the robotic group.

Outcome of inguinal hernia repair after previous radical prostatectomy: a registry-based analysis with 12,465 patients

INTRODUCTION

Following radical prostatectomy, the rate of inguinal hernias is fourfold higher compared to controls. Laparo-endoscopic repair after previous radical prostatectomy is considered complex. Therefore, the guidelines recommend open Lichtenstein repair. To date, there are limited data on inguinal hernia repair after prior prostatectomy.

METHODS

In a retrospective analysis from the Herniamed Registry, the outcomes of 255,182 primary elective unilateral inguinal hernia repairs were compared with those of 12,465 patients with previous radical prostatectomy in relation to the surgical technique. Furthermore, the outcomes of laparo-endoscopic versus open Lichtenstein repair techniques in the 12,465 patients after previous radical prostatectomy were directly compared.

RESULTS

Comparison of the perioperative complication rates for primary elective unilateral inguinal hernia repair with and without previous radical prostatectomy demonstrated for the laparo-endoscopic techniques significantly higher intraoperative complications (2.1% vs 0.9%; p < 0.001), postoperative complications (3.2% vs 1.9%; p < 0.001) and complication-related reoperations (1.1% vs 0.7%; p = 0.0442) to the disadvantage of previous prostatectomy. No significant differences were identified for Lichtenstein repair. Direct comparison of the laparo-endoscopic with the open Lichtenstein technique for inguinal hernia repair after previous radical prostatectomy revealed significantly more intraoperative complications for TEP and TAPP (2.1% vs 0.6%; p < 0.001), but more postoperative complications (4.8% vs 3.2%; p < 0.001) and complication-related reoperations (1.8% vs 1.1%; p = 0.003) for open Lichtenstein repair.

CONCLUSION

Since there are no clear advantages for the laparo-endoscopic vs the open Lichtenstein technique in inguinal hernia repair after previous radical prostatectomy, the surgeon can opt for one or the other technique in accordance with their experience.

Surgeon Variation in the Application of Robotic Technique for Abdominal Hernia Repair: A Mixed-Methods Study

INTRODUCTION

Although the utilization of robotic technique for abdominal hernia repair has increased rapidly, there is no consensus as to when it should be applied for optimal outcomes. High variability exists within surgeon practices regarding how they use this technology, and the factors that drive robotic utilization remain largely unknown. This study aims to explore the motivating factors associated with surgeons' decisions to utilize a robotic approach for abdominal hernia repair.

METHODS

An exploratory mixed-methods approach was utilized. Surgeons who performed abdominal hernia repairs were interviewed to identify impactful themes motivating surgical approach. This informed a retrospective analysis of ventral hernia repairs performed in 2020 within the Michigan Surgical Quality Collaborative. Surgeon robotic utilization rates were calculated. Among selective robotic users, multivariable regression evaluated the patient and hernia factors associated with robotic utilization.

RESULTS

Qualitative analysis of 21 interviews revealed three dominant themes in the decision to utilize robotic technology: access and resources, surgeon comfort, and market factors. Among 71 surgeons caring for 1174 hernia patients, robotic utilization rates ranged from 0% to 98% of cases. There were 27 surgeons identified as selective robotic users, who cared for 423 patients. Multivariable regression revealed that hernia location was the only factor associated with robotic technique, with non-midline hernias associated with a 4.47 (95% confidence interval 1.34-14.88) higher odds of robotic repair than epigastric hernias.

CONCLUSIONS

Major drivers of robotic technique for hernia repair were found to be perceived benefits and availability, rather than patient or hernia characteristics. These data will contribute to an understanding of surgeon decision-making and help develop improvements to patient care.

A modified Delphi process to establish research priorities in hernia surgery

BACKGROUND

Abdominal wall hernia repair is one of the most commonly performed surgical procedures worldwide, yet despite this, there remains a lack of high-quality evidence to support best management. The aim of the study was to use a modified Delphi process to determine future research priorities in this field.

METHODS

Stakeholders were invited by email, using British Hernia Society membership details or Twitter, to submit individual research questions via an online survey. In addition, questions obtained from a patient focus group (PFG) were collated to form Phase I. Two rounds of prioritization by stakeholders (phases II and III) were then completed to determine a final list of research questions. All questions were analyzed on an anonymized basis.

RESULTS

A total of 266 questions, 19 from the PFG, were submitted by 113 stakeholders in Phase I. Of these, 64 questions were taken forward for prioritization in Phase II, which was completed by 107 stakeholders. Following Phase II analysis, 97 stakeholders prioritized 36 questions in Phase III. This resulted in a final list of 14 research questions, 3 of which were from the PFG. Stakeholders included patients and healthcare professionals (consultant surgeons, trainee surgeons and other multidisciplinary members) from over 27 countries during the 3 phases.

CONCLUSION

The study has identified 14 key research priorities pertaining to abdominal wall hernia surgery. Uniquely, these priorities have been determined from participation by both healthcare professionals and patients. These priorities should now be addressed by well-designed, high-quality international collaborative research.

Assessing the Validity and Cover Rate of the National Swedish Hernia Register

Aim

To assess the validity and cover rate of the Swedish hernia register.

Material and Methods

Since the start of the Swedish Hernia register an annual review of randomly selected hospitals has been carried out, and since 2013 in a more standardized form to allow a systematic data collection and evaluation. 10% of all clinics were randomly selected each year in a specific region of Sweden, ensuring a systematic validation of all regions from north to south. Data from 2013 to 2018 were analyzed regarding data quality and from 2014 to 2018 regarding cover rate. All operations registered at the validated clinics were compared with the Swedish Hernia Register to assess cover rate. Fifty operations were randomly selected at each clinic and data in the Swedish Hernia register were compared with the medical records to evaluate data quality.

Results

Fifty-five clinics was evaluated and a total of 73,764 variables were compared with the medical records. Cover rate between 2014 and 2018 was 97%. The proportion of correct variables was 98% between 2013 and 2018. Most frequent errors were ASA score, date at which the patient was put on the waiting list and postoperative complications.

Conclusion

This unique validation of a national hernia register shows a high cover rate and good quality of data. Efforts to maintain and improve national registers are of great importance. Research with data from the Swedish hernia register should be evaluated on the basis of the results presented in this study.

Inguinal hernia repair in inpatient children: a nationwide analysis of German administrative data

Background

Contrary to adult inguinal hernia surgery, large-scale investigations using registries or administrative data are missing in paediatric surgery. We aimed to fill this gap by analysing German administrative hospital data to describe the current reality of inpatient hernia surgery in children.

Methods

We analysed aggregated data files bought from the German federals statistics office on hospital reimbursement data separately for principal diagnoses of inguinal hernia in children and for herniotomies in inpatients. Developments over time were assessed via regression and differences between groups with nonparametric comparisons.

Results

Principal diagnoses of hernias were decreasing over time with the exception of male bilateral and female bilateral incarcerated hernias in the first year of life which increased. The vast majority of operations were conducted via the open approach and laparoscopy was increasingly only used for females older than 1 year of age. Recurrent hernia repair was scarce. Rates of inguinal hernia repair were higher in both sexes the younger the patient was, but were also decreasing in all age groups despite a population growth since 2012. The amount of inguinal hernia repairs by paediatric surgeons compared to adult surgeons increased by 1.5% per year.

Conclusions

Our results corroborate previous findings of age and sex distribution. It demonstrates that inpatient hernia repair is primarily open surgery with herniorrhaphy and that recurrences seem to be rare. We observed decreasing rates of hernia repairs over time and as this has been described before in England, future studies should try to elucidate this development.

Level of evidence

III.

What is the reality in outpatient vs inpatient groin hernia repair? An analysis from the Herniamed Registry

INTRODUCTION

Groin hernia repair is performed increasingly more often as an outpatient procedure across the world. However, the rates are extremely different and vary between below 10% and above 90%. The outpatient procedure appears to negatively impact the proportion of laparo-endoscopic repairs. To date, only very few studies have compared inpatient vs outpatient groin hernia repair.

METHODS

All outpatient and inpatient primary elective unilateral groin hernia repairs performed between 2010 and 2019 were identified in the Herniamed Registry and their treatment and outcomes compared.

RESULTS

The 737 participating hospitals/surgeons performed a total of 342,072 primary elective unilateral groin hernia repairs from 2010 to 2019. The proportion of outpatient repairs was 20.2% in 2013 and 14.3% in 2019. Whereas the proportion of laparo-endoscopic repairs among the inpatient cases was 71.9% in 2019, the last year for which data are available, it was only 34.3%.for outpatient repairs. In outpatient groin hernia repairs, the rates of patients aged ≥ 60 years, with ASA score III and IV and risk factors were highly significantly lower. Given this rigorous patient selection for outpatient groin hernia repair, a more favorable perioperative outcome was achieved. At 1-year follow-up there were no significant differences in the pain and recurrence rates.

CONCLUSION

With an appropriate patient selection, outpatient primary elective unilateral groin hernia repair can be performed with acceptable risks and good outcomes. Since to date no studies have compared inpatient vs outpatient groin hernia repair, the impact of a higher rate of outpatient groin hernia repair cannot currently be evaluated.

Are the relative benefits of open versus laparoscopic intraperitoneal mesh repair of umbilical hernias dependent on the diameter of the defect?

BACKGROUND

The aim of this study was to assess whether the respective values of open and laparoscopic intraperitoneal repairs of umbilical hernias are related to the European Hernia Society diameter of defects.

METHODS

This registry-based study compared the early and 2-year outcomes of 776 open versus 1,019 consecutive laparoscopic intraperitoneal repairs performed from 2011 to 2019.

RESULTS

Intraperitoneal mesh repair, either laparoscopic or open, was found to be a safe procedure at the 2-year follow-up. The incidence of reoperated bowel obstructions was 0.3%. Compared with the open group: (1) postoperative surgical site occurrences in small (<2 cm) or medium (2-4 cm) hernias (0.3% vs 2.4%; P = .041; 1.4% vs 5.9%; P = .0002); (2) recurrence rates in large (≥4 cm) umbilical hernias (0.0% vs 8.6%; P = .0195); and (3) cumulative reoperation rates (0.9% vs 2.2%; P = .021) were significantly better in the laparoscopic group. Conversely, the rate of early pain on day 1 and 1 month postsurgery was higher in the laparoscopic group, for all hernia sizes (P < .001). The rate of moderate or severe chronic pain at 2 years was significantly higher in the laparoscopic group (8.1% vs 2.4%; P = .049) for small hernias.

CONCLUSION

The respective benefit to drawback ratios for open versus laparoscopic intraperitoneal repairs were related to the European Hernia Society diameter of hernia defect. In medium-large hernias, the benefits of laparoscopic repair overrode its drawbacks. In small hernias, the low recurrence rate, reduced early and chronic pain, and better rate of ambulatory surgery suggest there is still a place for open repair.

Parestomal hernia repair. Prospective observational study based on the Spanish Registry of Incisional Hernia (EVEREG)

INTRODUCTION

The results of parastomal hernia (PH) repair based on data from registries are scarce. The objective of this work is to analyze the data collected on PH in the National Registry of Incisional Hernia (EVEREG) and thus evaluate current practices and results in PH repair.

METHODS

Data from the PH cohort recorded in the period from July 2012 to June 2018 are analyzed. Complications, recurrences and associated factors of the entire PH cohort are analyzed, regardless of the type of stoma they are associated with. Subsequently, the same PH group analysis was performed in relation to a colostomy (larger group).

RESULTS

353 PH were studied. Of these, 259 (73%) were PH in the context of a terminal colostomy, 74 (21%) in the context of a terminal ileostomy, and 20 (6%) in the context of a ureteroileostomy (Bricker). The global mean age was 68.7 ± 11.1 years and 135 (38%) patients were female. The open approach and elective surgery were predominant (78% and 92% respectively); 99% were repaired with a non-absorbable synthetic mesh. Global postoperative complications were high (30.6%). As well as, the global recurrence (27.5%) after a mean follow-up of 9.4 months.

CONCLUSIONS

PH repair is infrequent. PH surgery seems to be associated with a high percentage of postoperative complications and recurrence.

Are immunosuppressive conditions and preoperative corticosteroid treatment risk factors in inguinal hernia repair?

INTRODUCTION

Immunosuppressive conditions and/or preoperative corticosteroid treatment have a negative influence on wound healing and can, therefore, lead to higher rates of surgical site infections (SSIs) and seromas. For inguinal hernia, no such studies have been carried out to date.

METHODS

In an analysis of data from the Herniamed Registry, 2312 of 142,488 (1.6%) patients with primary unilateral inguinal hernia repair had an anamnestic history of an immunosuppressive condition and/or preoperative corticosteroid treatment. Using propensity score matching, 2297 (99.4%) pairs with comparative patient characteristics were formed. These were then compared using the following primary outcome criteria: intra- and postoperative complications, complication-related reoperations, recurrence at one-year follow-up, pain on exertion, pain at rest, and chronic pain requiring treatment at one-year follow-up. Of the 2297 matched pairs with primary unilateral inguinal hernia repair, 82.76% were male patients. 1010 (44.0%) were operated in laparo-endoscopic techniques (TEP, TAPP), 1225 (53.3%) in open techniques (Bassini, Shouldice, Lichtenstein, Plug, TIP, Gilbert, Desarda), and 62 (2.7%) in other techniques.

RESULTS

The matched pair analysis results did not identify any disadvantage in terms of the outcome criteria for patients with an anamnestic history of immunosuppressive condition and/or preoperative corticosteroid treatment (yes vs no). In particular, no disadvantage was noted in the rate of surgical site infections (0.65% vs 0.70%; ns) or seromas (1.22% vs 1.57%; ns). The overall rates of postoperative complications were 3.40% vs 4.31% (p = ns) (plus 0.22% concordant events in five matched pairs).

CONCLUSION

In primary unilateral inguinal hernia surgery, an immunosuppressive condition and/or preoperative corticosteroid treatment does not appear to have a negative influence on wound complications.

Leveraging a statewide quality collaborative to understand population-level hernia care

BACKGROUND

Although ventral hernia repair (VHR) is extremely common, there is profound variation in operative technique and outcomes. This study describes the results of a statewide registry capturing hernia-specific variables to understand population-level practice patterns.

METHODS

Retrospective analysis of adult patients in a new statewide hernia registry undergoing VHR in 2020.

RESULTS

919 patients underwent VHR across 57 hospitals and 279 surgeons. Hernia width was <2 cm in 233 (25%) patients, 2-5 cm in 420 (46%) patients, 5-10 cm in 171 (19%) patients, and >10 cm in 95 (10%) patients. Mesh was used in 79% of cases and varied in use from 53% of hernias <2 cm to 95% of hernias >10 cm. The most common mesh type was synthetic non-absorbable (46%), followed by synthetic absorbable mesh (37%). The incidence of complications was significantly associated with hernia width.

CONCLUSIONS

A population-level, hernia-specific database captured operative details for 919 patients in 1 year. There was significant variation in mesh use and outcomes based on hernia size. These nuanced data may inform higher quality clinical practice.

Perioperative outcome in groin hernia repair: what are the most important influencing factors?

INTRODUCTION

Using registry analyses, a large number of influencing factors on the perioperative outcome of groin hernia repair has been identified. The interactions between several influencing factors and differences in the influencing value have to date been inadequately investigated.

METHODS

This retrospective analysis of prospectively collected data from the Herniamed Registry included all fully documented cases with minimum age of 16 years and groin hernia repair. Patients were assigned to the risk groups unilateral, bilateral, recurrent and emergency groin hernia repair. Multivariable analysis was performed to investigate the influence of confirmatory defined patient- and procedure-related characteristics on the outcome parameters intraoperative, postoperative general and postoperative surgical complications, complication-related reoperation and total perioperative complications.

RESULTS

A highly significantly unfavorable association with the total perioperative complication rate was identified for emergency groin hernia repair, scrotal hernia, anticoagulant medication and coagulopathy. A significantly unfavorable relation with the total perioperative complication rate was found for recurrence procedure, bilateral repair, high age, ASA score III/IV, femoral hernia, antithrombotic medication, smoking, COPD and corticosteroid medication. A significantly favorable correlation with the total perioperative complication rate was observed for the laparo-endoscopic techniques, smaller defects, female gender, normal weight and medial hernia.

CONCLUSION

Both the number of potential influencing factors and their influencing value on the perioperative outcome should be considered when estimating the individual risk of a patient with groin hernia repair.

Longitudinal cohort study on preoperative pain as a risk factor for chronic postoperative inguinal pain after groin hernia repair at 2-year follow-up

PURPOSE

To assess the rate of late chronic postoperative inguinal pain (CPIP) after groin hernia repair in patients with different categories of preoperative VRS (Verbal Rating Scale) pain and to make a pragmatic evaluation of the rates of potentially surgery-related CPIP vs. postoperative continuation of preexisting preoperative pain.

METHODS

Groin pain of patients operated from 01/11/2011 to 01/04/2014 was assessed preoperatively, postoperatively and at 2-year follow-up using a VRS-4 in 5670 consecutive groin hernia repairs. A PROM (Patient Related Outcomes Measurement) questionnaire studied the impact of CPIP on the patients' daily life.

RESULTS

Relevant (moderate or severe VRS) pain was registered preoperatively in 1639 of 5670 (29%) cases vs. 197 of 4704 (4.2%) cases at the 2-year follow-up. Among the latter, 125 (3.7%) cases were found in 3353 cases with no-relevant preoperative pain and 72 (5.3%) in 1351 cases with relevant preoperative pain. Relevant CPIP consisted of 179 (3.8%) cases of moderate pain and 18 (0.4%) cases of severe pain. The rate of severe CPIP was independent of the preoperative VRS-pain category while the rate of moderate CPIP (3.1%, 3.4%, 4.1%, 6.8%) increased in line with the preoperative (none, mild, moderate, and severe) VRS-pain categories. The VRS probably overestimated pain since 71.6% of the relevant CPIP patients assessed their pain as less bothersome than the hernia.

CONCLUSION

At the 2-year follow-up, relevant CPIP was registered in 4.2% cases, of which 63.5% were potentially surgery-related (no-relevant preoperative pain) and 36.5% possibly due to the postoperative persistence of preoperative pain. The rate of severe CPIP was constant around 0.4%.

What is the reality in epigastric hernia repair?-a trend analysis from the Herniamed Registry

INTRODUCTION

The proportion of epigastric hernias in the total collective of all operated abdominal wall hernias is 3.6-6.9%. The recently published guidelines for treatment of epigastric hernias of the European Hernia Society and the Americas Hernia Society recommend the use of a mesh for defect size of ≥ 1 cm, i.e., a preperitoneal flat mesh technique for sizes 1-4 cm, and laparoscopic IPOM technique for defects > 4 cm and/or obesity. Against that background, this analysis of data from the Herniamed Registry now aims to explore trends in epigastric hernia repair.

METHODS

To detect trends, the perioperative outcome was calculated separately for the years 2010 to 2019 and the 1-year follow-up for the years 2010 to 2018 and significant differences were identified. Analysis was based on 25,518 primary elective epigastric hernia repairs. The rates of postoperative surgical complications, pain at rest, pain on exertion, chronic pain requiring treatment and recurrence associated with the various surgical techniques were calculated separately for each year. Fisher's exact test for unadjusted analysis between years was applied with Bonferroni adjustment for multiple testing.

RESULTS

The proportion of laparoscopic IPOM repairs declined from 26.0% in 2013 to 18.2% in 2019 (p < 0.001). Instead, the proportion of open sublay repairs rose from 16.5% to 21.8% (p < 0.001). That was also true for innovative techniques such as the EMILOS, MILOS, eTEP and preperitoneal flat mesh technique (8.3% vs 15.3%; p < 0.001). This change in indication for the various surgical techniques led to a significant improvement in the postoperative surgical complication rate (3.8% vs 1.9%; p < 0.001).

CONCLUSION

The trend is for epigastric hernia repair to be performed less often in laparoscopic IPOM technique and instead more often in open sublay technique or the new innovative techniques.

Multistakeholder Collaborative Effort to Enhance Long-Term Follow-Up in the Abdominal Core Health Quality Collaborative

Objective

To determine the effectiveness of a clinical call center in performing focused long-term patient reported outcome (PRO)-based follow-up for ventral hernia patients in routine practice.

Background

Long-term follow-up remains the mainstay of assessing quality of care in hernia management. Achieving acceptable rates of long-term follow-up outside of clinical trials in the routine care of patients has been very difficult to achieve.

Methods

A prospective quality improvement intervention using a clinical call center in 1000 random patients eligible for long-term (1 year or greater) follow-up after ventral hernia repair in the Abdominal Core Health Quality Collaborative was performed. The primary outcome measure was the proportion of patients with successfully completed PRO-based long-term follow-up.

Results

Between 2013 and 2017, the baseline long-term follow-up PRO completion rate was 2167/13,950 (15.5%). For the Focus on Follow-Up initiative, 890 patients were eligible for contact; a completion rate of 450/890 (50.6%, P < 0.001) was achieved.

Conclusions

Clinical call center-based patient contact can greatly facilitate the completion of PROs utilized for long-term follow-up in ventral hernia repair. This has important implications for quality improvement programs and postmarket device surveillance.

Regulatory science for hernia mesh: Current status and future perspectives

Regulatory science for medical devices aims to develop new tools, standards and approaches to assess the safety, effectiveness, quality and performance of medical devices. In the field of biomaterials, hernia mesh is a class of implants that have been successfully translated to clinical applications. With a focus on hernia mesh and its regulatory science system, this paper collected and reviewed information on hernia mesh products and biomaterials in both Chinese and American markets. The current development of regulatory science for hernia mesh, including its regulations, standards, guidance documents and classification, and the scientific evaluation of its safety and effectiveness was first reported. Then the research prospect of regulatory science for hernia mesh was discussed. New methods for the preclinical animal study and new tools for the evaluation of the safety and effectiveness of hernia mesh, such as computational modeling, big data platform and evidence-based research, were assessed. By taking the regulatory science of hernia mesh as a case study, this review provided a research basis for developing a regulatory science system of implantable medical devices, furthering the systematic evaluation of the safety and effectiveness of medical devices for better regulatory decision-making. This was the first article reviewing the regulatory science of hernia mesh and biomaterial-based implants. It also proposed and explained the concepts of evidence-based regulatory science and technical review for the first time.

What is the outcome of the open IPOM versus sublay technique in the treatment of larger incisional hernias?: A propensity score-matched comparison of 9091 patients from the Herniamed Registry

INTRODUCTION

In an Expert Consensus guided by systematic review, the panel agreed that for open elective incisional hernia repair, sublay mesh location is preferred, but open intraperitoneal onlay mesh (IPOM) may be useful in certain settings. This analysis of data from the Herniamed Registry aimed to compare the outcomes of open IPOM and sublay technique.

METHODS

Propensity score matching of 9091 patients with elective incisional hernia repair and with defect width ≥ 4 cm was performed. The following matching variables were selected: age, gender, risk factors, ASA score, preoperative pain, defect size, and defect localization.

RESULTS

For the 1977 patients with open IPOM repair and 7114 patients with sublay repair, n = 1938 (98%) pairs were formed. No differences were seen between the two groups with regard to the intraoperative, postoperative and general complications, complication-related reoperations and recurrences. But significant disadvantages were identified for the open IPOM repair in respect of pain on exertion (17.1% vs. 13.7%; p = 0.007), pain at rest (10.4% vs. 8.3%; p = 0.040) and chronic pain requiring treatment (8.8% vs. 5.8%; p < 0.001), in addition to rates of 3.8%, 1.1% and 1.1%, respectively, occurring in both matched patients. No relationship with tacker mesh fixation was identified. There are only very few reports in the literature with comparable findings.

CONCLUSION

Compared with sublay repair, open IPOM repair appears to pose a higher risk of chronic pain. This finding concords with the Expert Consensus recommending that incisional hernia should preferably be repaired using the sublay technique.

Potential influencing factors on the outcome in incisional hernia repair: a registry-based multivariable analysis of 22,895 patients

INTRODUCTION

Due to the paucity of randomized controlled trials, meta-analyses of incisional hernia repair can hardly give any insights into the influence factors on the various outcome criteria. Therefore, a multivariable analysis of data from the Herniamed Registry was undertaken with the aim to define potential influencing factors for the outcome.

METHODS

Multivariable analysis of the data available for 22,895 patients with primary elective incisional hernia repair was performed to assess the confirmatory predefined potential influence factors and their association with the perioperative and 1-year follow-up outcomes. A model validation procedure was implemented using a bootstrap algorithm in order to account for the robustness of results.

RESULTS

Higher European Hernia Society (EHS) width classification, open procedure, female gender, and preoperative pain have a highly significant association with an unfavorable outcome in incisional hernia repair. Larger defect width and open operation have a highly significantly unfavorable relation to the postoperative surgical complications, general complications, and the complication-related reoperations, while female gender and preoperative pain have a highly significantly unfavorable association with the rates of pain at rest, pain on exertion, and chronic pain requiring treatment at 1-year follow-up. The recurrence rate is significantly unfavorably influenced by higher EHS width classification, higher BMI, and lateral EHS classification.

CONCLUSION

Higher EHS width classification, open procedure, female gender, higher BMI, and lateral EHS classification, as well as preoperative pain are the most important unfavorable influencing factors associated with a worse outcome in incisional hernia repair.

Laparoscopic vs. Open Surgical Repair of Subxiphoidal Hernia Following Median Sternotomy for Coronary Bypass - Analysis of the Herniamed Registry

Introduction: The repair of subxiphoidal incisional hernia following median sternotomy is technically demanding due to the specific anatomic situation and the lateral distracting forces in this region. Published data are available from retrospective reports with limited number of patients only. The aim of this study was to evaluate the outcome of subxiphoidal hernia repair comparing laparoscopic and open surgical approach.

Materials and Methods: This analysis of Herniamed registry data of patients with subxiphoidal incisional hernia following sternotomy for coronary bypass assesses the perioperative and 1 year follow-up outcome of laparoscopic and open repair. Demographic data and perioperative outcomes were stratified by surgical approach (laparoscopic vs. open) and compared as unadjusted analyses using Chi square and Students t-tests.

Results: Of 208 patients identified for the analysis 69 patients (33.2%) underwent laparoscopic and 139 (66.8%) patients had open repair. Concerning demographic data (gender, age, BMI, ASA score), risk factors and hernia size there were no significant differences between laparoscopic and open repair group. For intraoperative, postoperative and general complications as well as complication related re-operations no significant differences were seen between the groups. No significant advantage could be stated for laparoscopic repair regarding duration of operation and hospital stay. The recurrence rate at 1 year follow-up was higher in the laparoscopic group (7.2 vs. 2.2%; p = 0.072). No significant differences were reported in the 1 year follow-up evaluation of pain at rest, pain on exertion and pain requiring treatment.

Conclusion: The repair of subxiphoidal incisional hernia is safe in both open and laparoscopic technique. With regard to the lower recurrence rate preference can be given to open repair.

Treatment of small (< 2 cm) umbilical hernias: guidelines and current trends from the Herniamed Registry

INTRODUCTION

Based on meta-analyses and registry data, the European Hernia Society and the Americas Hernia Society have published guidelines for the treatment of umbilical hernias. These recommend that umbilical hernia should generally be treated by placing a non-absorbable (permanent) flat mesh into the preperitoneal space with an overlap of the hernia defect of 3 cm. Suture repair should only be considered for small hernia defects of less than 1 cm. Hence, the use of a mesh in general is subject to controversial debate particularly for small (< 2 cm) umbilical hernias. This analysis of data from the Herniamed Registry now presents data on the treatment of small (< 2 cm) umbilical hernias over the past 10 years.

METHODS

Herniamed is an Internet-based hernia registry in which hospitals and surgical centers in Germany, Austria and Switzerland can voluntarily enter data on their routine hernia operations. Between 2010 and 2019, data were entered into the Herniamed Registry by 737 hospitals/surgery centers on a total of 111,765 patients with primary elective umbilical hernia repair. The prospective data were analyzed retrospectively for each year and statistically compared. Due to a higher number of cases, the years 2013 and 2019 were compared for the perioperative outcome and the years 2013 and 2018 for 1-year follow-up. Fisher's exact test was applied for unadjusted analyses between the years, using a significance level of alpha = 5%. For post hoc tests of single categories, a Bonferroni adjustment for multiple testing was implemented.

RESULTS

A mesh technique was used to treat 45.4% of all umbilical hernias. The proportion of small (< 2 cm) umbilical hernias in the total collective of umbilical hernias was 55.6%. Suture repair was used consistently over the 10-year period to treat around 75% of all small (< 2 cm) umbilical hernias. Preperitoneal mesh placement as recommended in the guidelines was used only in 1.8% of cases. Between 2013 and 2019, stable values of 2 and 0.7% were observed for the postoperative complications and complication-related reoperations, respectively, with no relevant effect identified for the surgical technique. At 1-year follow-up, significantly higher rates of pain at rest (2.6 vs. 3.3), pain on exertion (5.7 vs. 6.6), and recurrences (1.3 vs. 1.8) (all p < 0.05) were identified for 2018 compared with 2013.

CONCLUSIONS

A suture technique is still used to treat 75% of patients with small (< 2 cm) umbilical hernias. The pain and recurrence rates are significantly less favorable for 2018 compared with 2013.

What Is the Reality of Hiatal Hernia Management?-A Registry Analysis

Introduction: To date, the guidelines for surgical repair of hiatal hernias do not contain any clear recommendations on the hiatoplasty technique with regard to the use of a mesh or to the type of fundoplication (Nissen vs. Toupet). This present 10-years analysis of data from the Herniamed Registry aims to investigate these questions.

Methods: Data on 17,328 elective hiatal hernia repairs were entered into the Herniamed Registry between 01.01.2010 and 31.12.2019. 96.4% of all repairs were completed by laparoscopic technique. One-year follow-up was available for 11,280 of 13,859 (81.4%) patients operated during the years 2010–2018. The explorative Fisher's exact test was used for statistical calculation of significant differences with an alpha = 5%. Since the annual number of cases in the Herniamed Registry in the years 2010–2012 was still relatively low, to identify significant differences the years 2013 and 2019 were compared.

Results: The use of mesh hiatoplasty for axial and recurrent hiatal hernias remained stable over the years from 2013 to 2019 at 20 and 45%, respectively. In the same period the use of mesh hiatoplasty for paraesophageal hiatal hernia slightly, but significantly, increased from 33.0 to 38.9%. The proportion of Nissen and Toupet fundoplications for axial hiatal hernia repair dropped from 90.2% in 2013 to 74.0% in 2019 in favor of “other techniques” at 20.9%. For the paraesophageal hiatal hernias (types II–IV) the proportion of Nissen and Toupet fundoplications was 68.1% in 2013 and 66.0% in 2019. The paraesophageal hiatal hernia repairs included a proportion of gastropexy procedures of 21.7% in 2013 and 18.7% in 2019. The recurrent hiatal hernia repairs also included a proportion of gastropexies 12.8% in 2013 and 15.1% in 2019, Nissen and Toupet fundoplications of 72.7 and 62.7%, respectively, and “other techniques” of 14.5 and 22.2%, respectively. No changes were seen in the postoperative complication and recurrence rates.

Conclusion: Clear trends are seen in hiatal hernia repair. The use of meshes has only slightly increased in paraesophageal hiatal hernia repairs. The use of alternative techniques has resulted in a reduction in the use of the “classic” Nissen and Toupet fundoplication surgical techniques.

What are the trends in incisional hernia repair? Real-world data over 10 years from the Herniamed registry

INTRODUCTION

There is an increasingly controversial debate about the best possible incisional hernia repair technique. Despite the good outcomes of laparoscopic IPOM, concerns about the intraperitoneal mesh placement and its potential intraabdominal complications have risen. Against that background, this paper now analyzes changes and trends in incisional hernia repair techniques in the recent decade.

METHODS

Between 2010 and 2019 a total of 61,627 patients with primary elective incisional hernia repair were enrolled in the Herniamed Registry. The outcome results were assigned to the year of repair and summarized as curves to visualize trends. The explorative Fisher's exact test was used for statistical calculation of significant differences. Since the number of cases entered into the Herniamed Registry for the years 2010-2012 was still relatively small, the years 2013 and 2019 were compared for statistical analysis.

RESULTS

In the analyzed time period, the proportion of incisional hernias repaired in open suture technique remained unchanged at about 10%. The proportion of laparoscopic IPOM repairs decreased significantly from 33.8% in 2013 to 21.0% (p < 0.001) in 2019. Conversely, the proportion of open sublay repairs increased significantly from 32.1% in 2013 to 41.4% (p < 0.001) in 2019. Starting in 2015, there has also been the introduction and increasing use (4.5% in 2013 vs. 10.0% in 2019; p < 0.001) of new minimally-invasive techniques with placement of a mesh into the sublay/retromuscular/preperitoneal abdominal wall layer (E/MILOS, eTEP, preperitoneal mesh technique).

CONCLUSION

Analysis of data from the Herniamed Registry shows a significant trend to the disadvantage of the laparoscopic IPOM and to the advantage of the open sublay operation and the new minimally-invasive techniques (E/MILOS, eTEP, preperitoneal mesh technique). Despite all the recommendations in the guidelines, 10% of incisional hernias continue to be treated by means of a suture technique.

Building a national hernia registry in South Africa: initial ventral hernia repair results from a diverse healthcare sector

PURPOSE

The purpose of this paper was to introduce a new registry in a developing country by describing the demographics, management and 30-day outcomes of patients undergoing ventral hernia repair in the public and private healthcare sectors of South Africa.

METHODS

This study was a retrospective review of a prospectively maintained hernia registry from the 1st of February 2019 to 29th of February 2020.

RESULTS

353 ventral hernia repair cases were recorded of which 47% were incisional hernias and the remainder were primary hernias. The median age was 54 years with even distribution of males and females. Half of the patients were obese with a median BMI of 31 kg/m². The private sector performed 190 cases (54%) and the public sector 163 cases (46%). The public sector had more current smokers undergoing elective repairs, 28% vs 15%, p = 0.01 and performed more emergency repair cases, 21% vs 8%, p < 0.01. The majority (89%) of hernias were repaired with mesh and one-third were repaired laparoscopically. 30 day follow up was obtained in 30% of cases, the private sector had better follow up rates (42% vs 14%).

CONCLUSION

Participation in the HIG (SA) registry was low with poor follow up over the first year. Ongoing prospective data capture on the HIG (SA) hernia registry will continue to provide further insights into hernia repair practices in South Africa.

Assessment of potential influencing factors on the outcome in small (< 2 cm) umbilical hernia repair: a registry-based multivariable analysis of 31,965 patients

INTRODUCTION

How best to treat a small (< 2 cm) umbilical hernia continues to be the subject of controversial debate. The recently published guidelines for treatment of umbilical hernias from the European Hernia Society and Americas Hernia Society recommend open mesh repair for defects ≥ 1 cm. Since the quality of evidence is limited for hernias with defect sizes smaller than 1 cm, suture repair can be considered. To date, little is known about the potential influencing factors on the outcome in small (< 2 cm) umbilical hernia repair. This multivariable analysis of data from the Herniamed Registry now aims to assess these factors.

METHODS

The data of patients with primary elective umbilical hernia repair and defect size < 2 cm entered into the Herniamed Registry from September 1, 2009 to December 31, 2018 were analyzed to assess through multivariable analysis all confirmatory pre-defined potential influencing factors on the primary outcome criteria intraoperative and postoperative complications, general complications, complication-related reoperations, recurrence rate and rates of pain at rest, pain on exertion and chronic pain requiring treatment at 1-year follow-up.

RESULTS

31,965 patients (60%) met the inclusion criteria. The proportion of suture repairs was 78.6% (n = 25,119), of open mesh repairs 15.2% (n = 4853), and of laparoscopic mesh repairs 6.2% (n = 1993). Compared with open mesh repair, suture repair had a highly significantly unfavorable association with the recurrence rate (OR = 1.956 [1.463; 2.614]; p < 0.001). Female gender also had an unfavorable relation to the recurrence rate (OR = 1.644 [1.385; 1.952]; p < 0.001). Compared with open mesh repair, open suture repair had a highly significantly favorable association with the rate of postoperative complications (OR = 0.583 [0.484; 0.702]; p < 0.001) and complication-related reoperations (OR = 0.567 [0.397; 0.810]; p = 0.002).While laparoscopic IPOM showed a favorable relationship with the postoperative complications and complication-related reoperations, it demonstrated an unfavorable association with the intraoperative complications, general complications, recurrence rate and pain rates.

CONCLUSION

Suture repair continues to be used for 78% of umbilical hernias with a defect < 2 cm. While suture repair has a favorable influence on the rates of postoperative complications and complication-related reoperations, it has a higher risk of recurrence. Female gender also has an unfavorable influence on the recurrence rate. Laparoscopic IPOM appears to be indicated only in settings of obesity (BMI ≥ 30).

Parestomal hernia repair. Prospective observational study based on the Spanish Registry of Incisional Hernia (EVEREG)

INTRODUCTION

The results of parastomal hernia (PH) repair based on data from registries are scarce. The objective of this work is to analyze the data collected on PH in the National Registry of Incisional Hernia (EVEREG) and thus evaluate current practices and results in PH repair.

METHODS

Data from the PH cohort recorded in the period from July 2012 to June 2018 are analyzed. Complications, recurrences and associated factors of the entire PH cohort are analyzed, regardless of the type of stoma they are associated with. Subsequently, the same PH group analysis was performed in relation to a colostomy (larger group).

RESULTS

353 PH were studied. Of these, 259 (73%) were HP in the context of a terminal colostomy, 74 (21%) in the context of a terminal ileostomy, and 20 (6%) in the context of a ureteroileostomy (Bricker). The global mean age was 68.7±11.1 years and 135 (38%) patients were female. The open approach and elective surgery were predominant (78% and 92% respectively); 99% were repaired with a non-absorbable synthetic mesh. Global postoperative complications were high (30.6%). As well as, the global recurrence (27.5%) after a mean follow-up of 9.4 months.

CONCLUSIONS

PH repair is infrequent. PH surgery seems to be associated with a high percentage of postoperative complications and recurrence.