Postoperative complications and hernia recurrence after the use of various ventral hernia repair techniques
DOI:
https://doi.org/10.30978/GS-2024-2-9Keywords:
ventral hernia, incisional hernia, hernia repair, meshAbstract
Prosthetic hernioplasty (HP) for ventral hernias (VH) has a complication rate of up to 27% and a hernia recurrence rate up of to 37%, depending on the chosen technique. The use of laparoscopic HP techniques allows for a shorter hospital stay and a lower risk of wound infection. There is a wide range of data on the superiority of laparoscopy over the open technique in terms of recurrence rates and various types of complications. The results of comparing HP with and without suturing of the hernia defect are controversial.
Objective — to study the structure and incidence of postoperative complications, as well as the frequency of hernia recurrences after the use of open and laparoscopic HP for VH.
Materials and methods. A multicenter prospective study, which included 482 patients diagnosed with VH, was conducted at the clinical base of the Department of General Surgery No. 2 at Bogomolets National Medical University. A total of 279 (57.9%) patients had primary VH, while 203 (42.1%) had incisional VH. The patients were divided into two groups, comparable in terms of age, sex, and hernia size distribution. Group 1 included 250 (51.9%) patients who underwent open HP with suturing of the hernia defect: subgroup 1a — open sublay (n=243; 50.4%), and subgroup 1b — open intraperitoneal onlay mesh technique (IPOM) (n=7; 1.5%). Group 2 included 232 (48.1%) patients who underwent laparoscopic HP using the IPOM technique: subgroup 2a — IPOM without suturing of the aponeurosis defect (n=81; 16.8%), subgroup 2b — IPOM with suturing of the aponeurosis defect (n=108; 22.4%), and subgroup 2c — IPOM+ with open aponeurosis defect suturing (n=43; 8.9%). Follow‑up evaluations were carried out at intervals of 2 weeks, 1 month, 6 months, and 1 year to assess the presence of complications, recurrence, and satisfaction with the cosmetic effect of the operation.
Results. The overall frequency of complications after HP was 15.6%, while after open sublay it was 21.2%, and after laparoscopic IPOM it was 9.9%. All cases of complications belonged to Grades I—IIIb according to the Clavien‑Dindo classification. In both groups, there were no fatalities. In group 1, the frequency of seroma was 11.6% and hematoma was 5.6%, and in group 2, it was 7.3% and 0.9%, respectively. A statistically significant increase in the frequency of hematoma development was observed after open HP techniques compared to laparoscopic ones (p=0.004), while the frequency of seroma detection was comparable (p=0.148). Non‑suturing of the aponeurosis defect after laparoscopic IPOM in patients with VH did not result in an increase in the total number of complications or the percentage of recurrence (p >0.05). Laparoscopic IPOM with hernia suturing demonstrated significantly higher patient satisfaction with the appearance of the anterior abdominal wall compared to other HP techniques (р <0.05).
Conclusions. The open sublay and laparoscopic IPOM HP procedures have a comparable recurrence rate of VH (p >0.05). The incidence of infectious complications and hematomas is significantly higher after open operations compared to laparoscopic ones (p=0.041 and p=0.004, respectively).
References
Ahonen-Siirtola M, Vironen J, Mäkelä J, Paajanen H. Surgery-related complications of ventral hernia reported to the Finnish Patient Insurance Centre. Scand J Surg. 2015;104(2):66-71. http://doi.org/10.1177/1457496914534208.
Assakran BS, Al-Harbi AM, Abdulrahman Albadrani H, Al-Dohaiman RS. Risk factors for postoperative complications in hernia repair. Cureus. 2024;16(1):e51982. Published 2024 Jan 9. http://doi.org/10.7759/cureus.51982.
Bittner R, Bain K, Bansal VK, et al. Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS))-Part A [published correction appears in Surg Endosc. 2019 Oct;33(10):3140-2. http://doi.org/10.1007/s00464-019-06977-7]. Surg Endosc. 2019;33(10):3069-3139. http://doi.org/10.1007/s00464-019-06907-7.
Chow A, Mayer EK, Darzi AW, Athanasiou T. Patient-reported outcome measures: the importance of patient satisfaction in surgery. Surgery. 2009;146(3):435-43. http://doi.org/10.1016/j.surg.2009.03.019.
Clapham PJ, Pushman AG, Chung KC. A systematic review of applying patient satisfaction outcomes in plastic surgery. Plast Reconstr Surg. 2010;125(6):1826-33. http://doi.org/10.1097/PRS.0b013e3181d51276.
Dey A. Should seroma be considered a complication?. Hernia. 2022;26(1):377-8. http://doi.org/10.1007/s10029-021-02385-w.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-13. http://doi.org/10.1097/01.sla.0000133083.54934.ae.
Eker HH, Hansson BM, Buunen M, et al. Laparoscopic vs. open incisional hernia repair: a randomized clinical trial. JAMA Surg. 2013;148(3):259-63. http://doi.org/10.1001/jamasurg.2013.1466.
Howard R, Johnson E, Berlin NL, et al. Hospital and surgeon variation in 30-day complication rates after ventral hernia repair. Am J Surg. 2021;222(2):417-23. http://doi.org/10.1016/j.amjsurg.2020.12.021.
Jeong S, Anwoju TA, Olavarria OA, et al. Fascial defect closure during ventral hernia repair: a systematic review of randomized controlled trials. HCA Healthc J Med. 2023;4(4):267-78. Published 2023 Aug 29. http://doi.org/10.36518/2689-0216.1469.
Kokotovic D, Bisgaard T, Helgstrand F. Long-term recurrence and complications associated with elective incisional hernia repair. JAMA. 2016;316(15):1575-82. http://doi.org/10.1001/jama.2016.15217.
Li J, Wang Y, Wu L. The comparison of eTEP and IPOM in ventral and incisional hernia repair: a systematic review and meta-analysis. Surg Laparosc Endosc Percutan Tech. 2022;32(2):252-8. Published 2022 Jan 17. http://doi.org/10.1097/SLE.0000000000001035.
Liang MK, Berger RL, Li LT, Davila JA, Hicks SC, Kao LS. Outcomes of laparoscopic vs open repair of primary ventral hernias. JAMA Surg. 2013;148(11):1043-8. http://doi.org/10.1001/jamasurg.2013.3587.
Lindmark M, Löwenmark T, Strigård K, Gunnarsson U. Major complications and mortality after ventral hernia repair: an eleven-year Swedish nationwide cohort study. BMC Surg. 2022;22(1):426. Published 2022 Dec 13. http://doi.org/10.1186/s12893-022-01873-9.
Mercoli H, Tzedakis S, D’Urso A, et al. Postoperative complications as an independent risk factor for recurrence after laparoscopic ventral hernia repair: a prospective study of 417 patients with long-term follow-up. Surg Endosc. 2017;31(3):1469-77. http://doi.org/10.1007/s00464-016-5140-2.
Morales-Conde S. A new classification for seroma after laparoscopic ventral hernia repair [published correction appears in Hernia. 2013 Feb;17(1):153]. Hernia. 2012;16(3):261-7. http://doi.org/10.1007/s10029-012-0911-8.
Olmi S, Millo P, Piccoli M, et al. Laparoscopic Treatment of Incisional and Ventral Hernia. JSLS. 2021;25(2):e2021.00007. http://doi.org/10.4293/JSLS.2021.00007.
Olmi S, Scaini A, Cesana GC, Erba L, Croce E. Laparoscopic versus open incisional hernia repair: an open randomized controlled study. Surg Endosc. 2007;21(4):555-9. http://doi.org/10.1007/s00464-007-9229-5.
Othman IH, Metwally YH, Bakr IS, Amer YA, Gaber MB, Elgohary SA. Comparative study between laparoscopic and open repair of paraumbilical hernia. J Egypt Soc Parasitol. 2012;42(1):175-82. http://doi.org/10.12816/0006305.
Owei L, Swendiman RA, Kelz RR, Dempsey DT, Dumon KR. Impact of body mass index on open ventral hernia repair: A retrospective review. Surgery. 2017;162(6):1320-9. http://doi.org/10.1016/j.surg.2017.07.025.
Owei L, Swendiman RA, Torres-Landa S, Dempsey DT, Dumon KR. Impact of body mass index on minimally invasive ventral hernia repair: an ACS-NSQIP analysis. Hernia. 2019;23(5):899-907. http://doi.org/10.1007/s10029-019-01944-6.
Rogmark P, Petersson U, Bringman S, Ezra E, Österberg J, Montgomery A. Quality of life and surgical outcome 1 year after open and laparoscopic incisional hernia repair: PROLOVE: a randomized controlled trial. Ann Surg. 2016;263(2):244-50. http://doi.org/10.1097/SLA.0000000000001305.
Sanders DL, Pawlak MM, Simons MP, et al. Midline incisional hernia guidelines: the European Hernia Society [published correction appears in Br J Surg. 2024 Jan 3;111(1):znad349. http://doi.org/10.1093/bjs/znad349]. Br J Surg. 2023;110(12):1732-68. http://doi.org/10.1093/bjs/znad284.
Sauerland S, Walgenbach M, Habermalz B, Seiler CM, Miserez M. Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev. 2011;(3):CD007781. Published 2011 Mar 16. http://doi.org/10.1002/14651858.CD007781.pub2.
Silecchia G, Campanile FC, Sanchez L, et al. Laparoscopic ventral/incisional hernia repair: updated Consensus Development Conference based guidelines [corrected] [published correction appears in Surg Endosc. 2015 Sep;29(9):2485. http://doi.org/10.1007/s00464-015-4470-9]. Surg Endosc. 2015;29(9):2463-84. http://doi.org/10.1007/s00464-015-4293-8.
Tandon A, Pathak S, Lyons NJ, Nunes QM, Daniels IR, Smart NJ. Meta-analysis of closure of the fascial defect during laparoscopic incisional and ventral hernia repair. Br J Surg. 2016;103(12):1598-607. http://doi.org/10.1002/bjs.10268.
Zou Z, Zhang D, Liu Y, Wang M. Postoperative compression in preventing early complications after groin hernia repair. Hernia. 2023;27(4):969-77. http://doi.org/10.1007/s10029-023-02752-9.
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