Mads Marckmann, Nadia A Henriksen, Kristian S Kiim
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引用次数: 0
Abstract
Purpose: Recurrence after open incisional hernia repair remains an issue. Where the mesh preferably is placed in a retrorectus position, it is undetermined what the optimal mesh overlap is. This study aimed to assess the effect of mesh width on long-term recurrence after open incisional hernia repair.
Method: The Danish Ventral Hernia Database was merged with The Danish National Patients Registry allowing a 100% follow-up. From 2011 to 2023 we included patients who underwent elective incisional hernia repair with vertical incision, retromuscular mesh placement, and linea alba reconstruction. Mesh and hernia size and repair type were registered. Kaplan-Meier plots showed cumulative incidences of operation for hernia recurrence over a 5-year period. Possible confounders were included in Cox proportional hazard and logistic regression analyses.
Results: We included 1,539 patients. Mean (sd) age was 61.2 (12.4) years, 46.2% were females. Mean horizontal defect size was 8.4 (4.2) cm. Seventy-two (4.7%) patients underwent reoperation within 90 days and 112 (7.3%) developed recurrence (median follow-up 3.8 (IQR 1.8-6.1) years). Mesh width of 10-15 cm was associated with significantly decreased risk of operation for recurrence compared to both smaller and larger sizes (HR 0.38, CI 0.16-0.90, P = 0.029). Interestingly, fascial defect width was not associated with recurrence risk when adjusting for mesh width.
Conclusion: A 10-15 cm mesh width is associated with lower risk of recurrence for patients undergoing elective open midline retromuscular incisional hernia repair: this "golden mean" should be of aim rather than "too little" or "as much as possible".
期刊介绍：
Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery.
Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.
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