A novel classification system for hernia recurrence after hernia repair: A call to standardize hernia recurrence nomenclature and severity classification.

Abstract

Introduction: Avoidance of a hernia recurrence is the most desirable outcome following an on abdominal wall reconstruction, prompting all hernia publications to quote hernia recurrence rates. However, the scientific literature reports recurrence as a dichotomous outcome without evaluating the quality of life or clinical history of patients who present with recurrence after a hernia repair. There is a need for more granular information on the quality of life of patients with hernia recurrence and a need for standardization to allow for comparisons of future studies. The objective of our study is to propose a novel classification for hernia recurrence after ventral hernia repair.

Methods: We investigated known classification systems published in the literature such as the Clavien-Dindo classification for surgical complication, The European Hernia Society (EHS) classification, the Morales-Conde classification for seroma and created a new system to evaluate ventral hernia recurrence based on the clinical history of patients presenting with recurrence.

Results: A new classification system with five grades was created based on the patient's quality of life and clinical outcomes. Grade 0 - no recurrence. Grade IA - Asymptomatic recurrence, identified by a surgeon or imaing with no need for surgical intervention. Grade IB - Asymptomatic recurrence, patient reported, with no need for surgical intervention. Grade IIA - Symptomatic recurrence with no surgical inveetnion (watchful watiting). Grade IIB - Symptomaotic reucrruence which requires elective repair. Grade III - Symptomatic recurrence requiring an urgent repair with no evidence of a Grade IV hernia recurrence. Grade IV - Life-threatening complications directly related to the recurrence - Strangulation, Bowel Ischemia, Bowel Obstruction, Perforation, Abdominal Compartment Syndrome; Septic Shock, Requiring emergent operation. Grade V - Death of patient directly or related to a complication from the hernia recurrence. Grade IV - Death of a patient not related to the hernia recurrence.

Conclusions: A classification for hernia recurrence and division on subgroups was formulated to better understand the clinical outcomes of patients with recurrence after ventral hernia repair and to unify criteria among surgeons when describing it.