Shirin Zadeh, Mercer University College of Pharmacy
Despite the annual volume of hernia repair surgeries, sufficient data to establish best practice was declared to be lacking.1 Surgical hernia repair falls into three categories: open repair without the use of a mesh implant (sutured), open repair with mesh, and laparoscopic repair with mesh.2
Mesh placement has been suggested to reduce the risk of hernia recurrence and is done in at least half of the abdominal wall hernia repairs performed in the United States.2 Whether or not the benefits of risk reduction with mesh outweigh possible mesh-related complications is still unknown.
Long-term Recurrence and Complications Associated with Elective Incisional Hernia Repair3
|Design||Cohort study; N= 3,242|
|Objective||To investigate the risks of long-term recurrence and mesh-related complications
following elective abdominal wall hernia repair
|Study Groups||Mesh (n= 1,119); non-mesh (n= 366); laparoscopic mesh repair (n= 1,757)|
|Methods||Hernia repair was performed using either mesh with the open and laparoscopic techniques or no mesh with the open suture technique. The risk of reoperation occurrence and 5-year risk of all mesh-related complications requiring subsequent surgery were evaluated using the Danish Hernia Database and the index repair was defined as a patient’s first incisional hernia repair in the database.|
|Duration||2007 – 2010, follow-up until 2014|
|Primary Outcome Measure||Risk of reoperation for hernia recurrence and risk of mesh-related complications|
|Baseline Characteristics||Mesh||Non-mesh||Laparoscopic mesh|
|Male, n (%)||547 (48.9)||170 (46.4)||805 (45.8)|
|Female, n (%)||572 (51.1)||196 (53.6)||952 (54.2)|
|Age, years n (%)|
|18-50||267 (23.9)||128 (35.0)||462 (26.3)|
|51-60||324 (29.0)||93 (25.4)||498 (28.3)|
|61-70||301 (26.9)||63 (17.2)||456 (26.0)|
|>70||227 (20.3)||82 (22.4)||341 (19.4)|
|Mesh size, median (interquartile range), cm2||180 (66-400)||—||324 (225-500)|
|Major complications, n (%)|
|Bowel obstruction||9 (0.8)||0||28 (1.6)|
|Bowel perforation||1 (0.1)||0||2 (0.1)|
|Complication treated by surgical intervention, n (%)||58 (5.2)||3 (0.8)||43 (2.4)|
|Adverse Events||Common Adverse Events: N/A|
|Serious Adverse Events: N/A|
|Percentage that Discontinued due to Adverse Events: N/A|
|Study Author Conclusions||Among patients undergoing incisional repair, mesh repair was associated with a higher risk of reoperation recurrence over five years compared with non-mesh and laparoscopic mesh repair. With long-term follow-up, the benefits attributable to mesh are offset in part by mesh-related complications.|
These data suggest that benefits associated with the use of mesh are partially offset by long-term complications. Although the population was not prospective or randomized evenly, the large sample with complete follow-up reflects the clinical reality that may be expected in hernia repair. The incidence of mesh-related complications provides support of eliminating mesh use in hernia repair for best practice. Because hernias are common and the evidence supporting its treatment is limited, there is a pressing need to design, fund, and conduct these trials.
1. Helgstrand F. National results after ventral hernia repair. Dan Med J. 2016;63(7).
2. Treadwell J, Tipton K, Oyesanmi O, Sun F, Schoelles K. Surgical Options for Inguinal Hernia: Comparative Effectiveness Review. Rockville, MD: Agency for Healthcare Research and Quality. August 2012.
3. Bittner R, Bingener-casey J, Dietz U, et al. Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS)-part 1. Surg Endosc. 2014;28(1):2-29.
4. Kokotovic D, Bisgaard T, Helgstrand F. Long-term Recurrence and Complications Associated with Elective Incisional Hernia Repair. JAMA. 2016;316(15):1575-1582.