Identifying predictors of ventral hernia recurrence: systematic review and meta-analysis

Abstract

Background: Ventra hernias are increasing in prevalence and many recur despite attempted repair. To date, much of the literature is underpowered and divergent. As a result there is limited high quality evidence to inform surgeons succinctly which perioperative variables influence postoperative recurrence. This systematic review aimed to identify predictors of ventral hernia recurrence.

Methods: PubMed was searched for studies reporting prognostic data of ventral hernia recurrence between 1 January 1995 and 1 January 2018. Extracted data described hernia type (primary/incisional), definitions of recurrence, methods used to detect recurrence, duration of follow-up, and co-morbidity. Data were extracted for all potential predictors, estimates and thresholds described. Random-effects meta-analysis was used. Bias was assessed with a modified PROBAST (Prediction model Risk Of Bias ASsessment Tool).

Results: Screening of 18 214 abstracts yielded 274 individual studies for inclusion. Hernia recurrence was defined in 66 studies (24.1 per cent), using 41 different unstandardized definitions. Three patient variables (female sex, age 65 years or less, and BMI greater than 25, 30, 35 or 40 kg/m2), five patient co-morbidities (smoking, diabetes, chronic obstructive pulmonary disease, ASA grade III-IV, steroid use), two hernia-related variables (incisional/primary, recurrent/primary), six intraoperative variables (biological mesh, bridged repair, open versus laparoscopic surgery, suture versus mesh repair, onlay/retrorectus, intraperitoneal/retrorectus), and six postoperative variables (any complication, surgical-site occurrence, wound infection, seroma, haematoma, wound dehiscence) were identified as significant prognostic factors for hernia recurrence.

Conclusion: This study summarized the current evidence base for predicting ventral hernia recurrence. Results should inform best practice and future research.

Fig. 1

PRISMA diagram showing selection of studies for review

Fig. 2

Risk-of-bias graph using an adapted version of the PROBAST The graph illustrates the present authors’ judgements for each risk-of-bias category, presented as percentages across all included studies. PROBAST, Prediction model Risk Of Bias ASsessment Tool.

Fig. 3

Overall meta-analysis results, showing the number of studies, patients and hernia recurrence events Values in parentheses are 95 per cent confidence intervals. Weights are from random-effects analysis. OR, odds ratio; BPH, benign prostatic hypertrophy; COPD, chronic obstructive pulmonary disease; VHWG, Ventral Hernia Working Group; SSO, surgical-site occurrence. Further details, including the population/hernia type, can be found in Appendix S6.