Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Oct;36(10):7731-7737.
doi: 10.1007/s00464-022-09101-4. Epub 2022 Mar 1.

Emergent and urgent ventral hernia repair: comparing recurrence rates amongst procedures utilizing mesh versus no mesh

Rachel Whittaker  1 , Zachary Lewis  1 , Margaret A Plymale  2 , Michael Nisiewicz  3 , Ajadi Ebunoluwa  3 , Daniel L Davenport  2 , Jessica K Reynolds  2 , John Scott Roth  4   5
Affiliations

Emergent and urgent ventral hernia repair: comparing recurrence rates amongst procedures utilizing mesh versus no mesh

Rachel Whittaker et al. Surg Endosc. 2022 Oct.

Abstract

Background: The decision for emergent and urgent ventral hernia repair (VHR) is driven by acute symptomatology, concern for incarceration and strangulation, and perforation. Although mesh has been established to reduce hernia recurrences, the potential for mesh complications may impact the decision for utilization in emergent repairs. This study evaluates hernia repair outcomes in the emergent setting with/without mesh.

Methods: An IRB-approved review of NSQIP and retrospective chart review data of emergent/urgent VHRs performed between 2013 and 2017 was conducted at a single academic institution. Six-month postoperative emergency department and surgery clinic visits, hospital readmissions, and hernia recurrences were recorded. Patients were grouped based on mesh utilization. Perioperative and outcome variables were compared using Chi-square, Fisher's exact, and t-tests.

Results: Among 94 patients, 41 (44%) received mesh; 53 (56%) did not. Synthetic mesh was used in 27 cases (65.9%); bioresorbable or biologic mesh was used in 14 cases (34.1%). ASA class (p = 0.016) was higher in the no-mesh group, as were emergent vs. urgent cases (p ≤ 0.001). Preoperative SIRS/Sepsis, COPD, and diabetes were increased in the no-mesh group. Hernia recurrence was significantly higher in the no-mesh group vs. the mesh group (24.5% vs. 7.3%, p = 0.03). No difference was found in wound complications between groups. ED visits occurred almost twice as often in the mesh group (42% vs. 23%, p = 0.071). Postoperative surgery clinic visits were more frequent among the mesh group (> 1 visit 61% vs. 24%, p = 0.004).

Conclusions: Mesh-based hernia repairs in the urgent/emergent patient population are performed in fewer than half of patients in our tertiary care referral center. Repairs without mesh were associated with over a three-fold increase in recurrence without a difference in the risk of infectious complications. Efforts to understand the rationale for suture-based repair compared to mesh repair are needed to reduce hernia recurrences in the emergent population.

Keywords: Emergent ventral hernia repair; Urgent ventral hernia repair; Ventral hernia mesh repair; Ventral hernia recurrence.

PubMed Disclaimer

References

    1. Mrdutt MM, Munoz-Maldonado Y, Regner JL (2016) Impact of obesity on post-operative 30-day outcomes in emergent open ventral hernia repairs. Am J Surg 212:1068–1075. https://doi.org/10.1016/j.amjsurg.2016.09.007 - DOI - PubMed
    1. Poulose BK, Shelton J, Phillips S, Moore D, Nealon W, Penson D, Holzman MD (2012) Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia 16:179–183. https://doi.org/10.1007/s10029-011-0879-9 - DOI - PubMed
    1. Kao AM, Huntington CR, Otero J, Prasad T, Augenstein VA, Lincourt AE, Colavita PD, Heniford BT (2018) Emergent laparoscopic ventral hernia repairs. J Surg Res 232:497–502. https://doi.org/10.1016/j.jss.2018.07.034 - DOI - PubMed
    1. Beadles CA, Meagher AD, Charles AG (2015) Trends in emergent hernia repair in the United States. JAMA Surg 150:194–200. https://doi.org/10.1001/jamasurg.2014.1242 - DOI - PubMed
    1. Simon KL, Frelich MJ, Gould JC, Zhao HS, Szabo A, Goldblatt MI (2015) Inpatient outcomes after elective versus nonelective ventral hernia repair. J Surg Res 198:305–310. https://doi.org/10.1016/j.jss.2015.03.073 - DOI - PubMed - PMC

Substances

LinkOut - more resources