Authors’ Reply: Outcomes of Incisional Hernia Repair Surgery After Multiple Recurrences: A Propensity Score-Matched Analysis

Background & Aims: Although incisional hernia repair in women of childbearing age is not rare, hernia disease in this group of patients is sparsely documented. The aim of this study was to examine long-term clinical results after incisional hernia repair in women of childbearing age. Material and methods: This nationwide cohort study examined incisional hernia repair from 2007 to 2013 in women of childbearing age, registered prospectively in the Danish Ventral Hernia Database. All women with a subsequent pregnancy were included, and a 1:3 propensity-score matched group of women with an incisional hernia repair without a subsequent pregnancy. A prospective follow-up was conducted, including a validated questionnaire. The primary outcome was recurrence, and the secondary outcome was chronic pain from the operated site. Results: In total, 124 (70.5%) women responded, 47 and 77 women with and without a subsequent pregnancy, respectively. The 5-year cumulative incidence of recurrence was 41.0% (95% confidence interval 32.0%–49.9%). After adjustment for potential confounders, subsequent pregnancy was independently associated with recurrence (hazard ratio 1.83, 95% confidence interval 1.02–3.29, p = 0.044). Twenty-six (21.0%) women reported chronic pain (moderate, n = 21; severe, n = 5) with no difference between women with and without a subsequent pregnancy. Hernia recurrence, higher body mass index, and smoking were associated with chronic pain. Conclusion: Pregnancy following incisional hernia repair was associated with an increased risk of recurrence, but not with chronic pain.

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Female sex as independent risk factor for chronic pain following elective incisional hernia repair: registry-based, propensity score-matched comparison

Hernia ◽

10.1007/s10029-019-02089-2 ◽

2019 ◽

Vol 24 (3) ◽

pp. 567-576 ◽

Cited By ~ 3

Author(s):

F. Köckerling ◽

H. Hoffmann ◽

D. Adolf ◽

D.Weyhe ◽

W. Reinpold ◽

...

Keyword(s):

Chronic Pain ◽

Risk Factor ◽

Propensity Score ◽

Incisional Hernia ◽

Hernia Repair ◽

Surgical Procedures ◽

Independent Risk Factor ◽

Incisional Hernia Repair ◽

Female Sex ◽

Onlay Technique

Abstract Introduction To date, little attention has been paid by surgical scientific studies to sex as a potential influence factor on the outcome. Therefore, there is a sex bias in the surgical literature. With an incidence of more than 20% after 3 years, incisional hernias are a common complication following abdominal surgical procedures. The proportion of women affected is around 50%. There are very few references in the literature to the influence of sex on the outcome of elective incisional hernia repair. Materials and methods In all, 22,895 patients with elective incisional hernia repair from the Herniamed Registry were included in the study. The patients had undergone elective incisional hernia repair in a laparoscopic IPOM, open sublay, open IPOM, open onlay or suture technique. 1-year follow-up was available for all patients. Propensity score matching was performed for the 11,480 female (50.1%) and 11,415 male (49.9%) patients, creating 8138 pairs (82.0%) within fixed surgical procedures. Results For pain on exertion (11.7% vs 18.3%; p < 0.001), pain at rest (7.53% vs 11.1%; p < 0.001), and pain requiring treatment (5.4% vs 9.1%; p < 0.001) highly significant disadvantages were identified for the female sex when comparing the different results within the matched pairs. That was also confirmed on comparing sex within the individual surgical procedures. No sex-specific differences were identified for the postoperative complications, complication-related reoperations or recurrences. Less favorable intraoperative complication results in the female sex were observed only for the onlay technique. Conclusions Female sex is an independent risk factor for chronic pain after elective incisional hernia repair.

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Long-term results of laparoscopic versus open intraperitoneal onlay mesh incisional hernia repair: a propensity score-matched analysis

Surgical Endoscopy ◽

10.1007/s00464-018-6298-6 ◽

2018 ◽

Vol 33 (1) ◽

pp. 225-233 ◽

Cited By ~ 10

Author(s):

Joël L. Lavanchy ◽

Stefan E. Buff ◽

Andreas Kohler ◽

Daniel Candinas ◽

Guido Beldi

Keyword(s):

Propensity Score ◽

Incisional Hernia ◽

Hernia Repair ◽

Incisional Hernia Repair ◽

Long Term Results ◽

Intraperitoneal Onlay Mesh ◽

Onlay Mesh

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Mesh fixation to fascia during incisional hernia repair results in increased prevalence of pain at long-term follow up: a multicenter propensity score matched prospective observational study

Surgical Endoscopy ◽

10.1007/s00464-021-08355-8 ◽

2021 ◽

Author(s):

Andreas Kohler ◽

Joël L. Lavanchy ◽

Rahel Gasser ◽

Roland Wyss ◽

Lars Nowak ◽

...

Keyword(s):

Postoperative Pain ◽

Propensity Score ◽

Incisional Hernia ◽

Hernia Repair ◽

Mesh Fixation ◽

Incisional Hernia Repair ◽

Hernia Recurrence ◽

Long Term Follow Up

Abstract Background Patient-reported outcomes such as postoperative pain are critical for the evaluation of outcomes after incisional hernia repair. The aim of this study is to determine the long-term impact of mesh fixation on postoperative pain in patients operated by open and laparoscopic technique. Methods A multicenter prospective observational cohort study was conducted from September 2011 until March 2016 in nine hospitals across Switzerland. Patients undergoing elective incisional hernia repair were included in this study and stratified by either laparoscopic or open surgical technique. Propensity score matching was applied to balance the differences in baseline characteristics between the treatment groups. Clinical follow-up was conducted 3, 12 and 36 months postoperatively to detect hernia recurrence, postoperative pain and complications. Results Three-hundred-sixty-one patients were included into the study. No significant differences in hernia recurrence and pain at 3, 12 and 36 months postoperatively were observed when comparing the laparoscopic with the open treatment group. Mesh fixation by sutures to fascia versus other mesh fixation led to significantly more pain at 36 months postoperatively (32.8% vs 15.7%, p = 0.025). Conclusions At long-term follow-up, no difference in pain was identified between open and laparoscopic incisional hernia repair. Mesh fixation by sutures to fascia was identified to be associated with increased pain 36 months after surgery. Omitting mesh fixation by sutures to the fascia may reduce long-term postoperative pain after hernia repair.

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