A systematic methodological review of reported perioperative variables, postoperative outcomes and hernia recurrence from randomised controlled trials of elective ventral hernia repair: clear definitions and standardised datasets are needed

Abstract Purpose Inguinal hernia repair using surgical mesh is a very common surgical operation. Currently, there is no consensus on the best technique for mesh fixation. We conducted an overview of existing systematic reviews (SRs) of randomised controlled trials to compare the risk of chronic pain and recurrence following open and laparoscopic inguinal hernia repairs using various mesh fixation techniques. Methods We searched major electronic databases in April 2020 and assessed the methodological quality of identified reviews using the AMSTAR-2 tool. Results We identified 20 SRs of variable quality assessing suture, self-gripping, glue, and mechanical fixation. Across reviews, the risk of chronic pain after open mesh repair was lower with glue fixation than with suture and comparable between self-gripping and suture. Incidence of chronic pain was lower with glue fixation than with mechanical fixation in laparoscopic repairs. There were no significant differences in recurrence rates between fixation techniques in open and laparoscopic mesh repairs, although fewer recurrences were reported with suture. Many reviews reported wide confidence intervals around summary estimates. Despite no clear evidence of differences among techniques, two network meta-analyses (one assessing open repairs and one laparoscopic repairs) ranked glue fixation as the best treatment for reducing pain and suture for reducing the risk of recurrence. Conclusion Glue fixation may be effective in reducing the incidence of chronic pain without increasing the risk of recurrence. Future research should consider both the effectiveness and cost-effectiveness of fixation techniques alongside the type of mesh and the size and location of the hernia defect.

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Laparoscopic vs Robotic Ventral Hernia Repair: 1-Year Postoperative Outcomes from the PROVE-IT Trial

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2021.07.144 ◽

2021 ◽

Vol 233 (5) ◽

pp. S79

Author(s):

Jonah D. Thomas ◽

Clayton C. Petro ◽

Katherine C. Montelione ◽

Samuel J. Zolin ◽

David M. Krpata ◽

...

Keyword(s):

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Postoperative Outcomes ◽

Robotic Ventral Hernia Repair

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Recurrence and Pseudorecurrence after Laparoscopic Ventral Hernia Repair: Predictors and Patient-focused Outcomes

The American Surgeon ◽

10.1177/000313481408000221 ◽

2014 ◽

Vol 80 (2) ◽

pp. 138-148 ◽

Cited By ~ 30

Author(s):

Stacey A. Carter ◽

Stephanie C. Hicks ◽

Reshma Brahmbhatt ◽

Mike K. Liang

Keyword(s):

Surgical Technique ◽

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Multivariate Analyses ◽

Surgical Site Infections ◽

Hernia Recurrence ◽

Laparoscopic Ventral Hernia Repair ◽

Factors Associated ◽

Hernia Size

Laparoscopic ventral hernia repair (LVHR) is gaining popularity as an option to repair abdominal wall hernias. Bulging after repair remains common after this technique. This study evaluates the incidence and factors associated with bulging after LVHR. Between 2000 and 2010, 201 patients underwent LVHR at two affiliated institutions. Patients who developed recurrence or pseudorecurrence (seroma or eventration) were analyzed with univariate and multivariate analyses to identify predictors of these complications. Of the 201 patients who underwent LVHR, 40 (19.9%) patients developed a seroma, 63 (31.3%) patients had radiographically proven eventration, and 25 (12.4%) patients had a hernia recurrence. On multivariate analysis, seromas were associated with number of prior ventral hernia repairs, surgical site infections, and prostate disease. Mesh eventration was associated with hernia size and surgical technique. Tissue eventration was associated with primary hernias and surgical technique. Hernia recurrence was associated with incisional hernias and mesh type used. Recurrence and pseudorecurrence are important complications after LVHR. Large hernia size, infections, and surgical technique are important clinical factors that affect outcomes after LVHR.

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Effects of Malignancy on Hernia Recurrence and Perioperative Outcomes of Laparoscopic Ventral Hernia Repair

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2016.08.196 ◽

2016 ◽

Vol 223 (4) ◽

pp. e75

Author(s):

Raul J. Rosenthal ◽

Sherif Y. Shalaby ◽

David Gutierrez Blanco ◽

Emanuele Lo Menzo ◽

Samuel Szomstein

Keyword(s):

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Hernia Recurrence ◽

Laparoscopic Ventral Hernia Repair ◽

Perioperative Outcomes

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Does negative pressure wound therapy applied to closed incisions following ventral hernia repair prevent wound complications and hernia recurrence? A systematic review and meta-analysis

Plastic Surgery ◽

10.1177/229255031602400207 ◽

2016 ◽

Vol 24 (2) ◽

pp. 113-118 ◽

Cited By ~ 16

Author(s):

Edward W Swanson ◽

Hsu-Tang Cheng ◽

Srinivas M Susarla ◽

Denver M Lough ◽

Anand R Kumar

Keyword(s):

Systematic Review ◽

Hernia Repair ◽

Ventral Hernia ◽

Negative Pressure ◽

Ventral Hernia Repair ◽

Negative Pressure Wound Therapy ◽

Meta Analysis ◽

Hernia Recurrence ◽

Wound Complications ◽

Wound Therapy

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A Prospective, Single Arm, Multi-Center Study Evaluating the Clinical Outcomes of Ventral Hernias Treated with OviTex® 1S Permanent Reinforced Tissue Matrix: The BRAVO Study 12-Month Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10214998 ◽

2021 ◽

Vol 10 (21) ◽

pp. 4998

Author(s):

George DeNoto ◽

Eugene P. Ceppa ◽

Salvatore J. Pacella ◽

Michael Sawyer ◽

Geoffrey Slayden ◽

...

Keyword(s):

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Hernia Recurrence ◽

Patient Reported ◽

Multi Center Study ◽

Tissue Matrix ◽

Ventral Hernias ◽

Center Study

Background: Conflicting results from previous studies have led to dissent over whether surgical mesh is safe and effective in ventral hernia repair. A newer class of mesh known as a reinforced tissue matrix, combining a biologic scaffold and minimal polymer reinforcement, offers promise in reducing inflammatory response and increasing abdominal wall support. This study sought to assess the clinical utility of a reinforced tissue matrix (OviTex) in ventral hernia repair 12 months after implantation. Methods: This is a prospective, single-arm, multi-center study to evaluate the clinical performance of OviTex® 1S Permanent (OviTex) in the repair of primary or recurrent ventral hernias (VH) in consecutive patients (ClinicalTrials.gov/NCT03074474). The rate of surgical site occurrences (SSOs) was evaluated 90 days post-surgery as the primary endpoint. Hernia recurrence and the incidence of postoperative events were evaluated between three and 12 months as secondary endpoints. The incidence of other complications and patient-reported outcomes were also recorded. Results: Ninety-two (92) patients were enrolled in the study, of whom seventy-six (76) reached the 12-month follow-up. All patients were at least 18 years of age with a BMI of <40 kg/m2. Hernia defects were <20 × 20 cm, classified as class I–III according to the CDC wound classification system. Of the 76 patients who reached 12-month follow-up, twenty-six (34%) had previous VH repairs and thirteen (17%) had previous surgical infection. Sixty (79%) had factors known to increase the risk of recurrence. Twenty patients (26%) experienced SSOs, with ten (13%) requiring procedural intervention. Two of the 75 patients (2.7%) experienced a recurrence. Conclusions: The low rate of hernia recurrence and SSOs requiring intervention illustrates the potential that reinforced tissue matrices, and OviTex 1S, in particular, have to improve outcomes in VH repairs. Follow-up to 24 months is ongoing.

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