Analysis of related factors of recurrence after abdominal incisional hernia repair_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XU Boyu ^1,2 , WU Yunhua ¹ , NIE Lingzhi ¹ , SHI Shuai ¹ , ZHANG Jin ¹ ,  DUAN Xianglong ^1,2

1. Second Department of General Surgery, Shaanxi Provincial People’s Hospital, Affiliated of Xi'an Medical University, Xi’an 710068, P. R. China;
2. XI’AN Medical University, Xi’an 710068, P. R. China;

Corresponding?author：

DUAN Xianglong, Email: duanxl@21cn.com

Keywords：

Incisional hernia; laparoscopic surgery; open surgery; recurrence; risk factor

DOI：

10.7507/1007-9424.202106021

Video：

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Objective To explore the incidence of postoperative recurrence of abdominal incisional hernia and its related risk factors. Methods The clinical data of 213 patients with abdominal incisional hernia treated in the General Surgery of Shaanxi Provincial People’s Hospital from January 2015 to December 2019 were collected retrospectively, and the incidence of postoperative recurrence of abdominal incisional hernia and its related influencing factors were analyzed. Results A total of 213 patients underwent a complete follow-up. The follow-up time was 3 to 60 months, and the median follow-up time was 46 months. A total of 24 cases (11.27%) of hernia recurred after surgery. The univariate analysis results showed that body mass index (BMI), hernia ring size, incarceration, recurrent hernia, history of multiple abdominal operations, postoperative incision complications, factors such as increased abdominal pressure, and whether the patch were used for postoperative recurrence of abdominal incisional hernia influences (P<0.05). Further logistic multi-factor analysis results showed that BMI [OR=1.14, 95%CI (1.01, 1.29), P=0.040], incarcerated hernia [OR=8.94, 95%CI (1.94, 40.98), P=0.005], recurrent hernia [OR=10.91, 95%CI (2.09, 56.84), P=0.005], and hernia ring size [OR=1.15, 95%CI (1.03, 1.28), P=0.010] were related to the recurrence of abdominal incisional hernia after surgery (P<0.05). Conclusions The risk factors for hernia recurrence after abdominal incisional hernia repair include recurrent hernia, incarcerated hernia, hernia ring size, and BMI. For patients with high-risk factors, corresponding measures should be taken to prevent hernia recurrence.

Citation： XU Boyu, WU Yunhua, NIE Lingzhi, SHI Shuai, ZHANG Jin, DUAN Xianglong. Analysis of related factors of recurrence after abdominal incisional hernia repair. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(3): 322-327. doi: 10.7507/1007-9424.202106021 Copy

1.	Rios-Diaz AJ, Cunning J, Hsu JY, et al. Incidence, burden on the health care system, and factors associated with incisional hernia after trauma laparotomy. JAMA Surg, 2021, 156(9): e213104. doi: 10.1001/jamasurg.2021.3104.
2.	Tarasova NK, Dynkov SM, Pozdeev VN, et al. Analysis of the causes of recurrent postoperative ventral hernias. Khirurgiia (Mosk), 2019, 10): 36-42.
3.	Blatnik JA, Michael Brunt L. Controversies and techniques in the repair of abdominal wall hernias. J Gastrointest Surg, 2019, 23(4): 837-45.
4.	Romain B, Renard Y, Binquet C, et al. Recurrence after elective incisional hernia repair is more frequent than you think: An international prospective cohort from the French Society of Surgery. Surgery, 2020, 168(1): 125-134.
5.	中華醫學會健康管理學分會, 中國營養學會, 中國醫療保健國際交流促進會生殖醫學分會, 等. 超重或肥胖人群體重管理專家共識及團體標準. 中華健康管理學雜志, 2018, 12(3): 200-207.
6.	中華醫學會外科學分會疝與腹壁外科學組, 中國醫師協會外科醫師分會疝和腹壁外科醫師委員會. 腹壁切口疝診斷和治療指南(2018年版). 中華疝和腹壁外科雜志(電子版), 2018, 12(4): 241-243.
7.	王明剛, 劉雨辰, 曹金鑫. 手術治療腹壁切口疝的歷史與現狀. 腹腔鏡外科雜志, 2017, 22(2): 81-85.
8.	Sauerland S, Korenkov M, Kleinen T, et al. Obesity is a risk factor for recurrence after incisional hernia repair. Hernia, 2004, 8(1): 42-46.
9.	van Silfhout L, Leenders LAM, Heisterkamp J, et al. Recurrent incisional hernia repair: surgical outcomes in correlation with body-mass index. Hernia, 2021, 25(1): 77-83.
10.	陳亞柯, 陳建民, 王殿琢, 等. 3種不同層次間放置補片治療腹壁疝的臨床療效. 中國普外基礎與臨床雜志, 2021, 28(1): 38-42.
11.	Varela JE, Hinojosa M, Nguyen N. Correlations between intra-abdominal pressure and obesity-related co-morbidities. Surg Obes Relat Dis, 2009, 5(5): 524-528.
12.	Lambert DM, Marceau S, Forse RA. Intra-abdominal pressure in the morbidly obese. Obes Surg, 2005, 15(9): 1225-1232.
13.	Aquina CT, Rickles AS, Probst CP, et al. Visceral obesity, not elevated BMI, is strongly associated with incisional hernia after colorectal surgery. Dis Colon Rectum, 2015, 58(2): 220-227.
14.	Mercoli H, Tzedakis S, D’Urso A, et al. Postoperative complications as an independent risk factor for recurrence after laparoscopic ventral hernia repair: a prospective study of 417 patients with long-term follow-up. Surg Endosc, 2017, 31(3): 1469-1477.
15.	Cox TC, Blair LJ, Huntington CR, et al. The cost of preventable comorbidities on wound complications in open ventral hernia repair. J Surg Res, 2016, 206(1): 214-222.
16.	Kaoutzanis C, Leichtle SW, Mouawad NJ, et al. Risk factors for postoperative wound infections and prolonged hospitalization after ventral/incisional hernia repair. Hernia, 2015, 19(1): 113-123.
17.	Menzo EL, Hinojosa M, Carbonell A, et al. American Society for Metabolic and Bariatric Surgery and American Hernia Society consensus guideline on bariatric surgery and hernia surgery. Surg Obes Relat Dis, 2018, 14(9): 1221-1232.
18.	Chandeze MM, Moszkowicz D, Beauchet A, et al. Ventral hernia surgery in morbidly obese patients, immediate or after bariatric surgery preparation: Results of a case-matched study. Surg Obes Relat Dis, 2019, 15(1): 83-88.
19.	楊良, 范慶, 魏士博, 等. 國際內鏡疝學會腹壁疝和切口疝腹腔鏡治療指南更新解讀(一). 中華疝和腹壁外科雜志(電子版), 2019, 13(4): 289-293.
20.	Köckerling F, Koch A, Lorenz R, et al. How long do we need to follow-up our hernia patients to find the real recurrence rate? Front Surg, 2015, 2: 24. doi: 10.3389/fsurg.2015.00024.
21.	Helgstrand F, Rosenberg J, Kehlet H, et al. Nationwide prospective study of outcomes after elective incisional hernia repair. J Am Coll Surg, 2013, 216(2): 217-228.
22.	Flum DR, Horvath K, Koepsell T. Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg, 2003, 237(1): 129-135.
23.	Juvany M, Hoyuela C, Trias M, et al. Impact of surgical site infections on elective incisional hernia surgery: a prospective study. Surg Infect (Larchmt), 2018 Feb 13. Online ahead of print. doi: 10.1089/sur.2017.233.
24.	Luijendijk RW, Hop WC, van den Tol MP, et al. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med, 2000, 343(6): 392-398.
25.	Nardi M, Millo P, Brachet Contul R, et al. Laparoscopic ventral hernia repair with composite mesh: Analysis of risk factors for recurrence in 185 patients with 5 years follow-up. Int J Surg, 2017, 40: 38-44.
26.	周力, 王曉輝, 李小軍, 等. 切口疝無張力修補術后復發的多因素分析. 中國普外基礎與臨床雜志, 2015, 22(8): 972-976.

1. Rios-Diaz AJ, Cunning J, Hsu JY, et al. Incidence, burden on the health care system, and factors associated with incisional hernia after trauma laparotomy. JAMA Surg, 2021, 156(9): e213104. doi: 10.1001/jamasurg.2021.3104.
2. Tarasova NK, Dynkov SM, Pozdeev VN, et al. Analysis of the causes of recurrent postoperative ventral hernias. Khirurgiia (Mosk), 2019, 10): 36-42.
3. Blatnik JA, Michael Brunt L. Controversies and techniques in the repair of abdominal wall hernias. J Gastrointest Surg, 2019, 23(4): 837-45.
4. Romain B, Renard Y, Binquet C, et al. Recurrence after elective incisional hernia repair is more frequent than you think: An international prospective cohort from the French Society of Surgery. Surgery, 2020, 168(1): 125-134.
5. 中華醫學會健康管理學分會, 中國營養學會, 中國醫療保健國際交流促進會生殖醫學分會, 等. 超重或肥胖人群體重管理專家共識及團體標準. 中華健康管理學雜志, 2018, 12(3): 200-207.
6. 中華醫學會外科學分會疝與腹壁外科學組, 中國醫師協會外科醫師分會疝和腹壁外科醫師委員會. 腹壁切口疝診斷和治療指南(2018年版). 中華疝和腹壁外科雜志(電子版), 2018, 12(4): 241-243.
7. 王明剛, 劉雨辰, 曹金鑫. 手術治療腹壁切口疝的歷史與現狀. 腹腔鏡外科雜志, 2017, 22(2): 81-85.
8. Sauerland S, Korenkov M, Kleinen T, et al. Obesity is a risk factor for recurrence after incisional hernia repair. Hernia, 2004, 8(1): 42-46.
9. van Silfhout L, Leenders LAM, Heisterkamp J, et al. Recurrent incisional hernia repair: surgical outcomes in correlation with body-mass index. Hernia, 2021, 25(1): 77-83.
10. 陳亞柯, 陳建民, 王殿琢, 等. 3種不同層次間放置補片治療腹壁疝的臨床療效. 中國普外基礎與臨床雜志, 2021, 28(1): 38-42.
11. Varela JE, Hinojosa M, Nguyen N. Correlations between intra-abdominal pressure and obesity-related co-morbidities. Surg Obes Relat Dis, 2009, 5(5): 524-528.
12. Lambert DM, Marceau S, Forse RA. Intra-abdominal pressure in the morbidly obese. Obes Surg, 2005, 15(9): 1225-1232.
13. Aquina CT, Rickles AS, Probst CP, et al. Visceral obesity, not elevated BMI, is strongly associated with incisional hernia after colorectal surgery. Dis Colon Rectum, 2015, 58(2): 220-227.
14. Mercoli H, Tzedakis S, D’Urso A, et al. Postoperative complications as an independent risk factor for recurrence after laparoscopic ventral hernia repair: a prospective study of 417 patients with long-term follow-up. Surg Endosc, 2017, 31(3): 1469-1477.
15. Cox TC, Blair LJ, Huntington CR, et al. The cost of preventable comorbidities on wound complications in open ventral hernia repair. J Surg Res, 2016, 206(1): 214-222.
16. Kaoutzanis C, Leichtle SW, Mouawad NJ, et al. Risk factors for postoperative wound infections and prolonged hospitalization after ventral/incisional hernia repair. Hernia, 2015, 19(1): 113-123.
17. Menzo EL, Hinojosa M, Carbonell A, et al. American Society for Metabolic and Bariatric Surgery and American Hernia Society consensus guideline on bariatric surgery and hernia surgery. Surg Obes Relat Dis, 2018, 14(9): 1221-1232.
18. Chandeze MM, Moszkowicz D, Beauchet A, et al. Ventral hernia surgery in morbidly obese patients, immediate or after bariatric surgery preparation: Results of a case-matched study. Surg Obes Relat Dis, 2019, 15(1): 83-88.
19. 楊良, 范慶, 魏士博, 等. 國際內鏡疝學會腹壁疝和切口疝腹腔鏡治療指南更新解讀(一). 中華疝和腹壁外科雜志(電子版), 2019, 13(4): 289-293.
20. Köckerling F, Koch A, Lorenz R, et al. How long do we need to follow-up our hernia patients to find the real recurrence rate? Front Surg, 2015, 2: 24. doi: 10.3389/fsurg.2015.00024.
21. Helgstrand F, Rosenberg J, Kehlet H, et al. Nationwide prospective study of outcomes after elective incisional hernia repair. J Am Coll Surg, 2013, 216(2): 217-228.
22. Flum DR, Horvath K, Koepsell T. Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg, 2003, 237(1): 129-135.
23. Juvany M, Hoyuela C, Trias M, et al. Impact of surgical site infections on elective incisional hernia surgery: a prospective study. Surg Infect (Larchmt), 2018 Feb 13. Online ahead of print. doi: 10.1089/sur.2017.233.
24. Luijendijk RW, Hop WC, van den Tol MP, et al. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med, 2000, 343(6): 392-398.
25. Nardi M, Millo P, Brachet Contul R, et al. Laparoscopic ventral hernia repair with composite mesh: Analysis of risk factors for recurrence in 185 patients with 5 years follow-up. Int J Surg, 2017, 40: 38-44.
26. 周力, 王曉輝, 李小軍, 等. 切口疝無張力修補術后復發的多因素分析. 中國普外基礎與臨床雜志, 2015, 22(8): 972-976.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of related factors of recurrence after abdominal incisional hernia repair

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