Hernia : the journal of hernias and abdominal wall surgery · 2026
Repair of elective epigastric hernias in adults: nationwide registry study of short- and long-term complications requiring reoperation.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Fredberg Jeppe, Oma Erling, Brandenburger Nils, Öztoprak Mehmet, Helgstrand Frederik, Jørgensen Lars N
Аннотация
PURPOSE: To define the role of different mesh positions in elective epigastric hernia repair (EHR) for fascial defects < 10 cm.
METHODS: A retrospective nationwide Danish cohort of adult patients undergoing EHR from 2017 to 2020, ensuring complete follow-up on December 31, 2023, through nationwide registries and scrutiny of all operative notes of subsequent re-interventions. Primary outcome was reoperation for recurrence. Secondary outcomes were reoperation for non-recurrence and any complications. Multivariable analyses were performed using Cox proportional hazards regression, with Firth's penalized likelihood when applicable.
RESULTS: Among 1,112 patients included, 69.2% underwent mesh repair. Median follow-up was 4.77 years. Mesh repair had significant lower risk of reoperation for hernia recurrence than suture repair (hazard-ratio (HR) 0.28, p = 0.007). Open preperitoneal, retromuscular, or intraperitoneal (open sublay or open IPOM) and laparoscopic intraperitoneal onlay mesh (lap-IPOM) were independently associated with lower recurrence risk compared with suture repair (p < 0.001 and p = 0.006). Reoperation for non-recurrence complications was more frequent after mesh repair than after suture repair (5.27, p = 0.029). Open onlay and lap-IPOM were associated with a nearly sevenfold increased risk of non-recurrence complications (p = 0.014 and p = 0.033). Few non-recurrence complications were directly mesh-related, and severe complications were rare. Open sublay or open IPOM repair was associated with a reduced risk of reoperation for any complication (0.21, p = 0.039).
CONCLUSION: Mesh repair was associated with reduced reoperation for hernia recurrence, but increased risk of non-recurrence complications compared with suture repair, resulting in a comparable overall risk of reoperation. Open sublay or open IPOM repair demonstrated the most favorable profile, with reduced recurrence and few overall complications, whereas open onlay and lap-IPOM were associated with increased non-recurrence complications.
TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT06783036.
METHODS: A retrospective nationwide Danish cohort of adult patients undergoing EHR from 2017 to 2020, ensuring complete follow-up on December 31, 2023, through nationwide registries and scrutiny of all operative notes of subsequent re-interventions. Primary outcome was reoperation for recurrence. Secondary outcomes were reoperation for non-recurrence and any complications. Multivariable analyses were performed using Cox proportional hazards regression, with Firth's penalized likelihood when applicable.
RESULTS: Among 1,112 patients included, 69.2% underwent mesh repair. Median follow-up was 4.77 years. Mesh repair had significant lower risk of reoperation for hernia recurrence than suture repair (hazard-ratio (HR) 0.28, p = 0.007). Open preperitoneal, retromuscular, or intraperitoneal (open sublay or open IPOM) and laparoscopic intraperitoneal onlay mesh (lap-IPOM) were independently associated with lower recurrence risk compared with suture repair (p < 0.001 and p = 0.006). Reoperation for non-recurrence complications was more frequent after mesh repair than after suture repair (5.27, p = 0.029). Open onlay and lap-IPOM were associated with a nearly sevenfold increased risk of non-recurrence complications (p = 0.014 and p = 0.033). Few non-recurrence complications were directly mesh-related, and severe complications were rare. Open sublay or open IPOM repair was associated with a reduced risk of reoperation for any complication (0.21, p = 0.039).
CONCLUSION: Mesh repair was associated with reduced reoperation for hernia recurrence, but increased risk of non-recurrence complications compared with suture repair, resulting in a comparable overall risk of reoperation. Open sublay or open IPOM repair demonstrated the most favorable profile, with reduced recurrence and few overall complications, whereas open onlay and lap-IPOM were associated with increased non-recurrence complications.
TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT06783036.