Long term Recurrence and Complications Associated With Elective Incisional Hernia Repair.
Importance Prosthetic mesh is frequently used to reinforce the repair of abdominal wall incisional hernias. The benefits of mesh for reducing the risk of hernia recurrence or the long term risks of mesh related complications are not known. Objective To investigate the risks of long term recurrence and mesh related complications following elective abdominal wall hernia repair in a population with complete follow up. Design, Setting, and Participants Registry based nationwide cohort study including all elective incisional hernia repairs in Denmark from January 1, 2007, to December 31, 2010. A total of 3242 patients with incisional repair were included. Follow up until November 1, 2014, was obtained by merging data with prospective registrations from the Danish National Patient Registry supplemented with a retrospective manual review of patient records. A 100% follow up rate was obtained. Exposures Hernia repair using mesh performed by either open or laparoscopic techniques vs open repair without use of mesh. Main Outcomes and Measures Five year risk of reoperation for recurrence and 5 year risk of all mesh related complications requiring subsequent surgery. Results Among the 3242 patients (mean age, 58.5 [SD, 13.5] years; 1720 women [53.1% 1119 underwent open mesh repair (34.5% 366 had open nonmesh repair (11.3% and 1757 had laparoscopic mesh repair (54.2% The median follow up after open mesh repair was 59 (interquartile range [IQR] 44 80) months, after nonmesh open repair was 62 (IQR, 44 79) months, and after laparoscopic mesh repair was 61 (IQR, 48 78) months. The risk of the need for repair for recurrent hernia following these initial hernia operations was lower for patients with open mesh repair (12.3% [95% CI, 10.4% 14.3% risk difference, 4.8% [95% CI, 9.1% to 0.5% and for patients with laparoscopic mesh repair (10.6% [95% CI, 9.2% 12.1% risk difference, 6.5% [95% CI, 10.6% to 2.4% compared with nonmesh repair (17.1% [95% CI, 13.2% 20.9% For the entirety of the follow up duration, there was a progressively increasing number of mesh related complications for both open and laparoscopic procedures. At 5 years of follow up, the cumulative incidence of mesh related complications was 5.6% (95% CI, 4.2% 6.9% for patients who underwent open mesh hernia repair and 3.7% (95% CI, 2.8% 4.6% for patients who underwent laparoscopic mesh repair. The long term repair related complication rate for patients with an initial nonmesh repair was 0.8% (open nonmesh repair vs open mesh repair: risk difference, 5.3% [95% CI, 4.4% 6.2% open nonmesh repair vs laparoscopic mesh repair: risk difference, 3.4% [95% CI, 2.7% 4.1% Conclusions and Relevance Among patients undergoing incisional repair, sutured repair was associated with a higher risk of reoperation for recurrence over 5 years compared with open mesh and laparoscopic mesh repair. With long term follow up, the benefits attributable to mesh are offset in part by mesh related complications.
JAMA