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.	中华医学会健康管理学分会, 中国营养学会, 中国医疗保健国际交流促进会生殖医学分会, 等. 超重或肥胖人群体重管理专家共识及团体标准. 中华健康管理学杂志, 2018, 12(3): 200-207.
6.	中华医学会外科学分会疝与腹壁外科学组, 中国医师协会外科医师分会疝和腹壁外科医师委员会. 腹壁切口疝诊断和治疗指南(2018年版). 中华疝和腹壁外科杂志(电子版), 2018, 12(4): 241-243.
7.	王明刚, 刘雨辰, 曹金鑫. 手术治疗腹壁切口疝的历史与现状. 腹腔镜外科杂志, 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.	陈亚柯, 陈建民, 王殿琢, 等. 3种不同层次间放置补片治疗腹壁疝的临床疗效. 中国普外基础与临床杂志, 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.	杨良, 范庆, 魏士博, 等. 国际内镜疝学会腹壁疝和切口疝腹腔镜治疗指南更新解读(一). 中华疝和腹壁外科杂志(电子版), 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, 王晓辉, 李小军, 等. 切口疝无张力修补术后复发的多因素分析. 中国普外基础与临床杂志, 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. 中华医学会健康管理学分会, 中国营养学会, 中国医疗保健国际交流促进会生殖医学分会, 等. 超重或肥胖人群体重管理专家共识及团体标准. 中华健康管理学杂志, 2018, 12(3): 200-207.
6. 中华医学会外科学分会疝与腹壁外科学组, 中国医师协会外科医师分会疝和腹壁外科医师委员会. 腹壁切口疝诊断和治疗指南(2018年版). 中华疝和腹壁外科杂志(电子版), 2018, 12(4): 241-243.
7. 王明刚, 刘雨辰, 曹金鑫. 手术治疗腹壁切口疝的历史与现状. 腹腔镜外科杂志, 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. 陈亚柯, 陈建民, 王殿琢, 等. 3种不同层次间放置补片治疗腹壁疝的临床疗效. 中国普外基础与临床杂志, 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. 杨良, 范庆, 魏士博, 等. 国际内镜疝学会腹壁疝和切口疝腹腔镜治疗指南更新解读(一). 中华疝和腹壁外科杂志(电子版), 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, 王晓辉, 李小军, 等. 切口疝无张力修补术后复发的多因素分析. 中国普外基础与临床杂志, 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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