Reporting guideline for interventional trials of primary and incisional ventral hernia repair.

BACKGROUND: Primary and incisional ventral hernia trials collect unstandardized inconsistent data, limiting data interpretation and comparison. This study aimed to create two minimum data sets for primary and incisional ventral hernia interventional trials to standardize data collection and improve trial comparison. To support these data sets, standardized patient-reported outcome measures and trial methodology criteria were created. METHODS: To construct these data sets, nominal group technique methodology was employed, involving 15 internationally recognized abdominal wall surgeons and two patient representatives. Initially a maximum data set was created from previous systematic and panellist reviews. Thereafter, three stages of voting took place: stage 1, selection of the number of variables for data set inclusion; stage 2, selection of variables to be included; and stage 3, selection of variable definitions and detection methods. A steering committee interpreted and analysed the data. RESULTS: The maximum data set contained 245 variables. The three stages of voting commenced in October 2019 and had been completed by July 2020. The final primary ventral hernia data set included 32 variables, the incisional ventral hernia data set included 40 variables, the patient-reported outcome measures tool contained 25 questions, and 40 methodological criteria were chosen. The best known variable definitions were selected for accurate variable description. CT was selected as the optimal preoperative descriptor of hernia morphology. Standardized follow-up at 30 days, 1 year, and 5 years was selected. CONCLUSION: These minimum data sets, patient-reported outcome measures, and methodological criteria have allowed creation of a manual for investigators aiming to undertake primary ventral hernia or incisional ventral hernia interventional trials. Adopting these data sets will improve trial methods and comparisons.

Circulating human papillomavirus DNA as a surveillance tool in head and neck squamous cell carcinoma: A systematic review and meta-analysis.

BACKGROUND: The incidence of human papillomavirus-induced (HPV+) head and neck squamous cell carcinoma (HNSCC), that is, especially oropharyngeal cancers (OPSCC), is increasing, and a significant proportion of patients encounter disease progression. A simple and sensitive test to identify patients with progression is an unmet need. OBJECTIVE OF REVIEW: To systematically review the literature and carry out a meta-analysis of studies, investigating circulating HPV-DNA as a biomarker for disease progression in patients with HNSCC. TYPE OF REVIEW: A systematic review and meta-analysis. SEARCH STRATEGY: PubMed, EMBASE and the Cochrane Library were systematically searched for articles published in English from January 1980 to November 2017. Search terms used were related to HPV, cancer sites, blood-based biomarkers and terms for specific use settings. EVALUATION METHOD: Articles reviewed and selected by authors and data on study design, demographic variables, location, HPV status, number of pre-treatment blood tests, number of post-treatment blood tests, blood HPV status and number of recurrences and length of follow-up were extracted. A meta-analysis of HPV-DNA as a diagnostic test for recurrence by means of a hierarchical summary receiver operating curve (HSROC) model was performed. RESULTS: We identified 5 studies (n = 600 subjects) examining circulating HPV-DNA in patients with HNSCC. In these 5 studies (n = 411), patients had both pre- and post-treatment blood samples. The pooled sensitivity, in detecting a recurrence, was estimated to be 54% (95% CI: 32%-74%), while the pooled specificity was 98% (95% CI: 93%-99.4%). The pooled false-positive rate is 2% (95% CI: 0.6%-7%). The area under the curve (AUC) of the summary HSROC was 0.93. Positive predictive value was estimated to 93% and the negative predictive value to 94%. CONCLUSIONS: Plasma HPV-DNA is a promising tool for surveillance in patients with HPV-related HNSCC, that is, OPSCC, and has a high specificity. By recent technical advances and by increasing follow-up blood samples, the sensitivity could likely be improved.

Pelvic floor reconstruction with a biological mesh after extralevator abdominoperineal excision leads to few perineal hernias and acceptable wound complication rates with minor movement limitations: single-centre experience including clinical examination and interview.

AIM: The aim of the study was to describe long-term subjective and objective results of pelvic floor reconstruction using an absorbable biological mesh after extralevator abdominoperineal excision (ELAPE) for low rectal cancer. METHOD: Records of 53 patients who had an ELAPE with reconstruction of the pelvic floor with a Permacol® mesh between August 2007 and August 2011 were reviewed. Thirty-one of the patients were called for interview and clinical examination. RESULTS: Three (6%) patients developed perineal hernia, 11 had fistulae (nine of which were treated successfully), four patients had a perineal abscess and four patients had superficial wound infections. Removal of the mesh was necessary in one case, while another patient needed implantation of a new mesh. In 13 of the 31 interviewed patients, long-term pain was present, but resolved after a median of 8 months (3-56). No major sitting or movement disabilities were encountered. Three-year survival was 82%, and no local recurrences were found. CONCLUSION: Pelvic floor reconstruction with a biological mesh is a feasible solution when performing ELAPE for low rectal cancer, although long-term pain is a frequent complication.

Short-term outcomes after open versus robot-assisted repair of ventral hernias: a nationwide database study.

PURPOSE: The robotic platform is widely implemented; however, evidence evaluating outcomes of robotic ventral hernia repair is still lacking. The aim of the study was to evaluate the short-term outcomes after open and robot-assisted repair of primary ventral and incisional hernias. METHODS: Nationwide register-based cohort study with data from the Danish Ventral Hernia Database and the National Danish Patients Registry was from January 1, 2017 to August 22, 2022. Robot-assisted ventral hernia repairs were propensity score matched 1:3 with open repairs according to the confounding variables defect size, Charlson comorbidity index score, and age. Logistic regression analyses were performed for factors associated with length of stay > 2 days, readmission, and reoperation within 90 days. RESULTS: A total of 528 and 1521 patients underwent robot-assisted and open repair, respectively. The mean length of hospital stay in days was 0.5 versus 2.1 for robot-assisted and open approach, respectively (P < 0.001) and open approach was correlated with risk of length of stay > 2 days (OR 23.25, CI 13.80-39.17, P < 0.001). The incidence of readmission within 90 days of discharge was significantly lower after robot-assisted repair compared to open approach (6.2% vs. 12.1%, P < 0.001). Open approach was independently associated with increased risk of readmission (OR 21.43, CI 13.28-39.17, P = 0.005, P < 0.001). CONCLUSION: Robot-assisted ventral hernia repair is safe and feasible and associated with shorter length of stay and decreased risk of readmission compared with open ventral hernia repair.

Enhanced recovery after robotic ventral hernia repair: factors associated with overnight stay in hospital.

PURPOSE: Enhanced recovery after surgery (ERAS) protocols lead to reduced post-operative stay and improved outcomes after most types of abdominal surgery. Little is known about the optimal post-operative protocol after robotic ventral hernia repair (RVHR), including the potential limits of outpatient surgery. We report the results of an ERAS protocol after RVHR aiming to identify factors associated with overnight stay in hospital, as well as patient-reported pain levels in the immediate post-operative period. METHODS: This was a prospective cohort study of consecutive patients undergoing RVHR. Patients were included in a prospective database, registering patient characteristics, operative details, pain and fatigue during the first 3 post-operative days and pre- and 30-day post-operative hernia-related quality of life, using the EuraHS questionnaire. RESULTS: A total of 109 patients were included, of which 66 (61%) underwent incisional hernia repair. The most performed procedure was TARUP (robotic transabdominal retromuscular umbilical prosthetic hernia repair) (60.6%) followed by bilateral roboTAR (robotic transversus abdominis release) (19.3%). The mean horizontal fascial defect was 4.8 cm, and the mean duration of surgery was 141 min. In total, 78 (71.6%) patients were discharged on the day of surgery, and factors associated with overnight stay were increasing fascial defect area, longer duration of surgery, and transverse abdominis release. There was no association between post-operative pain and overnight hospital stay. The mean EuraHS score decreased significantly from 38.4 to 6.4 (P < 0.001). CONCLUSION: An ERAS protocol after RVHR was associated with a high rate of outpatient procedures with low patient-reported pain levels.

Even minor alteration of plasma creatinine after open abdominal surgery is associated with 30-day mortality: A single-centre cohort study.

PURPOSE: Postoperative acute kidney injury is common and associated with increased length of hospital stay, costs and mortality. The impact from postoperative subclinical changes in plasma concentration of creatinine (p-creatinine) on postoperative mortality has received less attention. In this study, the association between the postoperative change of p-creatinine and all-cause mortality was investigated. METHODS: A single-centre register-based, retrospective study was conducted including patients ≥60 years undergoing open abdominal surgery from 2000 to 2013. Postoperative p-creatinine change was analysed for association with 30-day mortality following adjustment for age, gender, surgical setting and surgical procedure. Main findings A total of 3,460 patients were included in the study of whom 67.6% underwent emergency surgery. The 30-day mortality rate was 18.3%, and a given 10µmol/L daily postoperative increase in p-creatinine was associated with an increased mortality risk with an odds ratio (OR) of 2.67 (95% CI; 2.28-3.14, P<0.001). In patients undergoing emergency surgery, a daily 10µmol/L increase in p-creatinine increased the risk for a fatal outcome a 2.39 OR (CI 95%; 2.05-2.78), P<0.001). In patients undergoing elective surgery, a similar increase in p-creatinine increased risk of postoperative death with a 28.85 OR (CI 95%; 10.25-81.19). CONCLUSION: Even a minor postoperative p-creatinine increase following open abdominal surgery below the criteria for acute kidney injury was associated with increased 30-day mortality in patients aged 60 years or above.

Short-term complications after minimally invasive retromuscular ventral hernia repair: no need for preoperative weight loss or smoking cessation?

PURPOSE: Obesity and smoking are associated with postoperative wound complications following open hernia repair. However, with the advancements in minimally invasive surgical techniques, we hypothesized that obese and/or smoking patients undergoing minimally invasive repairs were not subjected to an increased risk of postoperative surgical complications. As opposed to nonobese and/or nonsmoking patients. METHODS: This was a retrospective cohort study including patients undergoing minimally invasive retromuscular repair at a single university hospital. Patients were divided into two groups according to exposure; obese vs. nonobese and smoking vs. nonsmoking. One month postoperatively, all patients underwent clinical follow-up. The main outcome was surgical site occurrence (SSO). RESULTS: A total of 94 patients were included, undergoing both laparoscopic (n = 32) and robotic (n = 62) retromuscular repair. Of these, 7.7% of the obese patients had SSO when compared with 19.1% of the nonobese patients. A total of 17.2% of the nonsmokers had SSO compared with 13.3% of the active smokers. Of the nonsmokers, 12.5% developed seroma and 6.2% hematoma postoperatively, the corresponding numbers were 13.3% and 0% among the active smokers. After multivariable analysis, there was no significant risk factors for developing postoperative SSO. CONCLUSION: There was no association between obesity or smoking and surgical complication in patients undergoing minimally invasive retromuscular repair. If the results of the current study are confirmed, patients who are unable to obtain weight loss or smoking cessation may be offered minimally invasive retromuscular ventral hernia repair without inducing an increased risk of short-term complications.

Skin closure following abdominal wall reconstruction: three-layer skin suture versus staples.

Skin closure following abdominal wall reconstruction (AWR) has received little attention, even though these patients have demonstrated insufficient wound healing. This study assessed the postoperative wound-related complications and patient-reported outcomes after skin closure using single- or triple layer closure following AWR. This was a retrospective study at a University Hospital from 2016 to 2018. Patients were grouped into a single-layer cohort (SLC) and a triple-layer cohort (TLC). Skin incisions closed with either technique were compared. Postoperative complications were registered from chart review (SLC: n = 48, TLC: n = 40). Patient reported-outcomes were assessed through the Patient Scar Assessment Questionnaire (PSAQ) and the Hernia Related Quality of Life survey. A total of 51 patients were included (SLC: n = 26, TLC: n = 25). There was no difference in wound complications after single- or triple-layer skin closure; seroma (SLC: 16.7% vs. TLC: 15%, p = 1.00), surgical site infection (SLC: 4.2% vs. TLC: 7.5%, p = .834), hematoma (SLC: 6.2% vs. TLC: 2.5%, p = .744) and wound rupture (SLC: 2.1% vs. TLC: 2.5%, p = 1.00). Patients who had incisions closed using single-layer closure were more satisfied; PSAQ satisfaction with scar symptoms (SLC: 6.7 points (IQR 0.0-18.3) vs. TLC: 26.7 points (IQR 0.0-33.3), p = .039) and scar aesthetics (SLC 25.9 points (IQR 18.5-33.3) vs. TLC: 37.0 (IQR 29.6-44.4), p = .013). There was no difference in 30-day wound complications after either skin closure technique. The results favoured the single-layer closure technique regarding the cosmetic outcome.Abbreviations: AWR: abdominal wall reconstruction; SLC: single-layer cohort; TLC: triple-layer cohort; PSAQ: patient scar assessment questionnaire; IH: incisional hernia; QOL: quality of life; BMI: body mass index; HerQLes: hernia-related quality of life; ASA: American Society of Anesthesiologists; SSO: surgical site occurence; SSI: surgical site infection; LOS: length of stay; RCT: randomized controlled trial.

Abdominal wound dehiscence is dangerous: a nationwide study of 14,169 patients undergoing elective open resection for colonic cancer.

PURPOSE: The potential impact of abdominal wound dehiscence on long-term survival after elective abdominal surgery is largely unknown. The aim of this study was to examine the impact of abdominal wound dehiscence on survival and incisional hernia repair after elective, open colonic cancer resection. METHODS: This was a nationwide cohort study based on merged data from Danish national registries, comprising patients subjected to elective, open resection for colonic cancer between May 1, 2001 and January 1, 2016. Multivariable Cox Regression analysis and propensity score matching was applied to adjust for confounding. The associations of abdominal wound dehiscence with 90-day mortality and subsequent incisional hernia repair were also examined. RESULTS: A total of 14,169 patients were included in the cohort, of which 549 (3.9%) developed abdominal wound dehiscence. The 5-year survival was significantly decreased in patients with abdominal wound dehiscence (42.4%, 95% CI 38.1-46.7 vs. 53.4%, 52.6-54.3, P < 0.001), which was confirmed in the multivariable analysis (HR 1.22, CI 1.06-1.39, P = 0.004). Abdominal wound dehiscence was significantly associated with increased risk of 90-day mortality (OR 1.60, CI 1.12-2.27, P = 0.009) as well as subsequent incisional hernia repair (HR 1.80, CI 1.07-3.01, P = 0.026). CONCLUSIONS: Abdominal wound dehiscence was significantly associated with decreased survival. Fascial closure after open colonic cancer resection should be given high priority to improve the long-term survival.

Visceral obesity is a predictor of surgical site occurrence and hernia recurrence after open abdominal wall reconstruction.

PURPOSE: High body mass index (BMI) increases the risk of postoperative complications and hernia recurrence after abdominal wall reconstruction (AWR). However, BMI does not provide specific information on the mass and distribution of adipose tissue. We hypothesized that visceral fat volume (VFV) was a better predictor than BMI for recurrence after AWR. METHODS: We included all patients undergoing AWR at our institution from November 2010 to December 2016. Data were collected from a prospective database and all patients were summoned for follow-up. VFV was calculated from preoperative CT. The primary and secondary outcomes were hernia recurrence and 30-day postoperative surgical site occurrences (SSO), respectively. RESULTS: We included a total of 154 patients. At follow-up, 42 (27.3%) patients had developed recurrence. The recurrence rate was significantly higher in patients with a VFV higher than the mean compared to a VFV lower than the mean, P = 0.004. After multivariable Cox-regression, VFV remained significantly predictive of recurrence (HR 1.09 per 0.5 L increase of VFV, P = 0.018). In contrary, BMI was not associated with hernia recurrence. There was no significant difference in the rate of SSO between patients with a VFV above and below the mean. A multivariable logistic regression model showed that VFV was significantly associated with development of SSO (OR 1.12 per 0.5 L increase, P = 0.009). CONCLUSION: VFV was significantly associated with recurrence and SSOs after AWR. This study suggests VFV as a risk assessment tool for patients undergoing AWR.

The European Hernia Society Prehabilitation Project: a systematic review of patient prehabilitation prior to ventral hernia surgery.

BACKGROUND: Ventral hernia repair is one of the most commonly performed surgical procedures worldwide. To reduce the risk of complications, patient prehabilitation has received increasing focus in recent years. To assess prehabilitation measures, this European Hernia Society endorsed project was launched. The aim of this systematic review was to evaluate the current literature on patient prehabilitation prior to ventral hernia repair. METHODS: The strategies examined were optimization of renal disease, obesity, nutrition, physical exercise, COPD, diabetes and smoking cessation. For each topic, a separate literature search was conducted, allowing for seven different sub-reviews. RESULTS: A limited amount of well-conducted research studies evaluating prehabilitation prior to ventral hernia surgery was found. The primary findings showed that smoking cessation and weight loss for obese patients led to reduced risks of complications after abdominal wall reconstruction. CONCLUSION: Prehabilitation prior to ventral hernia repair may be widely used; however, the literature supporting its use is limited. Future studies evaluating the impact of prehabilitation before ventral hernia surgery are warranted.

Umbilical hernia repair in patients with cirrhosis: systematic review of mortality and complications.

BACKGROUND: Umbilical hernia is a common and potential serious condition in patients with cirrhosis. This systematic review evaluated the risks associated with emergency and elective hernia repair in patients with cirrhosis. METHODS: Systematic review of clinical trials identified through manual and electronic searches in several databases (last update November 2021). The primary random-effects meta-analyses evaluated mortality in patients with or without cirrhosis or following emergency versus elective repair. The quality of the evidence was assessed using GRADE and Newcastle Ottawa Scale. RESULTS: Thirteen prospective and 10 retrospective studies including a total of 3229 patients were included. The evidence was graded as very low quality for all outcomes (mortality and postoperative complications within 90 days). In total 191 patients (6%) died after undergoing umbilical hernia repair. Patients with cirrhosis were more than eight times as likely to die after surgery compared with patients without cirrhosis [OR = 8.50, 95% CI (1.91-37.86)] corresponding to 69 more deaths/1000 patients. Among patients with cirrhosis, mortality was higher after emergency versus elective repair [OR = 2.67, 95% CI (1.87-3.97)] corresponding to 52 more deaths/1000 patients. Postoperative complications were more common in patients with cirrhosis compared with patients without cirrhosis. CONCLUSION: Patients with cirrhosis undergoing emergency umbilical hernia repair have a considerably increased risk of death and severe complications. Accordingly, additional evidence is needed to evaluate methods that would allow elective umbilical hernia repair in patients with cirrhosis.

Physical activity recommendations pre and post abdominal wall reconstruction: a scoping review of the evidence.

PURPOSE: There are no universally agreed guidelines regarding which types of physical activity are safe and/or recommended in the perioperative period for patients undergoing ventral hernia repair or abdominal wall reconstruction (AWR). This study is intended to identify and summarise the literature on this topic. METHODS: Database searches of PubMed, CINAHL, Allied & Complementary medicine database, PEDro and Web of Science were performed followed by a snowballing search using two papers identified by the database search and four hand-selected papers of the authors' choosing. Inclusion-cohort studies, randomized controlled trials, prospective or retrospective. Studies concerning complex incisional hernia repairs and AWRs including a "prehabilitation" and/or "rehabilitation" program targeting the abdominal wall muscles in which the interventions were of a physical exercise nature. RoB2 and Robins-I were used to assess risk of bias. Prospero CRD42021236745. No external funding. Data from the included studies were extracted using a table based on the Cochrane Consumers and Communication Review Group's data extraction template. RESULTS: The database search yielded 5423 records. After screening two titles were selected for inclusion in our study. The snowballing search identified 49 records. After screening one title was selected for inclusion in our study. Three total papers were included-two randomised studies and one cohort study (combined 423 patients). All three studies subjected their patients to varying types of physical activity preoperatively, one study also prescribed these activities postoperatively. The outcomes differed between the studies therefore meta-analysis was impossible-two studies measured hernia recurrence, one measured peak torque. All three studies showed improved outcomes in their study groups compared to controls however significant methodological flaws and confounding factors existed in all three studies. No adverse events were reported. CONCLUSIONS: The literature supporting the advice given to patients regarding recommended physical activity levels in the perioperative period for AWR patients is sparse. Further research is urgently required on this subject.

Increased risk of postoperative complications with retromuscular mesh placement in emergency incisional hernia repair: A nationwide register-based cohort study.

INTRODUCTION: Incisional hernia is common after abdominal surgery. Watchful waiting carries the risk of incarceration and a need for emergency intervention. The aim of this study was to examine the risk of postoperative complications after emergency versus elective incisional hernia repair. METHODS: Patients above 18 years of age undergoing open incisional hernia repair in Denmark in 2017-2018 were identified in the Danish Ventral Hernia Database. Patients were grouped according to elective or emergency hernia repair. The primary outcome was postoperative complications requiring operative intervention within 90 days, and the secondary outcome was postoperative length of stay. RESULTS: We included 1050 patients, of whom 882 were admitted for elective and 168 for emergency operation. Patients undergoing emergency repair were older (64.7 years vs 59.2 years, p < 0.001), more often smokers (25.8% vs 13.6%, p = 0.003), and more often had a Charlson comorbidity score ⩾2 (26.8% vs 19.2%, p = 0.005) compared to patients undergoing elective repair. In a multivariate regression analysis, emergency compared to elective operation (OR = 2.71, 95% CI = 1.4-5.25, p = 0.003) and retromuscular compared to onlay mesh placement (OR = 2.14, 95% CI = 1.08-4.24, p = 0.013) were factors significantly associated with increased risk of postoperative complications. In a subgroup analysis including only emergency repairs, risk of complications after retromuscular mesh placement was even higher (OR = 10.12, 95% CI = 1.81-56.68, p = 0.008). CONCLUSION: Emergency incisional hernia repair was associated with increased risk of postoperative complications and this risk was accentuated with retromuscular mesh placement. The use of retromuscular mesh in the emergency setting should be avoided, and the abdominal wall could either be closed by sutures or additional onlay mesh.

Should simultaneous stoma closure and incisional hernia repair be avoided?

PURPOSE: Patients scheduled for stoma closure may also have an incisional hernia. Studies have reported acceptable outcomes after contaminated ventral hernia repair, but whether stoma closure and incisional hernia repair should be performed as a combined procedure is unknown. This study examined combined stoma closure and incisional hernia repair compared with incisional hernia repair only. METHODS: This was a nationwide propensity-score matched study. Patients who underwent elective incisional hernia repair from 2007-2017 were identified in the Danish Hernia Database. All patients who underwent concurrent stoma closure were matched 1:3 with patients who underwent incisional hernia repair only. The primary outcome was reoperation for hernia recurrence, whereas secondary outcomes included anastomotic leakage, length of hospital stay, and 30-day reoperation and readmission rates. RESULTS: In total, 516 patients were included. The risk of reoperation for recurrence was increased after concurrent stoma closure compared with incisional hernia repair only (hazard ratio 1.69, 95% confidence interval 1.01-2.82, p = 0.044). Seven (5.4%) patients who underwent incisional hernia repair concurrent to stoma closure were reoperated for anastomotic leakage. Length of hospital stay and reoperation rates within 30 days were increased after concurrent stoma closure compared with incisional hernia repair only (median 8 versus 3 days, p < 0.001 and 29.5% versus 18.6%, p = 0.013), whereas there was no difference in 30-day readmission rates (p = 0.251). CONCLUSIONS: Stoma closure and incisional hernia repair should be performed as a dual-stage procedure to decrease the risk of hernia recurrence.

Prophylactic negative pressure wound therapy after open ventral hernia repair: a systematic review and meta-analysis.

PURPOSE: Negative pressure wound therapy on closed incisions (iNPWT) is a wound dressing system developed to promote wound healing and avoid complications after surgical procedures. The effect of iNPWT is well established in various surgical fields, however, the effect on postoperative wound complications after ventral hernia repair remains unknown. The aim of this systematic review and meta-analysis was to investigate the effect of iNPWT on patients undergoing open ventral hernia repair (VHR) compared with conventional wound dressing. MATERIALS AND METHODS: This systematic review and meta-analysis followed the PRISMA guidelines. The databases PubMed, Embase, Cochrane Library, Web of science and Cinahl were searched for original studies comparing iNPWT to conventional wound dressing in patients undergoing VHR. The primary outcome was surgical site occurrence (SSO), secondary outcomes included surgical site infection (SSI) and hernia recurrence. RESULTS: The literature search identified 373 studies of which 10 were included in the meta-analysis including a total of 1087 patients. Eight studies were retrospective cohort studies, one was a cross-sectional pilot study, and one was a randomized controlled trial. The meta-analysis demonstrated that iNPWT was associated with a decreased risk of SSO (OR 0.27 [0.19, 0.38]; P < 0.001) and SSI (OR 0.32 [0.17, 0.55]; P < 0.001). There was no statistically significant association with the risk of hernia recurrence (OR 0.62 [0.27, 1.43]; P = 0.26). CONCLUSION: Based on the findings of this systematic review and meta-analysis iNPWT following VHR was found to significantly reduce the incidence of SSO and SSI, compared with standard wound dressing. INPWT should be considered for patients undergoing VHR.

Causes of prolonged hospitalization after open incisional hernia repair: an observational single-center retrospective study of a prospective database.

PURPOSE: Enhanced recovery after surgery (ERAS) is a well-known approach to optimize the recovery after surgery. Little is known about specific causes of prolonged hospitalization despite enhanced recovery after open incisional hernia repair (OIHR). The purpose of this study was to identify the causes of continued hospitalization on each of the first 5 postoperative days (PODs) after OIHR. METHODS: This was a retrospective study of consecutive patients undergoing open AWR at a regional academic hernia center from 2008 to 2018. Patient charts were evaluated using predefined potential causes of continued hospitalization on each of the first five PODs. RESULTS: A total of 388 patients (mean age 60.9 years, 54.6% male, mean BMI 27.9 kg/m2) were included in the study. Mesh placement was either preperitoneal/intraperitoneal (20%) or retromuscular (80%) and 61% of the patients had an epidural catheter. The median length of stay (LOS) in the cohort was four [IQR 2-6] days. On PODs 4 and 5, causes of continued hospital stay were absent bowel function (2% on POD 4, 1% on POD 5), pain (7% on POD 3, 2% on POD 4), lack of mobilization (1% on POD 4, 1% on POD 5), and other causes (urinary retention, high drain output, and complications to the surgery). CONCLUSION: Causes for prolonged hospitalization after OIHR were possibly reducible. Future efforts to improve the ERAS regime and reduce LOS after OIHR should focus on pain treatment- and prevention, alternatives to epidural treatment, and well-defined, evidence-based discharge criteria.

Incisional hernia repair in women of childbearing age: A nationwide propensity-score matched study.

BACKGROUND & AIMS: Although incisional hernia repair in women of childbearing age is not rare, hernia disease in this group of patients is sparsely documented. The aim of this study was to examine long-term clinical results after incisional hernia repair in women of childbearing age. MATERIAL AND METHODS: This nationwide cohort study examined incisional hernia repair from 2007 to 2013 in women of childbearing age, registered prospectively in the Danish Ventral Hernia Database. All women with a subsequent pregnancy were included, and a 1:3 propensity-score matched group of women with an incisional hernia repair without a subsequent pregnancy. A prospective follow-up was conducted, including a validated questionnaire. The primary outcome was recurrence, and the secondary outcome was chronic pain from the operated site. RESULTS: In total, 124 (70.5%) women responded, 47 and 77 women with and without a subsequent pregnancy, respectively. The 5-year cumulative incidence of recurrence was 41.0% (95% confidence interval 32.0%-49.9%). After adjustment for potential confounders, subsequent pregnancy was independently associated with recurrence (hazard ratio 1.83, 95% confidence interval 1.02-3.29, p = 0.044). Twenty-six (21.0%) women reported chronic pain (moderate, n = 21; severe, n = 5) with no difference between women with and without a subsequent pregnancy. Hernia recurrence, higher body mass index, and smoking were associated with chronic pain. CONCLUSION: Pregnancy following incisional hernia repair was associated with an increased risk of recurrence, but not with chronic pain.

Mesh versus suture in elective repair of umbilical hernia: systematic review and meta-analysis.

BACKGROUND: Mesh repair of umbilical hernia has been associated with a reduced recurrence rate compared with suture closure, but potentially at the expense of increased postoperative complications and chronic pain. The objective of this systematic review and meta-analysis was to examine the outcomes after elective open mesh and suture repair for umbilical hernia in adults. METHODS: A literature search was conducted to identify studies presenting original data on elective open mesh and suture repair of umbilical hernia. The primary outcome was hernia recurrence. Secondary outcomes included surgical-site infection (SSI), seroma, haematoma and chronic pain. Meta-analyses were undertaken. RESULTS: The search resulted in 5353 hits and led to 14 studies being included (6 RCTs and 8 observational studies) describing a total of 2361 patients. Compared with suture, mesh repair was associated with a lower risk of recurrence (risk ratio (RR) 0·48, 95 per cent c.i. 0·30 to 0·77), with number needed to treat 19 (95 per cent c.i. 14 to 31). Mesh repair was associated with a higher risk of seroma (RR 2·37, 1·45 to 3·87), with number needed to harm 30 (17 to 86). There was no significant difference in the risk of SSI, haematoma or chronic pain. CONCLUSION: The use of mesh in elective repair of umbilical hernia reduced the risk of recurrence compared with suture closure without altering the risk of chronic pain.

ANTECEDENTES: La reparación con malla de la hernia umbilical se ha asociado con una tasa menor de recidivas en comparación con el cierre con suturas, pero potencialmente a expensas de un aumento de complicaciones postoperatorias y dolor crónico. El objetivo de esta revisión sistemática y metaanálisis fue examinar los resultados después de reparación abierta electiva con malla o suturas para la reparación de una hernia umbilical en adultos. MÉTODOS: Se llevó a cabo una búsqueda en la literatura para identificar estudios que presentaban datos originales sobre la reparación abierta electiva con malla y sutura de la hernia umbilical. El resultado primario fue la recidiva herniaria. Los resultados secundarios incluyeron la infección del sitio quirúrgico (surgical site infection, SSI), seroma, hematoma y dolor crónico. Se realizaron metaanálisis. RESULTADOS: En la búsqueda identificaron 5.353 documentos, incluyéndose 14 estudios (6 ensayos clínicos aleatorizados, 8 estudios observacionales) que presentaban datos de un total de 2.361 pacientes. En comparación con la sutura, la reparación con malla se asoció con un menor riesgo de recidiva (tasa de riesgo, risk ratio, RR 0,48, i.c. del 95% 0,30 a 0,77) y número necesario para tratar de 19 (i.c. del 95% 14 a 31). La reparación con malla se asoció con un mayor riesgo de seroma (RR 2,37, i.c. del 95% 1,45 a 3,87) y número necesario para provocar daño de 30 (i.c. del 95% 17 a 86). No hubo diferencia significativa en el riesgo de SSI, hematoma o dolor crónico. CONCLUSIÓN: El uso de malla en la reparación electiva de la hernia umbilical redujo el riesgo de recidiva en comparación con el cierre con sutura, sin modificar el riesgo de dolor crónico.

Short-term safety of preoperative administration of botulinum toxin A for the treatment of large ventral hernia with loss of domain.

PURPOSE: Preoperative intramuscular-administered botulinum toxin A (BTA) in the lateral abdominal muscles prior to abdominal wall reconstruction has been reported to produce a flaccid paralysis and improve the primary closure rate of large ventral hernias with loss of domain. Complications to this treatment remain sparsely described. The aim of the current study was to report safety and short-term outcome of abdominal wall reconstruction aided by BTA administration. METHODS: This was a retrospective two-center study including all patients undergoing abdominal wall reconstruction for ventral hernia aided by preoperative BTA administration to the lateral abdominal muscles. Data were retrieved from patient charts and included preoperative demographic and perioperative information as well as postoperative 30-day complications and readmissions. RESULTS: A total of 37 patients underwent BTA administration prior to hernia repair. The mean age and body mass index were 59.5 (SD 10.1) years and 31.1 (SD 5.2) kg/m2. The BTA injections were administered mean 31.6 days (SD 10.0) prior to the hernia repair. One (2.7%) patient reported pain as a complication immediately after the BTA administration. Subsequent to the hernia repair, six (16.2%) patients were readmitted within 30 days. Nine patients (24.3%) had wound complications and medical complications occurred in seven (18.9%) patients. CONCLUSIONS: We found early preoperative administration of BTA a safe adjunct to large ventral hernia repair, without adverse events related to the administration preoperative. Future studies should further highlight the efficacy of preoperative BTA for reconstruction of otherwise untreatable hernias.