Adverse Events after Ventral Hernia Repair: The Vicious Cycle of Complications Abstract presented at the Abdominal Wall Reconstruction Conference, Washington, DC, June 2014.

Julie L. Holihan, Zeinab Alawadi, Robert Martindale, J. Scott Roth, Curtis J. Wray, Tien C. Ko, Lillian S. Kao, Mike K. Liang

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

Background Ventral hernia repairs are one of the most common procedures performed by the general surgeon. They are also among the most complex procedures performed. We hypothesized that with each surgical failure, subsequent ventral hernia repair becomes more complicated and morbid. Study Design We assessed a multicenter database of patients who underwent an elective ventral hernia repair from 2000 to 2012 with at least 6 months of follow-up and elective repairs. Patients were evaluated by the number of previous ventral hernia repairs they had: primary ventral hernia repair (PVHR), first time incisional hernia repair (IHR1), second time incisional hernia repair (IHR2), or third time or greater incisional hernia repair (IHR3). The main outcomes measured were abdominal reoperation, operative duration, surgical site infection (SSI), and hernia recurrence. Complications were assessed and compared between the 4 groups. Time to recurrence was estimated using the Kaplan-Meier curve method by study cohort (PVHR, IHR1, IHR2, IHR3). Results A total of 794 patients were assessed; of these, 481 (60.6%) had PVHR, 207 (26.1%) had IHR1, 78 (9.8%) had IHR2, and 28 (3.5%) had IHR3. Patients with multiple repairs were more likely to undergo subsequent reoperation, have a longer operative duration, develop SSI, and have a recurrence. At 140 months of follow-up, 37% of primary ventral hernias and 64% of incisional hernias have recurred. The highest recurrence rates are seen in IHR3, with 73% recurring. Conclusions Previous ventral hernia repair increases the complication profile of repair, creating a vicious cycle of repair, complications, reoperation, and re-repair. Furthermore, long-term outcomes for ventral hernia repair are poor. Future studies should focus on hernia prevention and improving long-term outcomes after hernia repair.

Original languageEnglish (US)
Pages (from-to)478-485
Number of pages8
JournalJournal of the American College of Surgeons
Volume221
Issue number2
DOIs
StatePublished - Aug 1 2015

Fingerprint

Ventral Hernia
Herniorrhaphy
Abdominal Wall
Reoperation
Surgical Wound Infection
Recurrence
Hernia

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Adverse Events after Ventral Hernia Repair : The Vicious Cycle of Complications Abstract presented at the Abdominal Wall Reconstruction Conference, Washington, DC, June 2014. / Holihan, Julie L.; Alawadi, Zeinab; Martindale, Robert; Roth, J. Scott; Wray, Curtis J.; Ko, Tien C.; Kao, Lillian S.; Liang, Mike K.

In: Journal of the American College of Surgeons, Vol. 221, No. 2, 01.08.2015, p. 478-485.

Research output: Contribution to journalArticle

Holihan, Julie L. ; Alawadi, Zeinab ; Martindale, Robert ; Roth, J. Scott ; Wray, Curtis J. ; Ko, Tien C. ; Kao, Lillian S. ; Liang, Mike K. / Adverse Events after Ventral Hernia Repair : The Vicious Cycle of Complications Abstract presented at the Abdominal Wall Reconstruction Conference, Washington, DC, June 2014. In: Journal of the American College of Surgeons. 2015 ; Vol. 221, No. 2. pp. 478-485.
@article{a49bde94ae8f4e6ebf12e882b1db895f,
title = "Adverse Events after Ventral Hernia Repair: The Vicious Cycle of Complications Abstract presented at the Abdominal Wall Reconstruction Conference, Washington, DC, June 2014.",
abstract = "Background Ventral hernia repairs are one of the most common procedures performed by the general surgeon. They are also among the most complex procedures performed. We hypothesized that with each surgical failure, subsequent ventral hernia repair becomes more complicated and morbid. Study Design We assessed a multicenter database of patients who underwent an elective ventral hernia repair from 2000 to 2012 with at least 6 months of follow-up and elective repairs. Patients were evaluated by the number of previous ventral hernia repairs they had: primary ventral hernia repair (PVHR), first time incisional hernia repair (IHR1), second time incisional hernia repair (IHR2), or third time or greater incisional hernia repair (IHR3). The main outcomes measured were abdominal reoperation, operative duration, surgical site infection (SSI), and hernia recurrence. Complications were assessed and compared between the 4 groups. Time to recurrence was estimated using the Kaplan-Meier curve method by study cohort (PVHR, IHR1, IHR2, IHR3). Results A total of 794 patients were assessed; of these, 481 (60.6{\%}) had PVHR, 207 (26.1{\%}) had IHR1, 78 (9.8{\%}) had IHR2, and 28 (3.5{\%}) had IHR3. Patients with multiple repairs were more likely to undergo subsequent reoperation, have a longer operative duration, develop SSI, and have a recurrence. At 140 months of follow-up, 37{\%} of primary ventral hernias and 64{\%} of incisional hernias have recurred. The highest recurrence rates are seen in IHR3, with 73{\%} recurring. Conclusions Previous ventral hernia repair increases the complication profile of repair, creating a vicious cycle of repair, complications, reoperation, and re-repair. Furthermore, long-term outcomes for ventral hernia repair are poor. Future studies should focus on hernia prevention and improving long-term outcomes after hernia repair.",
author = "Holihan, {Julie L.} and Zeinab Alawadi and Robert Martindale and Roth, {J. Scott} and Wray, {Curtis J.} and Ko, {Tien C.} and Kao, {Lillian S.} and Liang, {Mike K.}",
year = "2015",
month = "8",
day = "1",
doi = "10.1016/j.jamcollsurg.2015.04.026",
language = "English (US)",
volume = "221",
pages = "478--485",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - Adverse Events after Ventral Hernia Repair

T2 - The Vicious Cycle of Complications Abstract presented at the Abdominal Wall Reconstruction Conference, Washington, DC, June 2014.

AU - Holihan, Julie L.

AU - Alawadi, Zeinab

AU - Martindale, Robert

AU - Roth, J. Scott

AU - Wray, Curtis J.

AU - Ko, Tien C.

AU - Kao, Lillian S.

AU - Liang, Mike K.

PY - 2015/8/1

Y1 - 2015/8/1

N2 - Background Ventral hernia repairs are one of the most common procedures performed by the general surgeon. They are also among the most complex procedures performed. We hypothesized that with each surgical failure, subsequent ventral hernia repair becomes more complicated and morbid. Study Design We assessed a multicenter database of patients who underwent an elective ventral hernia repair from 2000 to 2012 with at least 6 months of follow-up and elective repairs. Patients were evaluated by the number of previous ventral hernia repairs they had: primary ventral hernia repair (PVHR), first time incisional hernia repair (IHR1), second time incisional hernia repair (IHR2), or third time or greater incisional hernia repair (IHR3). The main outcomes measured were abdominal reoperation, operative duration, surgical site infection (SSI), and hernia recurrence. Complications were assessed and compared between the 4 groups. Time to recurrence was estimated using the Kaplan-Meier curve method by study cohort (PVHR, IHR1, IHR2, IHR3). Results A total of 794 patients were assessed; of these, 481 (60.6%) had PVHR, 207 (26.1%) had IHR1, 78 (9.8%) had IHR2, and 28 (3.5%) had IHR3. Patients with multiple repairs were more likely to undergo subsequent reoperation, have a longer operative duration, develop SSI, and have a recurrence. At 140 months of follow-up, 37% of primary ventral hernias and 64% of incisional hernias have recurred. The highest recurrence rates are seen in IHR3, with 73% recurring. Conclusions Previous ventral hernia repair increases the complication profile of repair, creating a vicious cycle of repair, complications, reoperation, and re-repair. Furthermore, long-term outcomes for ventral hernia repair are poor. Future studies should focus on hernia prevention and improving long-term outcomes after hernia repair.

AB - Background Ventral hernia repairs are one of the most common procedures performed by the general surgeon. They are also among the most complex procedures performed. We hypothesized that with each surgical failure, subsequent ventral hernia repair becomes more complicated and morbid. Study Design We assessed a multicenter database of patients who underwent an elective ventral hernia repair from 2000 to 2012 with at least 6 months of follow-up and elective repairs. Patients were evaluated by the number of previous ventral hernia repairs they had: primary ventral hernia repair (PVHR), first time incisional hernia repair (IHR1), second time incisional hernia repair (IHR2), or third time or greater incisional hernia repair (IHR3). The main outcomes measured were abdominal reoperation, operative duration, surgical site infection (SSI), and hernia recurrence. Complications were assessed and compared between the 4 groups. Time to recurrence was estimated using the Kaplan-Meier curve method by study cohort (PVHR, IHR1, IHR2, IHR3). Results A total of 794 patients were assessed; of these, 481 (60.6%) had PVHR, 207 (26.1%) had IHR1, 78 (9.8%) had IHR2, and 28 (3.5%) had IHR3. Patients with multiple repairs were more likely to undergo subsequent reoperation, have a longer operative duration, develop SSI, and have a recurrence. At 140 months of follow-up, 37% of primary ventral hernias and 64% of incisional hernias have recurred. The highest recurrence rates are seen in IHR3, with 73% recurring. Conclusions Previous ventral hernia repair increases the complication profile of repair, creating a vicious cycle of repair, complications, reoperation, and re-repair. Furthermore, long-term outcomes for ventral hernia repair are poor. Future studies should focus on hernia prevention and improving long-term outcomes after hernia repair.

UR - http://www.scopus.com/inward/record.url?scp=84937677623&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84937677623&partnerID=8YFLogxK

U2 - 10.1016/j.jamcollsurg.2015.04.026

DO - 10.1016/j.jamcollsurg.2015.04.026

M3 - Article

C2 - 26206646

AN - SCOPUS:84937677623

VL - 221

SP - 478

EP - 485

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

IS - 2

ER -