Is the outcome of laparoscopic incisional hernia repair affected by defect size? A prospective study

• Published in: The American journal of surgery Vol. 203; no. 1; pp. 87 - 94
• Main Authors: Moreno-Egea, Alfredo, M.D, Carrillo-Alcaraz, Andres, M.D, Aguayo-Albasini, J.L., M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2012; Elsevier; Elsevier Limited
• Subjects: Adult; Biological and medical sciences; Categories; Chi-Square Distribution; Defect size; Defects; Digestive system. Abdomen; Endoscopy; Female; General aspects; Hernia; Hernia, Abdominal - surgery; Hernias; Herniorrhaphy - methods; Humans; Incisional hernia; Investigative techniques, diagnostic techniques (general aspects); Laparoscopic repair; Laparoscopy; Maintenance; Male; Medical sciences; Middle Aged; Morbidity; Multivariate analysis; Obesity; Patients; Prognostic factors; Proportional Hazards Models; Prospective Studies; Recurrence; Regression analysis; Risk analysis; Risk Factors; ROC Curve; Sensitivity and Specificity; Studies; Surgery; Treatment Outcome; Recurrence; Laparoscopic repair; Prognostic factors; Defect size; Incisional hernia; Relapse; Prognosis; Size; Laparoscopy; Hernia; Medicine; Prospective; Treatment; Surgery; Defect; Evolution; Endoscopy; Repair
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2010.11.017

Abstract Background This study was performed to determine if defect size after laparoscopic incisional hernia repair is predictive of recurrence during the long-term follow-up evaluation. Methods We performed a prospective clinical study on 310 patients who underwent laparoscopic incisional hernia repair to identify predictable risk factors for hernia recurrence. Univariate and multivariate Cox regression analysis were used. The defect size was analyzed with curve receiver operating characteristic curve. Results The overall recurrence rate was 6% after an average follow-up period of 60 months. On univariate analysis of the defect size (categories: <10 cm, 10–12 cm, and >15 cm), obesity, previous repairs, hernia location, surgical time, hospital stay, morbidity, and recurrences were significantly different ( P < .001). By multivariate analysis, only obesity and defect size were independent prognostic factors ( P < .001). Conclusions The predictive value of defect size is shown. Patients with large defects have a higher risk of recurrence. Our study recommends reserving the laparoscopic technique for hernias not exceeding 10 cm in size, where it can be put to better use.