What are the influencing factors on the outcome in lateral incisional hernia repair? A registry-based multivariable analysis

• Published in: Hernia : the journal of hernias and abdominal wall surgery Vol. 27; no. 2; pp. 311 - 326
• Main Authors: Schaaf, S., Willms, A., Adolf, D., Schwab, R., Riediger, H., Köckerling, F.
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01-04-2023; Springer Nature B.V
• Subjects: Abdominal Surgery; Abdominal wall; Chronic pain; Chronic Pain - surgery; Complications; Female; Forum on Complexities in Hernia; Gender; Hernia; Hernia, Ventral - surgery; Hernias; Herniorrhaphy - methods; Humans; Incisional Hernia - surgery; Laparoscopy; Laparoscopy - methods; Localization; Medicine; Medicine & Public Health; Original; Original Article; Postoperative; Postoperative Complications - epidemiology; Recurrence; Registries; Surgical Mesh; Sutures; Hernia registry; Lateral hernias; Hernia surgery; Outcome; Incisional hernia; Lumbar hernias; Flank hernias
• ISSN: 1248-9204; 1265-4906; 1248-9204
• DOI: 10.1007/s10029-022-02690-y

Introduction
Incisional hernias following lateral abdominal wall incisions with an incidence of 1–4% are less common than following medial incisions at 14–19%. The proportion of lateral incisional hernias in the total collective of all incisional hernias is around 17%. Compared to midline defects, lateral incisional hernias are more difficult to repair because of the more complex anatomy and localization. A recent systematic review identified only 11 publications with a total of 345 patients reporting on lateral incisional hernia repair. Therefore, further studies are urgently needed.
Methods
Multivariable analysis of the data available for 6,306 patients with primary elective lateral incisional hernia repair was performed to assess the confirmatory pre-defined potential influence factors and their association with the perioperative and one-year follow-up outcomes.
Results
In primary elective lateral incisional hernia repair, open onlay, open IPOM and suture procedures were found to have an unfavorable effect on the recurrence rate. This was also true for larger defect sizes and higher BMI. A particularly unfavorable relationship was identified between larger defect sizes and perioperative complications. Laparoscopic-IPOM presented a higher risk of intraoperative, and open sublay of postoperative, complications. The chronic pain rates were especially unfavorably influenced by the postoperative complications, preoperative pain and female gender.
Conclusion
Open-onlay, open IPOM and suture procedures, larger defect sizes, female gender, higher BMI, preoperative pain and postoperative complications are associated with unfavorable outcomes following primary elective lateral incisional hernia repair.