What Are the Trends in Incisional Hernia Repair? Real-world Data over 10 years from the Herniamed Registry

Overview

Journal Hernia

Publisher Springer

Date 2020 Oct 19

PMID 33074396

Citations 27

Authors

F Kockerling

H Hoffmann

F Mayer

K Zarras

W Reinpold

R Fortelny

D Weyhe

B Lammers

D Adolf

C Schug-Pass

Affiliations

Soon will be listed here.

Abstract

Introduction: There is an increasingly controversial debate about the best possible incisional hernia repair technique. Despite the good outcomes of laparoscopic IPOM, concerns about the intraperitoneal mesh placement and its potential intraabdominal complications have risen. Against that background, this paper now analyzes changes and trends in incisional hernia repair techniques in the recent decade.

Methods: Between 2010 and 2019 a total of 61,627 patients with primary elective incisional hernia repair were enrolled in the Herniamed Registry. The outcome results were assigned to the year of repair and summarized as curves to visualize trends. The explorative Fisher's exact test was used for statistical calculation of significant differences. Since the number of cases entered into the Herniamed Registry for the years 2010-2012 was still relatively small, the years 2013 and 2019 were compared for statistical analysis.

Results: In the analyzed time period, the proportion of incisional hernias repaired in open suture technique remained unchanged at about 10%. The proportion of laparoscopic IPOM repairs decreased significantly from 33.8% in 2013 to 21.0% (p < 0.001) in 2019. Conversely, the proportion of open sublay repairs increased significantly from 32.1% in 2013 to 41.4% (p < 0.001) in 2019. Starting in 2015, there has also been the introduction and increasing use (4.5% in 2013 vs. 10.0% in 2019; p < 0.001) of new minimally-invasive techniques with placement of a mesh into the sublay/retromuscular/preperitoneal abdominal wall layer (E/MILOS, eTEP, preperitoneal mesh technique).

Conclusion: Analysis of data from the Herniamed Registry shows a significant trend to the disadvantage of the laparoscopic IPOM and to the advantage of the open sublay operation and the new minimally-invasive techniques (E/MILOS, eTEP, preperitoneal mesh technique). Despite all the recommendations in the guidelines, 10% of incisional hernias continue to be treated by means of a suture technique.

Citing Articles

Robotic Surgical Procedures for Ventral Hernia Repair.

Christoffersen M, Andresen K, Perregaard H, Henriksen N J Abdom Wall Surg. 2025; 4:14212.

PMID: 40018078 PMC: 11864877. DOI: 10.3389/jaws.2025.14212.

The Clinical Impact of the Introduction of a Robot-Assisted Program in a Specialized Hernia Center: A Propensity Score Matched Cohort Study on Short-Term Outcomes.

Marckmann M, Christoffersen M, Henriksen N, Kiim K World J Surg. 2025; 49(3):617-625.

PMID: 39814689 PMC: 11903252. DOI: 10.1002/wjs.12477.

Robot-Assisted Extraperitoneal Ventral Hernia Repair-Experience From the First 160 Consecutive Operations With Lateral eTEP and eTAR Techniques.

Vogel R, Heinzelmann F, Buchler P, Muck B J Abdom Wall Surg. 2024; 3:13055.

PMID: 39651458 PMC: 11621756. DOI: 10.3389/jaws.2024.13055.

Laparoendoscopic extraperitoneal surgical techniques for ventral hernias and diastasis recti repair: a systematic review.

Ferrara F, Fiori F Hernia. 2024; 28(6):2111-2124.

PMID: 39312025 PMC: 11530491. DOI: 10.1007/s10029-024-03144-3.

Robotic preperitoneal extended totally extraperitoneal (R-PeTEP) technique description for ventral hernia repair: preliminary results.

Arias-Espinosa L, Claus C, Malcher F, Valenzuela Alpuche H Updates Surg. 2024; 76(7):2715-2722.

PMID: 39297928 DOI: 10.1007/s13304-024-02002-2.

References

Bosanquet D, Ansell J, Abdelrahman T, Cornish J, Harries R, Stimpson A . Systematic Review and Meta-Regression of Factors Affecting Midline Incisional Hernia Rates: Analysis of 14,618 Patients. PLoS One. 2015; 10(9):e0138745. PMC: 4577082. DOI: 10.1371/journal.pone.0138745. View

Fink C, Baumann P, Wente M, Knebel P, Bruckner T, Ulrich A . Incisional hernia rate 3 years after midline laparotomy. Br J Surg. 2013; 101(2):51-4. DOI: 10.1002/bjs.9364. View

Itatsu K, Yokoyama Y, Sugawara G, Kubota H, Tojima Y, Kurumiya Y . Incidence of and risk factors for incisional hernia after abdominal surgery. Br J Surg. 2014; 101(11):1439-47. DOI: 10.1002/bjs.9600. View

Maneck M, Kockerling F, Fahlenbrach C, Heidecke C, Heller G, Meyer H . Hospital volume and outcome in inguinal hernia repair: analysis of routine data of 133,449 patients. Hernia. 2019; 24(4):747-757. PMC: 7395912. DOI: 10.1007/s10029-019-02091-8. View

Tubre D, Schroeder A, Estes J, Eisenga J, Fitzgibbons Jr R . Surgical site infection: the "Achilles Heel" of all types of abdominal wall hernia reconstruction. Hernia. 2018; 22(6):1003-1013. DOI: 10.1007/s10029-018-1826-9. View

Bittner R, Bingener-Casey J, Dietz U, Fabian M, Ferzli G, Fortelny R . Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS)-part 1. Surg Endosc. 2013; 28(1):2-29. PMC: 3872300. DOI: 10.1007/s00464-013-3170-6. View

Bittner R, Bingener-Casey J, Dietz U, Fabian M, Ferzli G, Fortelny R . Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society [IEHS])—Part 2. Surg Endosc. 2013; 28(2):353-79. PMC: 3936125. DOI: 10.1007/s00464-013-3171-5. View

Bittner R, Bingener-Casey J, Dietz U, Fabian M, Ferzli G, Fortelny R . Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society [IEHS])-Part III. Surg Endosc. 2013; 28(2):380-404. PMC: 3936126. DOI: 10.1007/s00464-013-3172-4. View

Silecchia G, Campanile F, Sanchez L, Ceccarelli G, Antinori A, Ansaloni L . Laparoscopic ventral/incisional hernia repair: updated Consensus Development Conference based guidelines [corrected]. Surg Endosc. 2015; 29(9):2463-84. DOI: 10.1007/s00464-015-4293-8. View

10.

Liang M, Holihan J, Itani K, Alawadi Z, Gonzalez J, Askenasy E . Ventral Hernia Management: Expert Consensus Guided by Systematic Review. Ann Surg. 2016; 265(1):80-89. DOI: 10.1097/SLA.0000000000001701. View

11.

Bittner R, Bain K, Bansal V, Berrevoet F, Bingener-Casey J, Chen D . Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS))-Part A. Surg Endosc. 2019; 33(10):3069-3139. PMC: 6722153. DOI: 10.1007/s00464-019-06907-7. View

12.

WATERLOW J . 15N end-product methods for the study of whole body protein turnover. Proc Nutr Soc. 1981; 40(3):317-20. DOI: 10.1079/pns19810047. View

13.

Kurian A, Gallagher S, Cheeyandira A, Josloff R . Laparoscopic repair of primary versus incisional ventral hernias: time to recognize the differences?. Hernia. 2010; 14(4):383-7. DOI: 10.1007/s10029-010-0649-0. View

14.

Stirler V, Schoenmaeckers E, de Haas R, Raymakers J, Rakic S . Laparoscopic repair of primary and incisional ventral hernias: the differences must be acknowledged: a prospective cohort analysis of 1,088 consecutive patients. Surg Endosc. 2013; 28(3):891-5. DOI: 10.1007/s00464-013-3243-6. View

15.

Kockerling F, Schug-Pass C, Adolf D, Reinpold W, Stechemesser B . Is pooled data analysis of ventral and incisional hernia repair acceptable?. Front Surg. 2015; 2:15. PMC: 4428214. DOI: 10.3389/fsurg.2015.00015. View

16.

Subramanian A, Clapp M, Hicks S, Awad S, Liang M . Laparoscopic ventral hernia repair: primary versus secondary hernias. J Surg Res. 2012; 181(1):e1-5. DOI: 10.1016/j.jss.2012.06.028. View

17.

Kroese L, Gillion J, Jeekel J, Kleinrensink G, Lange J . Primary and incisional ventral hernias are different in terms of patient characteristics and postoperative complications - A prospective cohort study of 4,565 patients. Int J Surg. 2018; 51:114-119. DOI: 10.1016/j.ijsu.2018.01.010. View

18.

Stabilini C, Cavallaro G, Dolce P, Capoccia Giovannini S, Corcione F, Frascio M . Pooled data analysis of primary ventral (PVH) and incisional hernia (IH) repair is no more acceptable: results of a systematic review and metanalysis of current literature. Hernia. 2019; 23(5):831-845. DOI: 10.1007/s10029-019-02033-4. View

19.

Al Chalabi H, Larkin J, Mehigan B, McCormick P . A systematic review of laparoscopic versus open abdominal incisional hernia repair, with meta-analysis of randomized controlled trials. Int J Surg. 2015; 20:65-74. DOI: 10.1016/j.ijsu.2015.05.050. View

20.

Awaiz A, Rahman F, Hossain M, Yunus R, Khan S, Memon B . Meta-analysis and systematic review of laparoscopic versus open mesh repair for elective incisional hernia. Hernia. 2015; 19(3):449-63. DOI: 10.1007/s10029-015-1351-z. View