Mesh Fixation to Fascia During Incisional Hernia Repair Results in Increased Prevalence of Pain at Long-term Follow Up: a Multicenter Propensity Score Matched Prospective Observational Study

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2021 Feb 23

PMID 33620567

Authors

Andreas Kohler

Joel L Lavanchy

Rahel Gasser

Roland Wyss

Lars Nowak

Andreas Scheiwiller

Peter Hammerli

Daniel Candinas

Guido Beldi

Affiliations

Soon will be listed here.

Abstract

Background: Patient-reported outcomes such as postoperative pain are critical for the evaluation of outcomes after incisional hernia repair. The aim of this study is to determine the long-term impact of mesh fixation on postoperative pain in patients operated by open and laparoscopic technique.

Methods: A multicenter prospective observational cohort study was conducted from September 2011 until March 2016 in nine hospitals across Switzerland. Patients undergoing elective incisional hernia repair were included in this study and stratified by either laparoscopic or open surgical technique. Propensity score matching was applied to balance the differences in baseline characteristics between the treatment groups. Clinical follow-up was conducted 3, 12 and 36 months postoperatively to detect hernia recurrence, postoperative pain and complications.

Results: Three-hundred-sixty-one patients were included into the study. No significant differences in hernia recurrence and pain at 3, 12 and 36 months postoperatively were observed when comparing the laparoscopic with the open treatment group. Mesh fixation by sutures to fascia versus other mesh fixation led to significantly more pain at 36 months postoperatively (32.8% vs 15.7%, p = 0.025).

Conclusions: At long-term follow-up, no difference in pain was identified between open and laparoscopic incisional hernia repair. Mesh fixation by sutures to fascia was identified to be associated with increased pain 36 months after surgery. Omitting mesh fixation by sutures to the fascia may reduce long-term postoperative pain after hernia repair.

References

Gillion J, Sanders D, Miserez M, Muysoms F . The economic burden of incisional ventral hernia repair: a multicentric cost analysis. Hernia. 2016; 20(6):819-830. DOI: 10.1007/s10029-016-1480-z. View

Wassenaar E, Schoenmaeckers E, Raymakers J, van der Palen J, Rakic S . Mesh-fixation method and pain and quality of life after laparoscopic ventral or incisional hernia repair: a randomized trial of three fixation techniques. Surg Endosc. 2009; 24(6):1296-302. PMC: 2869434. DOI: 10.1007/s00464-009-0763-1. View

Belyansky I, Daes J, Radu V, Balasubramanian R, Zahiri H, Weltz A . A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair. Surg Endosc. 2017; 32(3):1525-1532. DOI: 10.1007/s00464-017-5840-2. View

Kockerling F, Hoffmann H, Adolf D, Weyhe D, Reinpold W, Koch A . Female sex as independent risk factor for chronic pain following elective incisional hernia repair: registry-based, propensity score-matched comparison. Hernia. 2019; 24(3):567-576. PMC: 7210249. DOI: 10.1007/s10029-019-02089-2. View

Mangram A, Horan T, Pearson M, Silver L, Jarvis W . Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999; 20(4):250-78; quiz 279-80. DOI: 10.1086/501620. View

Lavanchy J, Buff S, Kohler A, Candinas D, Beldi G . Long-term results of laparoscopic versus open intraperitoneal onlay mesh incisional hernia repair: a propensity score-matched analysis. Surg Endosc. 2018; 33(1):225-233. PMC: 6336754. DOI: 10.1007/s00464-018-6298-6. View

Bansal V, Misra M, Babu D, Singhal P, Rao K, Sagar R . Comparison of long-term outcome and quality of life after laparoscopic repair of incisional and ventral hernias with suture fixation with and without tacks: a prospective, randomized, controlled study. Surg Endosc. 2012; 26(12):3476-85. DOI: 10.1007/s00464-012-2390-5. View

Ben Yehuda A, Nyska A, Szold A . Mesh fixation using novel bio-adhesive coating compared to tack fixation for IPOM hernia repair: in vivo evaluation in a porcine model. Surg Endosc. 2019; 33(7):2364-2375. DOI: 10.1007/s00464-019-06806-x. View

Basta M, Kozak G, Broach R, Messa 4th C, Rhemtulla I, DeMatteo R . Can We Predict Incisional Hernia?: Development of a Surgery-specific Decision-Support Interface. Ann Surg. 2019; 270(3):544-553. DOI: 10.1097/SLA.0000000000003472. View

10.

Rogmark P, Petersson U, Bringman S, Eklund A, Ezra E, Sevonius D . Short-term outcomes for open and laparoscopic midline incisional hernia repair: a randomized multicenter controlled trial: the ProLOVE (prospective randomized trial on open versus laparoscopic operation of ventral eventrations) trial. Ann Surg. 2013; 258(1):37-45. DOI: 10.1097/SLA.0b013e31828fe1b2. View

11.

Beldi G, Wagner M, Bruegger L, Kurmann A, Candinas D . Mesh shrinkage and pain in laparoscopic ventral hernia repair: a randomized clinical trial comparing suture versus tack mesh fixation. Surg Endosc. 2010; 25(3):749-55. DOI: 10.1007/s00464-010-1246-0. View

12.

Snyder C, Graham L, Vick C, Gray S, Finan K, Hawn M . Patient satisfaction, chronic pain, and quality of life after elective incisional hernia repair: effects of recurrence and repair technique. Hernia. 2010; 15(2):123-9. DOI: 10.1007/s10029-010-0750-4. View

13.

Eker H, Hansson B, Buunen M, Janssen I, Pierik R, Hop W . Laparoscopic vs. open incisional hernia repair: a randomized clinical trial. JAMA Surg. 2013; 148(3):259-63. DOI: 10.1001/jamasurg.2013.1466. View

14.

Sando A, Rosen M, Heniford B, Bisgaard T . Long-term patient-reported outcomes and quality of the evidence in ventral hernia mesh repair: a systematic review. Hernia. 2020; 24(4):695-705. DOI: 10.1007/s10029-020-02154-1. View

15.

Muysoms F, Vander Mijnsbrugge G, Pletinckx P, Boldo E, Jacobs I, Michiels M . Randomized clinical trial of mesh fixation with "double crown" versus "sutures and tackers" in laparoscopic ventral hernia repair. Hernia. 2013; 17(5):603-12. DOI: 10.1007/s10029-013-1084-9. View

16.

van Veenendaal N, Poelman M, van den Heuvel B, Dwars B, Schreurs W, Stoot J . The PINCH-Phone: a new screenings method for recurrent incisional hernias. Surg Endosc. 2018; 33(9):2794-2801. PMC: 6684537. DOI: 10.1007/s00464-018-6567-4. View

17.

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

18.

Burger J, Luijendijk R, Hop W, Halm J, Verdaasdonk E, Jeekel J . Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg. 2004; 240(4):578-83. PMC: 1356459. DOI: 10.1097/01.sla.0000141193.08524.e7. View

19.

Schwarz J, Reinpold W, Bittner R . Endoscopic mini/less open sublay technique (EMILOS)-a new technique for ventral hernia repair. Langenbecks Arch Surg. 2016; 402(1):173-180. DOI: 10.1007/s00423-016-1522-0. View

20.

Dindo D, Demartines N, Clavien P . Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2):205-13. PMC: 1360123. DOI: 10.1097/01.sla.0000133083.54934.ae. View