Mesh-reinforced compared with primary closure in emergent laparotomies for incarcerated ventral incisional hernias: Is the added complexity justified?

Abstract

<h4>Background</h4>Ventral incisional hernias are a common surgical challenge, particularly when incarcerated, necessitating emergent laparotomy to prevent bowel ischemia and necrosis. The optimal approach for abdominal wall closure in these cases remains debated, with primary repair associated with greater recurrence rates and mesh reinforcement raising concerns regarding infection risks. This study aimed to compare the efficacy, safety, and recurrence rates of mesh-reinforced compared with primary closure during emergent laparotomy for incarcerated ventral incisional hernia.<h4>Methods</h4>A retrospective analysis was conducted on 149 patients who underwent emergent laparotomy for incarcerated ventral incisional hernia at a tertiary center from 2010 to 2020. Patients were categorized into a mesh-repair group (n = 78, 54.5%) and a primary repair group (n = 65, 45.5%). Data included demographics, laboratory values, operative details, and 30-day postoperative outcomes. Propensity score weighting was applied to balance key covariates including age, body mass index, comorbidities, preoperative laboratory values, bowel resection, wound classification, and complication severity.<h4>Results</h4>Patients in the mesh-repair group were younger (61 vs 69 years old; P = .003) and had significantly lower inflammatory markers (C-reactive protein: 0.8 vs 1.5 mg/dL, P = .006). Bowel resection was more frequent in the primary repair group (31% vs 0%, P < .001). No significant differences were found in operative time (P = .14) or major complications (P = .4). Hernia recurrence was significantly lower in the mesh repair group (22% vs 44%, P = .01). After propensity score weighting, recurrence remained significantly lower with mesh (15% vs 39%; P = .002). Subgroup analysis showed no additional benefit in recurrence reduction from retro-muscular mesh placement despite increased operative time.<h4>Conclusion</h4>Mesh-reinforcement during emergent laparotomy for incarcerated ventral incisional hernia is associated with a significantly lower rate of hernia recurrence compared with primary closure. Mesh-reinforced repair demonstrated comparable postoperative morbidity, including rates of major complications, when carefully selected patients were treated. Although this study provides valuable insights into emergent ventral incisional hernia repair strategies, the high recurrence rate in the mesh group raises questions regarding the long-term efficacy of mesh reinforcement in emergent settings.