The interplay of surgeon judgment and available evidence in the long-term outcome of ventral hernia repair.

Abstract

<h4>Background</h4>Since 2011, the New England VA Hernia Registry (NEVAHR) prospectively collected operative details of ventral hernia repairs (VHRs) from 5 VA medical centers. This study aims to determine factors associated with recurrence.<h4>Methods</h4>Recurrence and surgical site occurrences (SSO) were directly identified via clinical and operative notes and/or imaging. Analysis was conducted via logistical regression.<h4>Results</h4>There were 681 VHRs. Mesh was used in 589 (86.5 ​%) repairs and was associated with larger average defect sizes (p ​< ​0.001) and incisional hernias (p ​= ​0.007). There were 117 (19.9 ​%) recurrences among mesh repairs and 22 (23.9 ​%) among suture repairs (p ​= ​0.033). Among mesh repairs, recurrence was associated with higher BMI (p ​= ​0.009), smoking (p ​= ​0.012), parastomal and subcostal hernias (p ​= ​0.003; p ​= ​0.042), SSOs (p ​= ​0.009), laparoscopy (p ​= ​0.042), and smaller mesh-fascia overlap (p ​= ​0.039). No factors associated with recurrence among suture repairs.<h4>Conclusion</h4>Despite proper decision-making by NEVAHR surgeons, suture repair underperforms for hernias >2 ​cm. Utility of suture repair for defects <2 ​cm requires more investigation.