Reoperation not reliable indicator for hernia recurrence

By Sarah Guy, medwireNews Reporter

Using reoperation rates as the indicator for recurrence after ventral hernia repair may underestimate the true recurrence rate, according to Danish study findings.

Indeed, basing recurrence estimates on the number of patients who received repeat surgery for their hernias resulted in a four- to five-fold underestimation of the rate of clinical recurrence in the group, report the researchers in the Annals of Surgery.

The team defined clinical recurrence as a palpable fascial defect with protrusion of bowel or lump and/or an ultrasound- or computed tomography-visualized fascial defect with protrusion of bowel or lump.

Frederik Helgstrand (University of Copenhagen) and co-researchers suggest that this definition "should be taken into consideration in future outcome studies in ventral hernia repair."

The team validated a recurrence-centered questionnaire in a group of 68 ventral hernia patients, then distributed the questionnaire among 902 further patients for analysis.

A total of 646 participants initially underwent umbilical/epigastric hernia repair and 256 underwent incisional repair, and a respective 27 and 19 of these patients underwent reoperation during the median 41-month follow up.

However, clinical recurrence was identified in 119 participants who did not undergo reoperation (60 umbilical/epigastric and 59 incisional patients), giving a total recurrence incidence - after combination with reoperation rates - of 13% and 30% for umbilical/epigastric and incisional patients, respectively.

The cumulative risks for reoperation and overall clinical recurrence after umbilical/epigastric hernia repair were 4% and 15%, meaning the reoperation rate was 3.8 times lower than the true recurrence rate. Similarly, for incisional ventral hernia repair, the reoperation rate, at 8%, was 4.5 times lower than the overall clinical recurrence rate of 37%, report Helgstrand et al.

Reasons that patients did not undergo surgical repair included them having no or limited symptoms, and that their surgeon and/or general physician advised against it.

The researchers found no significant differences between reoperation rates and clinical recurrence rates according to patient gender, age, hernia size, surgical technique, or whether their surgery was elective or emergency.

Furthermore, the median period between primary operation and reoperation was nonsignificantly different from the median period between primary operation and clinical recurrence among umbilical/epigastric patients, and only trended toward significance among incisional patients.

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