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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

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Abstract

Purpose

Primary (PVHs) and incisional (IHs) ventral hernias represent a common indication for surgery. Nevertheless, most of the papers presented in literature analyze both types of defect together, thus potentially introducing a bias in the results of interpretation. The purpose of this systematic review and meta-analysis is to highlight the differences between these two entities.

Methods

Methods MEDLINE, Scopus, and Web of Science databases were reviewed to identify studies evaluating the outcomes of both open and laparoscopic repair with mesh of PVHs vs IHs. Search was restricted to English language literature. Risk of bias was assessed with MINORS score. Primary outcome was recurrence, and secondary outcomes were baseline characteristics and intraoperative and postoperative data. Fixed effects model was used unless significant heterogeneity, assessed with the Higgins I square (I2), was encountered.

Results

The search resulted in 783 hits, after screening; 11 retrospective trials were selected including 38,727 patients. Mean MINORS of included trials was 15.2 (range 5–21). The estimated pooled proportion difference for recurrence was − 0.09 (− 0.11; − 0.07) between the two groups in favor of the PVH group. On metanalysis, PVHs were smaller in area and diameters, affected younger and less comorbid patients, and were more frequently singular; the operative time and length of stay was quicker. Other complications did not differ significantly.

Conclusion

Our paper supports the hypothesis that PVH and IH are different conditions with the latter being more challenging to treat. Accordingly, EHS classifications should be adopted systematically as well as pooling data analysis should be no longer performed in clinical trials.

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References

  1. Nguyen MT, Berger RL, Hicks SC, Davila JA, Li LT, Kao LS, Liang MK (2014) Comparison of outcomes of synthetic mesh vs suture repair of elective primary ventral herniorrhaphy: a systematic review and meta-analysis. JAMA Surg 149(5):415–421. https://doi.org/10.1001/jamasurg.2013.5014

    Article  PubMed  Google Scholar 

  2. Kroese LF, Gillion JF, Jeekel J, Kleinrensink GJ, Lange JF, Hernia-Club M (2018) 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 51:114–119. https://doi.org/10.1016/j.ijsu.2018.01.010

    Article  PubMed  Google Scholar 

  3. Poulose BK, Shelton J, Phillips S, Moore D, Nealon W, Penson D, Beck W, Holzman MD (2012) Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia 16(2):179–183. https://doi.org/10.1007/s10029-011-0879-9

    Article  CAS  PubMed  Google Scholar 

  4. Bosanquet DC, Ansell J, Abdelrahman T, Cornish J, Harries R, Stimpson A, Davies L, Glasbey JC, Frewer KA, Frewer NC, Russell D, Russell I, Torkington J (2015) Systematic review and meta-regression of factors affecting midline incisional hernia rates: analysis of 14,618 patients. PLoS One 10(9):e0138745. https://doi.org/10.1371/journal.pone.0138745

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Fink C, Baumann P, Wente MN, Knebel P, Bruckner T, Ulrich A, Werner J, Buchler MW, Diener MK (2014) Incisional hernia rate 3 years after midline laparotomy. Br J Surg 101(2):51–54. https://doi.org/10.1002/bjs.9364

    Article  CAS  PubMed  Google Scholar 

  6. Harris HW, Hope WH, Adrales G, Andersen DK, Deerenberg EB, Diener H, Dumanian G, East B, Fischer JP, Urena MAG, Gibeily GJ, Hansson BM, Hernandez-Granados P, Hiles MC, Jeekel J, Levinson H, Lopez-Cano M, Muysoms F, Pereira JA, Prudhomme M, Ramaswamy A, Stabilini C, Torkington J, Valverde S, Young DM (2018) Contemporary concepts in hernia prevention: selected proceedings from the 2017 international symposium on prevention of incisional hernias. Surgery 164(2):319–326. https://doi.org/10.1016/j.surg.2018.02.020

    Article  PubMed  Google Scholar 

  7. Pham CT, Perera CL, Watkin DS, Maddern GJ (2009) Laparoscopic ventral hernia repair: a systematic review. Surg Endosc 23(1):4–15. https://doi.org/10.1007/s00464-008-0182-8

    Article  PubMed  Google Scholar 

  8. Zhang Y, Zhou H, Chai Y, Cao C, Jin K, Hu Z (2014) Laparoscopic versus open incisional and ventral hernia repair: a systematic review and meta-analysis. World J Surg 38(9):2233–2240. https://doi.org/10.1007/s00268-014-2578-z

    Article  PubMed  Google Scholar 

  9. Castro PM, Rabelato JT, Monteiro GG, del Guerra GC, Mazzurana M, Alvarez GA (2014) Laparoscopy versus laparotomy in the repair of ventral hernias: systematic review and meta-analysis. Arq Gastroenterol 51(3):205–211

    Article  PubMed  Google Scholar 

  10. Silecchia G, Cavallaro G, Raparelli L, Olmi S, Baldazzi G, Campanile FC (2015) Titanium versus absorbable tacks comparative study (TACS): a multicenter, non-inferiority prospective evaluation during laparoscopic repair of ventral and incisional hernia: study protocol for randomized controlled trial. Trials 16:249. https://doi.org/10.1186/s13063-015-0779-x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Kurian A, Gallagher S, Cheeyandira A, Josloff R (2010) Laparoscopic repair of primary versus incisional ventral hernias: time to recognize the differences? Hernia 14(4):383–387. https://doi.org/10.1007/s10029-010-0649-0

    Article  CAS  PubMed  Google Scholar 

  12. Subramanian A, Clapp ML, Hicks SC, Awad SS, Liang MK (2013) Laparoscopic ventral hernia repair: primary versus secondary hernias. J Surg Res 181(1):e1–e5. https://doi.org/10.1016/j.jss.2012.06.028

    Article  PubMed  Google Scholar 

  13. Kockerling F, Schug-Pass C, Adolf D, Reinpold W, Stechemesser B (2015) Is pooled data analysis of ventral and incisional hernia repair acceptable? Front Surg 2:15. https://doi.org/10.3389/fsurg.2015.00015

    Article  PubMed  PubMed Central  Google Scholar 

  14. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8(5):336–341. https://doi.org/10.1016/j.ijsu.2010.02.007

    Article  PubMed  Google Scholar 

  15. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73(9):712–716

    Article  PubMed  Google Scholar 

  16. Rucker G, Schwarzer G, Carpenter J, Olkin I (2009) Why add anything to nothing? The arcsine difference as a measure of treatment effect in meta-analysis with zero cells. Stat Med 28(5):721–738. https://doi.org/10.1002/sim.3511

    Article  PubMed  Google Scholar 

  17. Viechtbauer W (2010) Conducting meta-analyses in R with the metafor Package. J Stat Softw. https://doi.org/10.18637/jss.v036.i03

    Article  Google Scholar 

  18. Lambrecht JR, Vaktskjold A, Trondsen E, Oyen OM, Reiertsen O (2015) Laparoscopic ventral hernia repair: outcomes in primary versus incisional hernias: no effect of defect closure. Hernia 19(3):479–486. https://doi.org/10.1007/s10029-015-1345-x

    Article  CAS  PubMed  Google Scholar 

  19. Gillion JF, Lepere M, Barrat C, Cas O, Dabrowski A, Jurczak F, Khalil H, Zaranis C, French Club Hernie Study G (2019) Two-year patient-related outcome measures (PROM) of primary ventral and incisional hernia repair using a novel three-dimensional composite polyester monofilament mesh: the SymCHro registry study. Hernia. https://doi.org/10.1007/s10029-019-01924-w

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kurian A, Gallagher S, Cheeyandira A, Josloff R (2010) Predictors of in-hospital length of stay after laparoscopic ventral hernia repair: results of multivariate logistic regression analysis. Surg Endosc 24(11):2789–2792. https://doi.org/10.1007/s00464-010-1048-4

    Article  PubMed  Google Scholar 

  21. Stirler VM, Schoenmaeckers EJ, de Haas RJ, Raymakers JT, Rakic S (2014) Laparoscopic repair of primary and incisional ventral hernias: the differences must be acknowledged: a prospective cohort analysis of 1,088 consecutive patients. Surg Endosc 28(3):891–895. https://doi.org/10.1007/s00464-013-3243-6

    Article  PubMed  Google Scholar 

  22. Dietz UA, Winkler MS, Hartel RW, Fleischhacker A, Wiegering A, Isbert C, Jurowich C, Heuschmann P, Germer CT (2014) Importance of recurrence rating, morphology, hernial gap size, and risk factors in ventral and incisional hernia classification. Hernia 18(1):19–30. https://doi.org/10.1007/s10029-012-0999-x

    Article  CAS  PubMed  Google Scholar 

  23. Polavarapu HV, Kurian AA, Josloff R (2012) Laparoscopic ventral hernia repair in the elderly: does the type of hernia matter? Hernia 16(4):425–429. https://doi.org/10.1007/s10029-012-0932-3

    Article  CAS  PubMed  Google Scholar 

  24. Tagaya N, Mikami H, Aoki H, Kubota K (2004) Long-term complications of laparoscopic ventral and incisional hernia repair. Surg Laparosc Endosc Percutan Tech 14(1):5–8

    Article  PubMed  Google Scholar 

  25. Gillion JF, Lepere M, Barrat C, Cas O, Dabrowski A, Jurczak F, Khalil H, Zaranis C, Antor M, Beck M, Berney C, Binot D, Blazquez D, Bonan A, Bousquet J, Demian H, Dubuisson V, Champault-Fezais A, Chastan P, Chollet JM, Cossa JP, Demaret S, Delaunay T, Drissi F, Dugue TG, Fromont G, Gillion JF, Jacquin C, Launay-Savary MV, Ledaguenel P, Lepère M, Lépront D, Le Toux N, Longeville JH, Magne E, Ngo P, Oberlin O, Pavis d’Escurac X, Putinier JB, Renard Y, Romain B, Roos S, Soler M, Thillois JM, Tiry P, Verhaeghe R, Vu P, Zaranis C (2019) Two-year patient-related outcome measures (PROM) of primary ventral and incisional hernia repair using a novel three-dimensional composite polyester monofilament mesh: the SymCHro registry study. Hernia. https://doi.org/10.1007/s10029-019-01924-w

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kroese LF, Gillion JF, Jeekel J, Kleinrensink GJ, Lange JF, Hernia-Club M (2018) 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 51:114–119. https://doi.org/10.1016/j.ijsu.2018.01.010

    Article  PubMed  Google Scholar 

  27. Wagh PV, Read RC (1972) Defective collagen synthesis in inguinal herniation. Am J Surg 124(6):819–822

    Article  CAS  PubMed  Google Scholar 

  28. Read RC (1970) Attenuation of the rectus sheath in inguinal herniation. Am J Surg 120(5):610–614

    Article  CAS  PubMed  Google Scholar 

  29. Friedman DW, Boyd CD, Norton P, Greco RS, Boyarsky AH, Mackenzie JW, Deak SB (1993) Increases in type III collagen gene expression and protein synthesis in patients with inguinal hernias. Ann Surg 218(6):754–760

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Deerenberg EB, Harlaar JJ, Steyerberg EW, Lont HE, van Doorn HC, Heisterkamp J, Wijnhoven BP, Schouten WR, Cense HA, Stockmann HB, Berends FJ, Dijkhuizen FPH, Dwarkasing RS, Jairam AP, van Ramshorst GH, Kleinrensink GJ, Jeekel J, Lange JF (2015) Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. Lancet (London, England) 386(10000):1254–1260. https://doi.org/10.1016/s0140-6736(15)60459-7

    Article  Google Scholar 

  31. White B, Osier C, Gletsu N, Jeansonne L, Baghai M, Sherman M, Smith CD, Ramshaw B, Lin E (2007) Abnormal primary tissue collagen composition in the skin of recurrent incisional hernia patients. Am Surg 73(12):1254–1258

    PubMed  Google Scholar 

  32. Salameh JR, Talbott LM, May W, Gosheh B, Vig PJ, McDaniel DO (2007) Role of biomarkers in incisional hernias. Am Surg 73(6):561–567 (discussion 567–568)

    CAS  PubMed  Google Scholar 

  33. Jairam AP, Timmermans L, Eker HH, Pierik R, van Klaveren D, Steyerberg EW, Timman R, van der Ham AC, Dawson I, Charbon JA, Schuhmacher C, Mihaljevic A, Izbicki JR, Fikatas P, Knebel P, Fortelny RH, Kleinrensink GJ, Lange JF, Jeekel HJ (2017) Prevention of incisional hernia with prophylactic onlay and sublay mesh reinforcement versus primary suture only in midline laparotomies (PRIMA): 2-year follow-up of a multicentre, double-blind, randomised controlled trial. Lancet (London, England) 390(10094):567–576. https://doi.org/10.1016/s0140-6736(17)31332-6

    Article  Google Scholar 

  34. Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, Dietz UA, Eker HH, El Nakadi I, Hauters P, Hidalgo Pascual M, Hoeferlin A, Klinge U, Montgomery A, Simmermacher RK, Simons MP, Smietanski M, Sommeling C, Tollens T, Vierendeels T, Kingsnorth A (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13(4):407–414. https://doi.org/10.1007/s10029-009-0518-x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Koehler RH, Voeller G (1999) Recurrences in laparoscopic incisional hernia repairs: a personal series and review of the literature. Jsls 3(4):293–304

    CAS  PubMed  PubMed Central  Google Scholar 

  36. Slater NJ, Montgomery A, Berrevoet F, Carbonell AM, Chang A, Franklin M, Kercher KW, Lammers BJ, Parra-Davilla E, Roll S, Towfigh S, van Geffen E, Conze J, van Goor H (2014) Criteria for definition of a complex abdominal wall hernia. Hernia 18(1):7–17. https://doi.org/10.1007/s10029-013-1168-6

    Article  CAS  PubMed  Google Scholar 

  37. Drissi F, Gillion JF, Cossa JP, Jurczak F, Baayen C (2019) Factors of selection and failure of ambulatory incisional hernia repair: a cohort study of 1429 patients. J Visc Surg 156(2):85–90. https://doi.org/10.1016/j.jviscsurg.2018.07.001

    Article  CAS  PubMed  Google Scholar 

  38. Hesselink VJ, Luijendijk RW, de Wilt JH, Heide R, Jeekel J (1993) An evaluation of risk factors in incisional hernia recurrence. Surg Gynecol Obstet 176(3):228–234

    CAS  PubMed  Google Scholar 

  39. Blatnik JA, Harth KC, Aeder MI, Rosen MJ (2011) Thirty-day readmission after ventral hernia repair: predictable or preventable? Surg Endosc 25(5):1446–1451. https://doi.org/10.1007/s00464-010-1412-4

    Article  PubMed  Google Scholar 

  40. Blair LJ, Ross SW, Huntington CR, Watkins JD, Prasad T, Lincourt AE, Augenstein VA, Heniford BT (2015) Computed tomographic measurements predict component separation in ventral hernia repair. J Surg Res 199(2):420–427. https://doi.org/10.1016/j.jss.2015.06.033

    Article  PubMed  Google Scholar 

  41. ten Broek RP, Schreinemacher MH, Jilesen AP, Bouvy N, Bleichrodt RP, van Goor H (2012) Enterotomy risk in abdominal wall repair: a prospective study. Ann Surg 256(2):280–287. https://doi.org/10.1097/SLA.0b013e31826029a8

    Article  PubMed  Google Scholar 

  42. Stabilini C, Cavallaro G, Bocchi P, Campanelli G, Carlucci M, Ceci F, Crovella F, Cuccurullo D, Fei L, Gianetta E, Gossetti F, Greco DP, Iorio O, Ipponi P, Marioni A, Merola G, Negro P, Palombo D, Bracale U (2018) Defining the characteristics of certified hernia centers in Italy: the Italian society of hernia and abdominal wall surgery workgroup consensus on systematic reviews of the best available evidences. Int J Surg (Lond, Engl) 54(Pt A):222–235. https://doi.org/10.1016/j.ijsu.2018.04.052

    Article  Google Scholar 

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Funding

The present meta-analysis or authors did not receive any funding.

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Authors and Affiliations

  1. Department of Surgical Science, University of Genoa, Policlinico San Martino IRCCS, Genoa, Italy

    C. Stabilini, S. Capoccia Giovannini & M. Frascio

  2. General and Laparoscopic Surgery Unit, Department of Surgery “P. Valdoni”, Sapienza University, Rome, Italy

    G. Cavallaro

  3. Department of Public Health, Federico II University, Naples, Italy

    P. Dolce & F. Corcione

  4. Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy

    M. Sodo, G. Merola & U. Bracale

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  1. C. Stabilini
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Correspondence to G. Cavallaro.

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Stabilini, C., Cavallaro, G., Dolce, P. et al. 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 23, 831–845 (2019). https://doi.org/10.1007/s10029-019-02033-4

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