Mesh overlap for ventral hernia repair in current practice.

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Clinical Guidelines
Authored By
Howard R, Ehlers A, O'Neill S, Shao J, Englesbe M, Dimick JB, Telem D, Huynh D
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Gastroenterology
Surgery
Emergency Medicine
Speciality
Gastroenterology
Surgery
Emergency Medicine
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volume
37
ISSN
1432-2218
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{"article_title":"Mesh overlap for ventral hernia repair in current practice.","author":"Howard, Ryan, Ehlers, Anne, O'Neill, Sean, Shao, Jenny, Englesbe, Michael, Dimick, Justin B., Telem, Dana, Huynh, Desmond","journal_title":"Surgical Endoscopy & Other Interventional Techniques","issn":"1866-6817","isbn":"","publication_date":"Dec2023","volume":"37","issue":"12","first_page":"9476","page_count":"","accession_number":"EPTOC174097356","doi":"10.1007\/s00464-023-10348-8","publisher":"Springer Nature","doctype":"","subjects":"","interest_area":["Gastroenterology"," Surgery"," Emergency Medicine"],"abstract":"Introduction: Sufficient overlap of mesh beyond the borders of a ventral hernia helps prevent hernia recurrence. Guidelines from the European Hernia Society and American Hernia Society recommend \u2265 2 cm overlap for open repair of < 1-cm hernias, \u2265 3-cm overlap for open repair of 1\u20134-cm hernias, \u2265 5-cm overlap for open repair of > 4-cm hernias, and \u2265 5-cm overlap for all laparoscopic ventral hernia repairs. We evaluated whether current practice reflects this guidance. Methods: We used the Michigan Surgical Quality Collaborative Hernia Registry to evaluate patients who underwent elective ventral and umbilical hernia repair between 2020 and 2022. Mesh overlap was calculated as [(width of mesh \u2212 width of hernia)\/2]. The main outcome was \"sufficient overlap,\" defined based on published EHS and AHS guidelines. Explanatory variables included patient, operative, and hernia characteristics. The main analysis was a multivariable logistic regression to evaluate the association between explanatory variables and sufficient mesh overlap. Results: 4178 patients underwent ventral hernia repair with a mean age of 55.2 (13.9) years, 1739 (41.6%) females, mean body mass index (BMI) of 33.1 (7.2) kg\/m2, and mean hernia width of 3.7 (3.4) cm. Mean mesh overlap was 3.7 (2.5) cm and ranged from \u2212 5.5 to 21.4 cm. Only 1074 (25.7%) ventral hernia repairs had sufficient mesh overlap according to published guidelines. Operative factors associated with increased odds of sufficient overlap included myofascial release (adjusted odds ratio [aOR] 5.35 [95% CI 4.07\u20137.03]), minimally invasive approach (aOR 1.86 [95% CI 1.60\u20132.17]), and onlay mesh location (aOR 1.31 [95% CI 1.07\u20131.59]). Patient factors associated with increased odds of sufficient overlap included prior hernia repair (aOR 1.59 [95% CI 1.32\u20131.92]). Conclusion: Although sufficient mesh overlap is recommended to prevent ventral hernia recurrence, only a quarter of ventral hernia repairs in a state-wide cohort of patients had sufficient overlap according to evidence-based guidelines. Factors strongly associated with sufficient overlap included myofascial release, mesh type, and laparoscopic repair.","url":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&db=mdl&AN=EPTOC174097356&authtype=shib&custid=ns346513","isPdfLink":true,"isSAML":false,"additionalInfo":{"Authored_By":"Howard R, Ehlers A, O'Neill S, Shao J, Englesbe M, Dimick JB, Telem D, Huynh D","Journal_Info":"Publisher: Springer Country of Publication: Germany NLM ID: 8806653 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-2218 (Electronic) Linking ISSN: 09302794 NLM ISO Abbreviation: Surg Endosc Subsets: MEDLINE","Publication_Type":"Journal Article","Published_Date":"2023-12-01","Source":"Surgical endoscopy [Surg Endosc] 2023 Dec; Vol. 37 (12), pp. 9476-9482. Date of Electronic Publication: 2023 Sep 11.","Languages":"English","Electronic_ISSN":"1432-2218","MeSH_Terms":"Hernia, Ventral*\/surgery , Laparoscopy*, Aged ; Female ; Humans ; Male ; Middle Aged ; Herniorrhaphy ; Recurrence ; Registries ; Surgical Mesh ; Adult","Subjects":"Aged, Female, Humans, Male, Middle Aged, Herniorrhaphy, Recurrence, Registries, Surgical Mesh, Adult, Hernia, Ventral surgery, Laparoscopy","Title_Abbreviations":"Surgical endoscopy","Volume":"37"},"header":{"DbId":"mdl","DbLabel":"MEDLINE Ultimate","An":"37697114","RelevancyScore":"947","PubType":"Academic Journal","PubTypeId":"academicJournal","PreciseRelevancyScore":"946.893615722656"},"plink":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=37697114&authtype=shib&custid=ns346513&group=main&profile=eds","upload_link":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=37697114&authtype=shib&custid=ns346513&group=main&profile=eds"}
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1866-6817
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true
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Additional Info
["Howard R, Ehlers A, O'Neill S, Shao J, Englesbe M, Dimick JB, Telem D, Huynh D","Publisher: Springer Country of Publication: Germany NLM ID: 8806653 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-2218 (Electronic) Linking ISSN: 09302794 NLM ISO Abbreviation: Surg Endosc Subsets: MEDLINE","Journal Article","2023-12-01","Surgical endoscopy [Surg Endosc] 2023 Dec; Vol. 37 (12), pp. 9476-9482. Date of Electronic Publication: 2023 Sep 11.","English","1432-2218","Hernia, Ventral*\/surgery , Laparoscopy*, Aged ; Female ; Humans ; Male ; Middle Aged ; Herniorrhaphy ; Recurrence ; Registries ; Surgical Mesh ; Adult","Aged, Female, Humans, Male, Middle Aged, Herniorrhaphy, Recurrence, Registries, Surgical Mesh, Adult, Hernia, Ventral surgery, Laparoscopy","Surgical endoscopy","37"]
Description
Introduction: Sufficient overlap of mesh beyond the borders of a ventral hernia helps prevent hernia recurrence. Guidelines from the European Hernia Society and American Hernia Society recommend ≥ 2 cm overlap for open repair of < 1-cm hernias, ≥ 3-cm overlap for open repair of 1-4-cm hernias, ≥ 5-cm overlap for open repair of > 4-cm hernias, and ≥ 5-cm overlap for all laparoscopic ventral hernia repairs. We evaluated whether current practice reflects this guidance.<br />Methods: We used the Michigan Surgical Quality Collaborative Hernia Registry to evaluate patients who underwent elective ventral and umbilical hernia repair between 2020 and 2022. Mesh overlap was calculated as [(width of mesh - width of hernia)/2]. The main outcome was "sufficient overlap," defined based on published EHS and AHS guidelines. Explanatory variables included patient, operative, and hernia characteristics. The main analysis was a multivariable logistic regression to evaluate the association between explanatory variables and sufficient mesh overlap.<br />Results: 4178 patients underwent ventral hernia repair with a mean age of 55.2 (13.9) years, 1739 (41.6%) females, mean body mass index (BMI) of 33.1 (7.2) kg/m <superscript>2</superscript> , and mean hernia width of 3.7 (3.4) cm. Mean mesh overlap was 3.7 (2.5) cm and ranged from - 5.5 to 21.4 cm. Only 1074 (25.7%) ventral hernia repairs had sufficient mesh overlap according to published guidelines. Operative factors associated with increased odds of sufficient overlap included myofascial release (adjusted odds ratio [aOR] 5.35 [95% CI 4.07-7.03]), minimally invasive approach (aOR 1.86 [95% CI 1.60-2.17]), and onlay mesh location (aOR 1.31 [95% CI 1.07-1.59]). Patient factors associated with increased odds of sufficient overlap included prior hernia repair (aOR 1.59 [95% CI 1.32-1.92]).<br />Conclusion: Although sufficient mesh overlap is recommended to prevent ventral hernia recurrence, only a quarter of ventral hernia repairs in a state-wide cohort of patients had sufficient overlap according to evidence-based guidelines. Factors strongly associated with sufficient overlap included myofascial release, mesh type, and laparoscopic repair.<br /> (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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