Hernia Repair Outcomes

This article is a comprehensive retrospective review of ventral hernia repair outcomes performed at one facility in the USA. The study was limited by a small sample size, facility treatment bias, retrospective review, and loss of information due to data extraction from paper charts; these are all acknowledged by the authors of the paper.

Kadakia N, Mudgway R, Vo J, et al. (August 02, 2020) Long-Term Outcomes of Ventral Hernia Repair: An 11-Year Follow-Up. Cureus 12(8): e9523. DOI 10.7759/cureus.9523

Key Points: Hernia Repair Outcomes

• Ventral hernia repairs (VHR) may be performed through open or laparoscopic techniques, and with or without mesh.

• Complication rates may be affected by various factors such as mesh placement and mesh position technique.

• Mesh use is associated with a lower risk for recurrence and a higher risk of infections.

• Laparoscopic repairs are associated with decreased quality of life, length of stay, and infection rates.

• VHRs with mesh had lower rates of recurrence than suture repairs, and lower rates of complications, but these were not statistically significant.

Obesity, COPD, component separation technique, and prolonged operating time were associated with increased risk of complications.

• Factors that contribute to post-operative complications after VHR in obese patients include:

  → Impaired visualization due to body habitus.

  → Defects in tissue structure.

  → Defects in tissue healing.

• There is variability in outcomes for VHR with obesity and pre-existing hypertension.

  → Addressing these modifiable risk factors prior to surgery is recommended.

• The primary outcome measure in this study was recurrence of hernia.

Clinical Pilates in Practice

• Begin with breathing.

• Optimizing breath biomechanics for someone with a compromised abdominal wall will decrease stress and strain into the surgical repair area.

• Given that breathing is also altered in those conditions that are associated with increased risk of complications, early education is key.

  Support the deep core cylinder with exercises focusing on the diaphragm, multifidus, psoas, and adductor-pelvic floor connections prior to anterior abdominal wall exercises:

  → Magic Circle adductor squeezes.

  → Side lying segmental lumbar control.

  → Reformer Footwork.

  → Side Lying Leg Lifts.