Mesh overlap for ventral hernia repair in current practice.

Evidence-based practice Hernia Hernia repair Mesh Overlap Practice guidelines Ventral hernia

Journal

Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653

Informations de publication

Date de publication:
Dec 2023
Historique:
received: 29 03 2023
accepted: 30 07 2023
pubmed: 12 9 2023
medline: 12 9 2023
entrez: 11 9 2023
Statut: ppublish

Résumé

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. 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. 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 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.

Identifiants

DOI: 10.1007/s00464-023-10348-8 PMID: 37697114
pubmed: 37697114
doi: 10.1007/s00464-023-10348-8
pii: 10.1007/s00464-023-10348-8
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

9476-9482

Informations de copyright

© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Références

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Auteurs

Ryan Howard (R)

Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA.
ORCID: 0000-0001-9877-9603

Anne Ehlers (A)

Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA.
Division of Minimally Invasive Surgery, Department of Surgery, Michigan Medicine, 2926 Taubman Center, 1500 E Medical Center Dr, SPC 5331, Ann Arbor, MI, 48109-5331, USA.

Sean O'Neill (S)

Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA.
Division of Minimally Invasive Surgery, Department of Surgery, Michigan Medicine, 2926 Taubman Center, 1500 E Medical Center Dr, SPC 5331, Ann Arbor, MI, 48109-5331, USA.

Jenny Shao (J)

Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
Division of Minimally Invasive Surgery, Department of Surgery, Michigan Medicine, 2926 Taubman Center, 1500 E Medical Center Dr, SPC 5331, Ann Arbor, MI, 48109-5331, USA.

Michael Englesbe (M)

Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA.

Justin B Dimick (JB)

Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA.
Division of Minimally Invasive Surgery, Department of Surgery, Michigan Medicine, 2926 Taubman Center, 1500 E Medical Center Dr, SPC 5331, Ann Arbor, MI, 48109-5331, USA.

Dana Telem (D)

Department of Surgery, University of Michigan, Ann Arbor, MI, USA. dtelem@med.umich.edu.
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA. dtelem@med.umich.edu.
Division of Minimally Invasive Surgery, Department of Surgery, Michigan Medicine, 2926 Taubman Center, 1500 E Medical Center Dr, SPC 5331, Ann Arbor, MI, 48109-5331, USA. dtelem@med.umich.edu.

Desmond Huynh (D)

Department of Surgery, University of Michigan, Ann Arbor, MI, USA.

Classifications MeSH