Background Ventral hernia repair (VHR) of large defects poses significant technical challenges due to the size of the hernia and complexity of operative techniques required for fascial closure. This study examined clinical outcomes in “giant” open VHR (GVHR), with hernia defect size (HDS) ≥ 200 cm2, versus “non-giant” open VHR (NGVHR) with HDS < 200 cm2 using a propensity-matched approach. Methods A prospectively-maintained database from a tertiary hernia center was reviewed for patients undergoing open VHR. 1:1 propensity-score matching was performed for GVHR versus NGVHR based on age, BMI, comorbidities, fascial defect closure, primary vs recurrent repair, CDC wound class, and ASA score. A multivariable regression model evaluated whether wound complications increased odds of recurrence. CDC class III/IV wounds and concomitant intraabdominal procedures were excluded. Standard statistical analyses were performed. Results PSM yielded 254 well-matched pairs (all p > 0.05). Average age (59.7 ± 11.3 vs. 59.3 ± 12.3 years) and BMI (32.1 ± 6.5 vs. 32.4 ± 6.6 kg/m2) were similar between GVHR and NGVHR. Tobacco status was similar for current and former smokers (3.9% vs. 3.9%; 29.9% vs. 29.9%). GVHR had larger defect size (354.7 ± 132.1 vs. 103.8 ± 61.9 cm2; p < 0.001) and mesh size (1161.9 ± 450.0 vs. 771.2 ± 388.4 cm2; p < 0.001). In GVHR, Botulinum toxin injections (15.4% vs. 2.8%; p < 0.001) and component separation (50.6% vs. 23.7%; p < 0.001) were more frequent. Fascial defect was closed in 100% of both groups (p > 0.999). GVHR had higher rates of wound complications (33.5% vs. 15.4%; p < 0.001), respiratory insufficiency or failure (4.7% vs. 0.8%; p = 0.012), reoperation (9.8% vs. 4.7%; p = 0.028), and greater average length-of-stay (6.9 ± 5.1 vs. 5.0 ± 2.0 days; p < 0.001). There was no statistical difference in recurrence (4.3% vs. 2.4%; p = 0.217) or follow-up (24.0 ± 37.8 vs. 27.4 ± 40.4 months; p = 0.558). Conclusion GVHR often required chemical and mechanical component separation to achieve fascial closure. However, with large preperitoneal mesh overlap and fascial closure, outcomes of large defects in VHR are comparable to smaller defects.

Are outcomes of giant ventral hernia repair inferior? A propensity-matched analysis

期刊论文
发表日期：

2025年7月16日

查看全文

Samantha W. Kerr,
Brittany S. Mead,
Alexis M. Holland,
William R. Lorenz,
Gregory T. Scarola,
Kent W. Kercher,
Vedra A. Augenstein,
B. Todd Heniford,
Sullivan A. Ayuso

摘要

Background

Ventral hernia repair (VHR) of large defects poses significant technical challenges due to the size of the hernia and complexity of operative techniques required for fascial closure. This study examined clinical outcomes in “giant” open VHR (GVHR), with hernia defect size (HDS) ≥ 200 cm², versus “non-giant” open VHR (NGVHR) with HDS < 200 cm² using a propensity-matched approach.

Methods

A prospectively-maintained database from a tertiary hernia center was reviewed for patients undergoing open VHR. 1:1 propensity-score matching was performed for GVHR versus NGVHR based on age, BMI, comorbidities, fascial defect closure, primary vs recurrent repair, CDC wound class, and ASA score. A multivariable regression model evaluated whether wound complications increased odds of recurrence. CDC class III/IV wounds and concomitant intraabdominal procedures were excluded. Standard statistical analyses were performed.

Results

PSM yielded 254 well-matched pairs (all p > 0.05). Average age (59.7 ± 11.3 vs. 59.3 ± 12.3 years) and BMI (32.1 ± 6.5 vs. 32.4 ± 6.6 kg/m²) were similar between GVHR and NGVHR. Tobacco status was similar for current and former smokers (3.9% vs. 3.9%; 29.9% vs. 29.9%). GVHR had larger defect size (354.7 ± 132.1 vs. 103.8 ± 61.9 cm²; p < 0.001) and mesh size (1161.9 ± 450.0 vs. 771.2 ± 388.4 cm²; p < 0.001). In GVHR, Botulinum toxin injections (15.4% vs. 2.8%; p < 0.001) and component separation (50.6% vs. 23.7%; p < 0.001) were more frequent. Fascial defect was closed in 100% of both groups (p > 0.999). GVHR had higher rates of wound complications (33.5% vs. 15.4%; p < 0.001), respiratory insufficiency or failure (4.7% vs. 0.8%; p = 0.012), reoperation (9.8% vs. 4.7%; p = 0.028), and greater average length-of-stay (6.9 ± 5.1 vs. 5.0 ± 2.0 days; p < 0.001). There was no statistical difference in recurrence (4.3% vs. 2.4%; p = 0.217) or follow-up (24.0 ± 37.8 vs. 27.4 ± 40.4 months; p = 0.558).

Conclusion

GVHR often required chemical and mechanical component separation to achieve fascial closure. However, with large preperitoneal mesh overlap and fascial closure, outcomes of large defects in VHR are comparable to smaller defects.