Fasical defect size predicts recurrence following incisional hernia repair: A 7-year, single-surgeon experience

BACKGROUND: This paper determines the most important risk factors associated with surgical site occurrence (SSO) and recurrence following open incisional hernia repair using synthetic mesh. METHODS: Retrospective review at a tertiary care hospital of adults who underwent incisional hernia repair using synthetic mesh by a single surgeon (2008-2015). Primary outcomes were SSO and hernia recurrence. Risk factors of body mass index >25, diabetes, active smoking, previous repair, bridged repair, and fascial defect size >10 cm were analyzed via Cox proportional hazard model and stepwise regression for SSO and recurrence. A Kaplan-Meier curve compares hernia recurrence for small versus large hernia groups. RESULTS: The overall recurrence rate was 19%. Only large fascial defect size was significantly associated with an increased risk of recurrence at all levels of analysis. Bridged repair was significantly associated with SSO on all levels of analysis except when paired with large hernia size in Cox multivariate analysis. CONCLUSIONS: Key technical aspects of the hernia repair surgery, specifically a fascial defect over 10 cm in width and performance of a bridged fascial repair pose a greater risk for hernia recurrence and SSO than patient comorbidities, including diabetes, active smoking, previous repair, and obesity. These results further indicate that synthetic mesh can be used safely in the one-stage repairs of incisional hernias in patients with comorbidities, without unacceptably high rates of SSO or hernia recurrence.