title: Long-term recurrence and chronic pain after repair for small umbilical or epigastric hernias: a regional cohort study.
abstract: BACKGROUND
  Mesh repair reduces the risk of reoperation for recurrence in patients with primary ventral hernias. However, reoperation for recurrence underestimates total recurrence (reoperation + clinical) and mesh reinforcement may induce chronic pain. This study investigated the total recurrence and risk of chronic pain in small primary ventral hernias.
  
  
  METHODS
  A cohort study with questionnaire and clinical follow-up was conducted. Patients with primary, elective, open mesh or sutured repair for a small umbilical or epigastric hernia (≤ 2 cm) were included.
  
  
  RESULTS
  One thousand three hundred thirteen patients completed the questionnaire. The total cumulated recurrence rate after primary repair was 10% for mesh repair and 21% for sutured repair (P = .001). The incidence of chronic pain was 6% after mesh repair and 5% after sutured repair (P = .711).
  
  
  CONCLUSIONS
  Mesh repair halved long-term risk of recurrence after repair for small ventral hernias without increased risk of chronic pain.
authors.affiliation: Gastro Unit Surgical Division, Hvidovre Hospital, Kettegård Alle 30, Copenhagen University, Hvidovre, DK-2650 Denmark. Electronic address: mette.willaume@gmail.com.
authors.forename: Mette W
authors.initials: MW
authors.lastname: Christoffersen
authors.affiliation: Danish Hernia Database, Copenhagen, Denmark; Department of Gastrointestinal Surgery, Rigshospitalet, Copenhagen University, Blegdamsvej 9, DK-2200 Copenhagen, Denmark.
authors.forename: Frederik
authors.initials: F
authors.lastname: Helgstrand
authors.affiliation: Danish Hernia Database, Copenhagen, Denmark; Gastro Unit, Surgical Division, Herlev Hospital, Copenhagen University, Herlev Ringvej 75, DK-2730 Copenhagen, Denmark.
authors.forename: Jacob
authors.initials: J
authors.lastname: Rosenberg
authors.affiliation: Danish Hernia Database, Copenhagen, Denmark; Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Blegdamsvej 9, DK-2200 Copenhagen, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
authors.affiliation: Gastro Unit Surgical Division, Hvidovre Hospital, Kettegård Alle 30, Copenhagen University, Hvidovre, DK-2650 Denmark.
authors.forename: Pernille
authors.initials: P
authors.lastname: Strandfelt
authors.affiliation: Gastro Unit Surgical Division, Hvidovre Hospital, Kettegård Alle 30, Copenhagen University, Hvidovre, DK-2650 Denmark; Danish Hernia Database, Copenhagen, Denmark.
authors.forename: Thue
authors.initials: T
authors.lastname: Bisgaard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D006554:Hernia, Umbilical / Q000473:pathology / Q000601:surgery; D006555:Hernia, Ventral / Q000473:pathology / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
keywords: Chronic pain; Mesh repair; Primary ventral hernia repair; Recurrence; Sutured repair