title: Patient profiles and outcomes following repair of irreducible and reducible Ventral Wall Hernias.
abstract: OBJECTIVE
  The belief that irreducible hernias are repaired less successfully and with higher morbidity drives patients to seek elective repair. The aims of this study were threefold. First, this study sought to compare characteristics of patients undergoing irreducible and reducible ventral hernia repair. Second, to compare morbidity rates. Third, to determine which factors, including irreducibility, might be associated with recurrence.
  
  
  METHODS
  This observational study was a retrospective review of 252 consecutive ventral hernia patients divided into two cohorts: 101 patients who underwent repair of an irreducible ventral hernia, and 152 patients underwent repair of a reducible ventral hernia. The mean follow-up time was approximately 4 years in both groups.
  
  
  RESULTS
  Patients undergoing repair of irreducible hernias had higher median BMI (31 vs. 27 kg/m2, p = 0.005), had their hernias longer (median 34 months compared to 12 months, p = 0.043), had more defects on average (mean 1.8 vs. 1.4, p < 0.001), and were more likely to be symptomatic (83 vs. 55%, p = 0.002). Interestingly, neither hernia size (p = 0.821), nor the location of hernia (p = 0.261) differed significantly between the two groups. Morbidity rates, including rates of surgical site infection, obstruction, and recurrence, did not differ significantly; nor did recurrence-free survival (RFS) distributions. Risk factors for hernia recurrence on multivariate analysis included the repaired hernia being itself recurrent (HR = 2.06, 95% CI = 1.07-3.99, p = 0.031), the occurrence of post-operative surgical site infection (HR = 5.10, 95% CI = 2.18-11.91, p < 0.001), and the occurrence of post-operative intestinal obstruction (HR = 5.18, 95% CI = 1.82-14.75, p = 0.002). Irreducibility was not a significant predictor of recurrence (p = 0.152).
  
  
  CONCLUSIONS
  Despite differing profiles, patients with these two types of hernias did not have statistically significant differences in morbidity. Recurrence was not observed to be associated with irreducibility but was found to be associated with other post-operative complications.
authors.affiliation: Department of Surgery, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, 10029, USA.
authors.forename: M R
authors.initials: MR
authors.lastname: Danzig
authors.affiliation: Department of Surgery, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, 10029, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Stey
authors.affiliation: Department of Surgery, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, 10029, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Yin
authors.affiliation: Department of Surgery, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, 10029, USA.
authors.forename: S
authors.initials: S
authors.lastname: Qiu
authors.affiliation: Department of Surgery, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, 10029, USA. celia.divino@mssm.edu.
authors.forename: C M
authors.initials: CM
authors.lastname: Divino
mesh_terms: D000368:Aged; D005260:Female; D006555:Hernia, Ventral / Q000453:epidemiology / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Herniorrhaphy; MeSH; Post-operative complications; Recurrences; Ventral hernia