title: Adverse Events after Ventral Hernia Repair: The Vicious Cycle of Complications.
abstract: BACKGROUND
  Ventral hernia repairs are one of the most common procedures performed by the general surgeon. They are also among the most complex procedures performed. We hypothesized that with each surgical failure, subsequent ventral hernia repair becomes more complicated and morbid.
  
  
  METHODS
  We assessed a multicenter database of patients who underwent an elective ventral hernia repair from 2000 to 2012 with at least 6 months of follow-up and elective repairs. Patients were evaluated by the number of previous ventral hernia repairs they had: primary ventral hernia repair (PVHR), first time incisional hernia repair (IHR1), second time incisional hernia repair (IHR2), or third time or greater incisional hernia repair (IHR3). The main outcomes measured were abdominal reoperation, operative duration, surgical site infection (SSI), and hernia recurrence. Complications were assessed and compared between the 4 groups. Time to recurrence was estimated using the Kaplan-Meier curve method by study cohort (PVHR, IHR1, IHR2, IHR3).
  
  
  RESULTS
  A total of 794 patients were assessed; of these, 481 (60.6%) had PVHR, 207 (26.1%) had IHR1, 78 (9.8%) had IHR2, and 28 (3.5%) had IHR3. Patients with multiple repairs were more likely to undergo subsequent reoperation, have a longer operative duration, develop SSI, and have a recurrence. At 140 months of follow-up, 37% of primary ventral hernias and 64% of incisional hernias have recurred. The highest recurrence rates are seen in IHR3, with 73% recurring.
  
  
  CONCLUSIONS
  Previous ventral hernia repair increases the complication profile of repair, creating a vicious cycle of repair, complications, reoperation, and re-repair. Furthermore, long-term outcomes for ventral hernia repair are poor. Future studies should focus on hernia prevention and improving long-term outcomes after hernia repair.
authors.affiliation: Department of Surgery, University of Texas Health Sciences Center at Houston, Houston, TX. Electronic address: holihanj@gmail.com.
authors.forename: Julie L
authors.initials: JL
authors.lastname: Holihan
authors.affiliation: Department of Surgery, University of Texas Health Sciences Center at Houston, Houston, TX.
authors.forename: Zeinab
authors.initials: Z
authors.lastname: Alawadi
authors.affiliation: Department of Surgery, Oregon Health Sciences Center, Portland, OR.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Martindale
authors.affiliation: Department of Surgery, University of Kentucky, Lexington, KY.
authors.forename: J Scott
authors.initials: JS
authors.lastname: Roth
authors.affiliation: Department of Surgery, University of Texas Health Sciences Center at Houston, Houston, TX.
authors.forename: Curtis J
authors.initials: CJ
authors.lastname: Wray
authors.affiliation: Department of Surgery, University of Texas Health Sciences Center at Houston, Houston, TX.
authors.forename: Tien C
authors.initials: TC
authors.lastname: Ko
authors.affiliation: Department of Surgery, University of Texas Health Sciences Center at Houston, Houston, TX.
authors.forename: Lillian S
authors.initials: LS
authors.lastname: Kao
authors.affiliation: Department of Surgery, University of Texas Health Sciences Center at Houston, Houston, TX.
authors.forename: Mike K
authors.initials: MK
authors.lastname: Liang
mesh_terms: D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome