title: Hidden Morbidity of Ventral Hernia Repair with Mesh: As Concerning as Common Bile Duct Injury?
abstract: Ventral hernia repair with mesh is increasingly common, but the incidence of long-term complications that necessitate mesh explantation is unknown. We aimed to determine the epidemiology of mesh explantation after ventral hernia repair and to compare this with common bile duct injury, a dreaded complication of laparoscopic cholecystectomy.
  
  
  
  We evaluated a retrospective cohort of patients undergoing ventral hernia repair by linking the all-payers State Inpatient Databases and State Ambulatory Surgery Databases for New York, California, and Florida. We followed patients longitudinally from 2005 to 2011 for the primary end point of mesh explantation, designated by concurrent procedure codes for ventral hernia repair and foreign body removal. We determined time to mesh explantation and calculated cumulative costs for surgical care, comparing these with historical data for common bile duct injury.
  
  
  
  During the study period, 619,751 patients underwent at least one ventral hernia repair (91% open, 9% laparoscopic). In a mean follow-up of 3 years, 438 patients (0.07%) had mesh removed at a median of 346 days after repair. Median cumulative cost for patients requiring mesh explantation was $21,889 vs $6,983 without (p < 0.01). Rates of mesh explantation and costs were on par with laparoscopic common bile duct injury, based on published data, but occurred later in the postoperative course.
  
  
  
  By this conservative estimate, complications of ventral hernia repair with implantable mesh are comparably as frequent as for common bile duct injury, but occur later in a patient's experience. Long-term follow-up is critically necessary to fully understand the ramifications of implanted devices.
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, Nashville, TN; Geriatric Research, Education, and Clinical Center, Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville, TN. Electronic address: kristy.l.kummerow@vanderbilt.edu.
authors.forename: Kristy
authors.initials: K
authors.lastname: Kummerow Broman
authors.affiliation: Center for Quantitative Sciences, Vanderbilt University, Nashville, TN.
authors.forename: Li-Ching
authors.initials: LC
authors.lastname: Huang
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Adil
authors.initials: A
authors.lastname: Faqih
authors.affiliation: Center for Quantitative Sciences, Vanderbilt University, Nashville, TN.
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Phillips
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Rebeccah B
authors.initials: RB
authors.lastname: Baucom
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Pierce
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Holzman
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Sharp
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Benjamin K
authors.initials: BK
authors.lastname: Poulose
mesh_terms: D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic; D003135:Common Bile Duct / Q000293:injuries; D020878:Device Removal / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation* / Q000379:methods; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology* / Q000601:surgery; D012189:Retrospective Studies; D013526:Surgical Mesh; D014481:United States