title: Long-term Recurrence and Complications Associated With Elective Incisional Hernia Repair.
abstract: Prosthetic mesh is frequently used to reinforce the repair of abdominal wall incisional hernias. The benefits of mesh for reducing the risk of hernia recurrence or the long-term risks of mesh-related complications are not known.
  
  
  
  To investigate the risks of long-term recurrence and mesh-related complications following elective abdominal wall hernia repair in a population with complete follow-up.
  
  
  
  Registry-based nationwide cohort study including all elective incisional hernia repairs in Denmark from January 1, 2007, to December 31, 2010. A total of 3242 patients with incisional repair were included. Follow-up until November 1, 2014, was obtained by merging data with prospective registrations from the Danish National Patient Registry supplemented with a retrospective manual review of patient records. A 100% follow-up rate was obtained.
  
  
  
  Hernia repair using mesh performed by either open or laparoscopic techniques vs open repair without use of mesh.
  
  
  
  Five-year risk of reoperation for recurrence and 5-year risk of all mesh-related complications requiring subsequent surgery.
  
  
  
  Among the 3242 patients (mean age, 58.5 [SD, 13.5] years; 1720 women [53.1%]), 1119 underwent open mesh repair (34.5%), 366 had open nonmesh repair (11.3%), and 1757 had laparoscopic mesh repair (54.2%). The median follow-up after open mesh repair was 59 (interquartile range [IQR], 44-80) months, after nonmesh open repair was 62 (IQR, 44-79) months, and after laparoscopic mesh repair was 61 (IQR, 48-78) months. The risk of the need for repair for recurrent hernia following these initial hernia operations was lower for patients with open mesh repair (12.3% [95% CI, 10.4%-14.3%]; risk difference, -4.8% [95% CI, -9.1% to -0.5%]) and for patients with laparoscopic mesh repair (10.6% [95% CI, 9.2%-12.1%]; risk difference, -6.5% [95% CI, -10.6% to -2.4%]) compared with nonmesh repair (17.1% [95% CI, 13.2%-20.9%]). For the entirety of the follow-up duration, there was a progressively increasing number of mesh-related complications for both open and laparoscopic procedures. At 5 years of follow-up, the cumulative incidence of mesh-related complications was 5.6% (95% CI, 4.2%-6.9%) for patients who underwent open mesh hernia repair and 3.7% (95% CI, 2.8%-4.6%) for patients who underwent laparoscopic mesh repair. The long-term repair-related complication rate for patients with an initial nonmesh repair was 0.8% (open nonmesh repair vs open mesh repair: risk difference, 5.3% [95% CI, 4.4%-6.2%]; open nonmesh repair vs laparoscopic mesh repair: risk difference, 3.4% [95% CI, 2.7%-4.1%]).
  
  
  
  Among patients undergoing incisional repair, sutured repair was associated with a higher risk of reoperation for recurrence over 5 years compared with open mesh and laparoscopic mesh repair. With long-term follow-up, the benefits attributable to mesh are offset in part by mesh-related complications.
authors.affiliation: Center for Surgical Science, Zealand University Hospital, Køge, Denmark.
authors.forename: Dunja
authors.initials: D
authors.lastname: Kokotovic
authors.affiliation: Gastro Unit, Surgical Division, Hvidovre Hospital, Hvidovre, Denmark3Danish Hernia Database, Danish Clinical Registries, Copenhagen, Denmark.
authors.forename: Thue
authors.initials: T
authors.lastname: Bisgaard
authors.affiliation: Center for Surgical Science, Zealand University Hospital, Køge, Denmark3Danish Hernia Database, Danish Clinical Registries, Copenhagen, Denmark.
authors.forename: Frederik
authors.initials: F
authors.lastname: Helgstrand
mesh_terms: D015331:Cohort Studies; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D059685:Herniorrhaphy / Q000009:adverse effects*; D006801:Humans; D000069290:Incisional Hernia / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation; D013526:Surgical Mesh / Q000009:adverse effects*; D013997:Time Factors