The reoperation rate for hernia repair probably underestimates the rate of recurrence by four to five times, according to results from a large Danish study.
In the cohort study of almost 1,000 hernia patients, 165 had a recurrence, but only 46 underwent a second repair, Dr. Frederik Helgstrand and his colleagues reported in the August issue of Annals of Surgery.
Recurrences were more common among patients who had an incisional repair than in those who had an umbilical or epigastric repair, wrote Dr. Helgstrand of the University of Copenhagen and his coauthors. Because the Danish hernia repair recommendations are different from other countries’, the investigators suggested that their observations could even further underestimate recurrence in some regions.
"Our results are based on a general Danish population, where the recommendation is to repair primary small (less than 2 cm) umbilical hernias with nonabsorbable sutures using open technique and to repair recurrences and all incisional hernias with a mesh, either laparoscopically or by open technique. The gap between reoperation and clinical recurrence might be different in other cultures and even wider in more narrowly defined populations with comorbidity such as obesity" (Ann. Surg. 2012 August [doi: 10.1097/SLA.0b013e318254f5b9]).
The study group comprised 902 patients who had hernia repair in 2007; they were all recruited from the Danish Ventral Hernia Database and the Danish National Patient Registry. In 2010, they all received a questionnaire inquiring about recurrence. Another hernia operation was considered a definite recurrence. Patients who suspected that their hernia recurred or were told by a physician that it had, came in for a clinical evaluation.
The patients’ mean ages were 51 years in the laparoscopic group and 61 years in the incisional group; the median postoperative follow-up was 41 months. There were 646 laparoscopic repairs and 256 incisional repairs. Overall, there were 119 clinical recurrences.
In the laparoscopic group, there were 87 recurrences (13%); of these, 27 were reoperations and 60 were clinically diagnosed. In the incisional group, there were 78 recurrences (30%); of these, 19 were reoperations and 59 were clinically diagnosed.
"Consequently," the authors wrote, "the overall recurrences after [laparoscopic] and incisional hernia repair exceeded the reoperations for recurrence by factors of four and five, respectively."
Most patients who did not have a reoperation said they had only minor symptoms or that the recurrence was asymptomatic (85% of the laparoscopic group and 58% of the incisional group). A number said their surgeon or general physician had recommended against another repair (10% of the laparoscopic group and 34% of the incisional group).
None of the authors had any financial disclosures.