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Reoperation Versus Clinical Recurrence Rate After Ventral Hernia Repair

Helgstrand, Frederik MD*,†; Rosenberg, Jacob MD, DMSc*,‡; Kehlet, Henrik MD, PhD*,§; Strandfelt, Pernille; Bisgaard, Thue MD, DMSc*,†

doi: 10.1097/SLA.0b013e318254f5b9
Prospective Cohort Study

Objective: To compare the clinical recurrence rate with reoperation rate for recurrence after ventral hernia repair.

Background: Reoperation is often used as an outcome measure after ventral hernia repair, but it is unknown whether reoperation rate reflects the overall clinical risk for recurrence.

Methods: The study cohort was recruited from the Danish Ventral Hernia Database and the Danish National Patient Registry during January 1, 2007, to December 31, 2007. Inclusion criteria were primary umbilical/epigastric (umb/epi) or incisional hernia repair from a regional area of 2 million inhabitants. A prospective clinical follow-up was conducted in January 2011 using a validated questionnaire on reoperation and possible recurrence. Suspicion of recurrence was the criterion for clinical examination. A telephone interview and/or patients' hospital files confirmed reoperation.

Results: A total of 945 patients were eligible, and 902 patients responded to the questionnaire (response rate 95%) with a median postoperative follow-up of 41 months (range 0–48 months). The analysis comprised 646 patients with umb/epi and 256 patients with incisional hernia repair. Clinical examination was required in 241 patients. After umb/epi and incisional hernia repair, the cumulative risks of reoperation and overall recurrence (reoperation + clinical) were 4% and 15% (fourfold underestimation), and 8% and 37% (fivefold underestimation) (P < 0.001), respectively.

Conclusions: Reoperation rate for recurrence 41 months after primary umbilical/epigastric or incisional hernia repair underestimated overall risk of recurrence by four- to fivefolds. This study was registered in www.clinicaltrials.gov (NCT01325246).

The Danish Ventral Hernia Database was used to identify 945 patients who underwent a primary ventral hernia repair in 2007. After median 41 months' follow-up, the reoperation rate for recurrence after primary umbilical/epigastric or incisional hernia repair underestimated overall risk of clinical recurrence by four- to fivefolds.

*Danish Hernia Database, Department of surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark

Department of surgery, Køge Sygehus, University of Copenhagen, Køge, Denmark

Department of surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark

§Section for Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, legdamsvej 9, 2100 Copenhagen, Denmark.

Reprints: Frederik Helgstrand, MD, Department of surgery, Køge Sygehus, University of Copenhagen, Lykkebækvej 1, 4600 Køge, Denmark. E-mail: freh@regionsjaelland.dk.

Disclosure: The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.