Long-Term Follow-Up of Retromuscular Incisional Hernia Repairs: Recurrence and Quality of Life.

Abstract

Incisional hernia repair (IHR) with a mesh is necessary to achieve low recurrence rates and pain relief. In the short term, quality of life (QoL) is restored by IHR. Two centers pioneered the IHR in Sweden with the highly standardized Rives-Stoppa technique using a retromuscular mesh. We assessed long-term follow-up of recurrence rate and QoL. Medical records were searched for IHRs performed from 1998 to 2006 and included living patients with midline repairs. Questionnaires about physical status, complaints, and QoL (SF-36) were mailed, offering a clinical examination. Assessment of medical records of later surgery was performed in 2015. Three hundred and one patients with midline incisional repairs were identified, and 217 accepted participation. Of these, 103 attended a clinical examination. Follow-up was 7 years until examination and 11 years to reassessment of medical records. In 26%, recurrent hernias were repaired. Postoperative complications were 26% Clavien-Dindo grade I-II and 1% grade III-IV. Mesh infections occurred in 1.4% without mesh removals, and 4% were reoperated because of complications. Overall recurrence rate was 8.1% and two-third of which were diagnosed at clinical examination. Recurrence after primary and recurrent hernia repair was 7.1 and 10.9%, respectively. Of all patients, 80% were satisfied; dissatisfaction was primarily caused by recurrence and chronic pain. SF-36 scores were 0.2 SD lower than the norm in all subscales, similar to those with 1-2 chronic conditions. Midline retromuscular mesh IHR has a low long-term recurrence rate even after recurrent repair. Patient satisfaction was high although QoL was reduced.