Minimising risk and optimising technique in ventral hernia repair

Abstract: Background: Abdominal wall hernia is a common pathology and adverse events related to hernia repair is thus a topic of considerable importance. Hernia is a disease that affect both sexes and people of all ages.The thesis is based upon four papers. Study I, II and III are analysing complications related to ventral hernia repair. Study IV is a multicentre trial.Aims:to analyse risk factors in open and minimally invasive ventral hernia repairto improve the technique of laparoscopic ventral hernia repair.Results: Study I: Hernia aperture size was the most important risk factor for serious complication after hernia repair. Study II: Inadvertent enterotomy occurred during 25 repairs and in these cases laparoscopic repair was clearly overrepresented (p<0.001). Study III: A total of 45 676 repairs were analysed. We found that patients 80 years and older had a 2.5 times higher risk for complication leading to reoperation, and a 12-fold higher mortality risk than patients aged 70-79 years. Study IV: Closure of the hernia aperture before mesh application does not decrease hernia site complications in small to medium-sized midline hernias at twelve-month follow-up (p = 0.73).Conclusions: Hernia aperture size is the leading risk factor for serious complication after ventral hernia repair. Accidental enterotomy is more common during laparoscopic repair. Risk of death after ventral hernia repair dramatically increases in the geriatric patient. Time should not be wasted on closure of small to medium-sized hernia apertures in the midline before laparoscopic application of a mesh.