21 Oct Hernias Repaired With Mesh Have Lower Risk of Re-Operation
MedicalResearch.com Interview with:
Thue Bisgaard, M.D., D.M.Sc
Professor of Surgery,
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The complete spectrum for the benefits and risks of mesh used to reinforce hernia repair is not known because there are very few clinical trial data reporting hernia outcomes as they pertain to mesh utilization.
Generally, there is evidence that mesh is beneficial in terms of less risk of reoperation for recurrence after incisional hernia repair compared with sutured repair. The present study confirmed this for the first time in nationwide analysis with a long-term follow-up of 5 years up. From earlier studies from our group (Ann Surg 2012) it is known that reoperation rate for recurrence severely underestimates overall (clinical) risk of recurrence making differences between mesh vs. sutured repair even much bigger. Although rare (5%) the incidence of mesh-related complications was progressively increasing throughout the study period suggesting that mesh-related complications rate may continue to accrue with even longer follow-up.
MedicalResearch.com: What should readers take away from your report?
Response: Repair for incisional hernia should be reinforced by a mesh as a standard but the long-term risk of mesh-related complications (5%) should be implemented in the standard information to patients prior to surgery.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: The present study highlights the need to assess long-term efficacy and safety of incisional hernia repair before making definitive conclusions about their eventual benefits. More long-term studies of mesh repair using well-functioning registries such as the one in Denmark are warranted.
MedicalResearch.com: Is there anything else you would like to add?
Response: Recurrence, morbidity and mortality are important outcomes after incisional hernia repair and optimally long-termed monitored by nationwide well-functioning is clinical databases providing data with large external validity. Well-functioning clinical nation-wide databases containing perioperative prospective registered information and long-term follow-up (such as the Danish Hernia Database) hold statistical power to monitor even low incidences of outcome such as postoperative complications. Nation-wide clinical databases may serve as a platform for surgeons and commercial mesh manufactures before routine recommendation of specific types and mesh placement (i.e. outside or inside the abdominal cavity of the abdomen). When commercial entities want to test a product, they should fund an independent research group to conduct the trial to avoid the perception of bias. The clinical nation-wide databases have potential statistical power to monitor even low incidences of outcome such as postoperative complications.
On the other hand patient reported outcomes such as long-term pain, patient satisfaction, and function have only sparsely been reported and quality of life never reported as primary endpoint in any randomized trials in incisional hernia repair. Whereas patient reported outcomes are not suitable outcome for nationwide clinical database these are most warranted as primary outcomes in future large well-designed randomized trials with long-term follow up.
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Dunja Kokotovic1, Thue Bisgaard2,3, Frederik Helgstrand1,3. Long-term recurrence and complications associated with elective incisional hernia repair. JAMA, October 18, 2016.
Zealand University Hospital, Køge1, Hvidovre Hospital, University of Copenhagen,3 Denmark & The Danish Hernia Database3
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