Emergency umbilical and epigastric hernia repair: nationwide registry-based study of long-term recurrence, mesh-related, and other complications

BACKGROUND: Emergency umbilical and epigastric hernia repairs (EUEHR) are common but understudied procedures. The role of different mesh positions in emergency settings is a topic of significant interest.

METHODS: A retrospective nationwide Danish cohort study of patients who underwent EUEHR from 2015 to 2020. A complete follow-up was obtained on December 31, 2023, through linkage of nationwide registries and full scrutiny of medical files for those patients who underwent a reoperation. The primary outcome was operation for recurrence. Secondary outcomes were non-recurrence reoperations, early (< 90 days) reoperations, and operations for severe complications. Multivariable analyses were performed using Fine-and-Gray competing risk models.

RESULTS: 639 patients were registered in the database, and 70.6% underwent mesh repair (open onlay: 44.1%, open sublay: 15.3%, or laparoscopic intraperitoneal (lap-IPOM): 11.1%. The median follow-up time was 4.3 years. The 5-year risk of operations for recurrence was lower after mesh use compared to suture (n = 6 (1.7%) vs. n = 8 (4.7%); p = 0.023), with a hazard ratio (HR) 0.32 (95% CI (0.11-0,92); p = 0.034). The 5-year risk of operation for other complications was similar between the suture and mesh group (n = 28 (6.2%) vs. n = 9 (4.8%); p = 0.40, HR 1.12 (0.51-2.48; p = 0.77)). Surgical site infection occurred in 1.1%, 4.3%, 2.0%, and 2.8% of suture, onlay, sublay, and Lap-IPOM repairs, respectively. Few complications were directly mesh related: onlay n = 3 (1.1%), sublay n = 2 (2.0%), and Lap-IPOM n = 1 (1.4%). Early (< 90 days) operation for other complications was more frequent after onlay than suture repair (Odds-ratio 2.95 (0.094-12.2): p = 0.066). In sub-group analysis, lap-IPOM showed a trend towards more severe complications than suture repair (HR 7.85 (0.82-75.5); p = 0.074).

CONCLUSION: Mesh repair significantly reduced operation for recurrence after EUEHR compared to suture repair with a similar risk of operation for other complications. Onlay may cause more early reoperations compared to suture repair and lap-IPOM may be associated with more severe complications.