D. T. Huynh1, R. Howard1, B. Fry1, A. Hallway1, A. Ehlers1, S. O’Neill1, J. Shao Kashmanian1, J. Dimick1, D. Telem1 1University Of Michigan, General Surgery, Ann Arbor, MI, USA
Introduction: Ventral hernia is a heterogenous surgical entity that presents in distinct anatomic distributions. While these defects are part of the same disease process, the presentation, management, and method of repair may differ based on location. To better understand these differences we used a population level hernia registry to characterize and compare the ways in which these classes of ventral hernia present and are managed.
Methods: All adult patients in the Michigan Surgical Quality Collaborative Core Optimization Hernia Registry (MSQC COHR) were included in this study. The registry is a representative, random sample of adult patients from 70 Hospitals across the state of Michigan and it encompasses surgeries performed between Jan 1, 2020 to March 31, 2023. These operations were classified by defect location according to the European Hernia Society ventral hernia classification system into 5 categories: supraumbilical (M1/2), umbilical (M3), infraumbilical (M4), suprapubic (M5), and non-midline (L1,2,3,4). Patient demographics, hernias specific characteristics, and operative techniques were characterized and compared between these anatomic groups using multivariable regression.
Results: During the study period 14619 ventral hernia repair operations were identified. Hernia specific, and operative characteristics are shown in Table 1. On multivariable regression controlling for defect size, recurrent operation, and wound class – non-midline defects were significantly more likely to be performed robotically (p=0.004, OR=1.63). When controlling for defect size, prior repair, surgical approach, and wound class, there was no significant difference in the use of mesh between the anatomic groups (p>0.05). The use of myofascial release techniques (p>0.05) as well as the size of mesh used (p>0.05) were also not significantly different between groups when controlling for these factors.
Conclusion: In this population level study ventral hernias presented in a wide distribution of anatomic locations and defect sizes. Surgeons appear to have adapted to some of these challenges by employing different operative approaches. However, for the most part surgeons do not change their operative techniques based on hernia location and most midline defects were repaired in similar fashion regardless of anatomy. This calls into question the relevance of hernia location in surgeon decision making as well and the utility of sub-stratify ventral hernias by anatomic location.
