Long-term recurrence and chronic pain after repair for small umbilical or epigastric hernias: a regional cohort study

• An operation for a small umbilical or epigastric hernia is one of the most frequent conducted surgical procedures but the long-term risk of recurrence (reoperation or clinical) and chronic pain is unknown.
• The optimal repair technique remains controversial, since mesh reinforcement lowers the risk of recurrence but may increase risk of chronic pain.
• This study found a high risk of recurrence and documented that mesh reinforcement halved the risk of recurrence from 21% to 10% without increasing the risk of moderate or severe chronic pain of 5%.

BackgroundMesh repair reduces the risk of reoperation for recurrence in patients with primary ventral hernias. However, reoperation for recurrence underestimates total recurrence (reoperation + clinical) and mesh reinforcement may induce chronic pain. This study investigated the total recurrence and risk of chronic pain in small primary ventral hernias.MethodsA cohort study with questionnaire and clinical follow-up was conducted. Patients with primary, elective, open mesh or sutured repair for a small umbilical or epigastric hernia (≤2 cm) were included.ResultsOne thousand three hundred thirteen patients completed the questionnaire. The total cumulated recurrence rate after primary repair was 10% for mesh repair and 21% for sutured repair (P = .001). The incidence of chronic pain was 6% after mesh repair and 5% after sutured repair (P = .711).ConclusionsMesh repair halved long-term risk of recurrence after repair for small ventral hernias without increased risk of chronic pain.