Long-term outcomes after epigastric hernia repair in women - a nationwide database study

Abstract Aim Outcomes after epigastric hernia repair are rarely reported independently. Repair of an epigastric hernia is more frequently performed in women. The aim of this study was to evaluate long-term outcomes after epigastric hernia repairs in women on a nationwide basis. Methods Nationwide database cohort study using prospectively recorded data from the Danish Hernia Database of women undergoing elective repair for epigastric hernias, during a 4-year period (2018–2021). A 100% follow-up was obtained by combining intra-operative data with data from the National Civil Register (NRC). The primary outcome was operation for recurrence, secondary outcomes were readmission and operation for complications. Results In total, 3031 women underwent elective epigastric hernia repair during the study period. Some 2462 were performed as open repairs and 569 underwent laparoscopic repair. Follow-up was median 4.8 years. The cumulative operation rate for recurrence for open mesh repairs was 3.3% vs. 7.7% for sutured repair (P=0.002). The risk of operation for complications was significantly higher after mesh repair vs. sutured repair (2.0% vs. 3.6%, P = 0.014) with more operations for surgical site infection in the mesh group. In multivariable analyses, risk factors for recurrence were operation for complications and sutured repair. For open vs. laparoscopic repairs there were no differences in recurrence rates (6.3% vs. 6.3%, P=0.915), but the readmission rate was higher for laparoscopic repairs 10.9% vs. 6.1 (P<0.001). Conclusion Mesh repair reduces the risk of operation for recurrence but at the expense of an increased risk of operation for superficial wound infection.