To Örebro University

Background: The aim of this study was to analyse the risk for reoperation following primary ventral hernia repair.

Methods: The study was based on umbilical hernia and epigastric hernia repairs registered in the population-based Swedish National Patient Register (NPR) 2010-2019. Reoperation was defined as repeat repair after primary repair.

Results: Altogether 29,360 umbilical hernia repairs and 6514 epigastric hernia repairs were identified. There were 624 reoperations registered following primary umbilical repair and 137 following primary epigastric repairs. In multivariable Cox proportional hazard analysis, the hazard ratio (HR) for reoperation was 0.292 (95% confidence interval (CI) 0.109-0.782) after open onlay mesh repair, 0.484 (CI 0.366-0.641) after open interstitial mesh repair, 0.382 (CI 0.238-0.613) after open sublay mesh repair, 0.453 (CI 0.169-1.212) after open intraperitoneal onlay mesh repair, 1.004 (CI 0.688-1.464) after laparoscopic repair, and 0.940 (CI 0.502-1.759) after other techniques, when compared to open suture repair as reference method. Following umbilical hernia repair, the risk for reoperation was also significantly higher for patients aged < 50 years (HR 1.669, CI 1.389-2.005), for women (HR 1.401, CI 1.186-1.655), and for patients with liver cirrhosis (HR 2.544, CI 1.049-6.170). For patients undergoing epigastric hernia repair, the only significant risk factor for reoperation was age < 50 years (HR 2.046, CI 1.337-3.130).

Conclusions: All types of open mesh repair were associated with lower reoperation rates than open suture repair and laparoscopic repair. Female sex, young age and liver cirrhosis were risk factors for reoperation due to hernia recurrence, regardless of method.

AIM: This study evaluates the impact of the minimal incision repair of rectus abdominis diastasis (MIRRAD) procedure on physical activity, muscle strength, quality of life, and overall satisfaction in women with postpartum rectus abdominis diastasis (PP-RAD).

METHODS: A cohort of 31 female patients, aged 20-50 years, diagnosed with PP-RAD unresponsive to conservative treatment, underwent the MIRRAD procedure. Assessments were conducted preoperatively and 1 year postoperatively, these included the Modified Abdominal Trunk Function Protocol (MATFP), Disability Rating Index (DRI), and Urinary Disability Index (UDI) questionnaires. Physical activity intensity was monitored using accelerometers. RESULTS: Significant improvements were observed in vigorous physical activities (Z = -2.352, p = 0.019), vector magnitude counts per minute (Z = -2.163, p = 0.031), and steps per minute (Z = -3.131, p = 0.002). DRI showed significant improvements in physical tasks like dressing, walking, and strenuous work (Z ranging from -2.705 to -4.603, p < 0.001). UDI indicated significant improvements in urinary symptoms, including reduced frequency (Z = -2.984, p = 0.003) and less urinary leakage (Z = -2.357, p = 0.018). MATFP demonstrated gains in back and abdominal muscle strength (Z = -4.321, p < 0.001) and trunk stability (Z = -3.991, p < 0.001).

CONCLUSION: The MIRRAD procedure significantly improves physical strength, trunk stability, and urinary function, enhancing daily activities and overall physical health in women with PP-RAD. Further research is recommended to evaluate long-term outcomes.