Predictors of hernia recurrence after Rives-Stoppa repair in the treatment of incisional hernias: a retrospective cohort.

BACKGROUND: Rives-Stoppa retromuscular repair (RSR) has been traditionally used to provide adequate coverage for large abdominal wall defects and appears to be more advantageous compared to other surgical techniques concerning complications and recurrence rates. The aim of this study was to identify the independent predictors associated to hernia recurrence after RSR in the treatment of incisional hernias.

METHODS: This is a retrospective observational study of 213 patients who underwent RSR between June 2007 and January 2014 at a tertiary centre. Main inclusion criteria were adults with midline hernia classified as M1, M2, M3, M4, or M5, according to EHS classification. All the cases presented a transverse hernia defect measurement greater than 5 cm (grades W2 and W3). Recurrence rate was determined by clinical examination plus confirmation by abdominal CT scan.

RESULTS: At a median of 57.6 months (range 46-75 months) of postoperative follow-up, we reported 15 cases of recurrence (7.1%). Recurrences occurred after a mean period of 19.4 months (range 2-49 months). On multivariate analysis, steroid or immunosuppressive drugs use (OR 2.02; CI 1.16-3.95, p = 0.004), the development of postoperative hematoma (OR 2.9; CI 1.55-4.10, p = 0.001), and needing surgery for the hematoma (OR 2.1; CI 1.21-3.29, p = 0.004) were predictors of recurrence after RSR. There was no significant difference in recurrence rate among obesity, smoking, urgent repair, type of mesh fixation, operative time, type of prosthesis, or concomitant procedures.

CONCLUSIONS: In our current study, using immunosuppressive drugs, the development of postoperative hematoma and needing surgery for the hematoma were associated with increased risk of hernia recurrence after RSR.