Are outcomes of giant ventral hernia repair inferior? A propensity-matched analysis.

[BACKGROUND] Ventral hernia repair (VHR) of large defects poses significant technical challenges due to the size of the hernia and complexity of operative techniques required for fascial closure. This study examined clinical outcomes in "giant" open VHR (GVHR), with hernia defect size (HDS) ≥ 200 cm, versus "non-giant" open VHR (NGVHR) with HDS < 200 cm using a propensity-matched approach.

[METHODS] A prospectively-maintained database from a tertiary hernia center was reviewed for patients undergoing open VHR. 1:1 propensity-score matching was performed for GVHR versus NGVHR based on age, BMI, comorbidities, fascial defect closure, primary vs recurrent repair, CDC wound class, and ASA score. A multivariable regression model evaluated whether wound complications increased odds of recurrence. CDC class III/IV wounds and concomitant intraabdominal procedures were excluded. Standard statistical analyses were performed.

[RESULTS] PSM yielded 254 well-matched pairs (all p > 0.05). Average age (59.7 ± 11.3 vs. 59.3 ± 12.3 years) and BMI (32.1 ± 6.5 vs. 32.4 ± 6.6 kg/m) were similar between GVHR and NGVHR. Tobacco status was similar for current and former smokers (3.9% vs. 3.9%; 29.9% vs. 29.9%). GVHR had larger defect size (354.7 ± 132.1 vs. 103.8 ± 61.9 cm; p < 0.001) and mesh size (1161.9 ± 450.0 vs. 771.2 ± 388.4 cm; p < 0.001). In GVHR, Botulinum toxin injections (15.4% vs. 2.8%; p < 0.001) and component separation (50.6% vs. 23.7%; p < 0.001) were more frequent. Fascial defect was closed in 100% of both groups (p > 0.999). GVHR had higher rates of wound complications (33.5% vs. 15.4%; p < 0.001), respiratory insufficiency or failure (4.7% vs. 0.8%; p = 0.012), reoperation (9.8% vs. 4.7%; p = 0.028), and greater average length-of-stay (6.9 ± 5.1 vs. 5.0 ± 2.0 days; p < 0.001). There was no statistical difference in recurrence (4.3% vs. 2.4%; p = 0.217) or follow-up (24.0 ± 37.8 vs. 27.4 ± 40.4 months; p = 0.558).

[CONCLUSION] GVHR often required chemical and mechanical component separation to achieve fascial closure. However, with large preperitoneal mesh overlap and fascial closure, outcomes of large defects in VHR are comparable to smaller defects.