Factors affecting recurrence following incisional herniorrhaphy

The purpose of this study was to determine the influence of chronic illness , obesity, and type of repair on the likelihood of recurrence following inc isional herniorrhaphy, The medical records of 77 patients who underwent ele ctive repair of a midline incisional hernia at the Dallas Veterans Affairs Medical Center between 1991 and 1995 sere reviewed, Demographic data, prese nce of chronic illnesses, type of repair, and presence of recurrence were n oted. Ninety-six percent of the patients were men, with an average age of 5 9 years, More than 50% of the patients had chronic lung or cardiac diseases and more than 30% neighed greater than or equal to 120% of their ideal bod y weight and had a body mass index (BMI) greater than or equal to 30. Sixty -two percent of the patients underwent primary reapproximation of the fasci a (tissue repair), whereas 38% underwent repair with prosthetic material (p rosthetic repair). The overall recurrence rate was 45%, with a median follo w-up of 45 months (range 6-73), Seventy-four percent of the recurrences pre sented within 3 years of repair, The recurrence rate for those patients und ergoing a tissue repair was 54%, whereas the recurrence rate following pros thetic repair was 29%. The incidence of recurrence for patients with pulmon ary or cardiac disease or diabetes mellitus was similar to that of patients without these illnesses. The percent ideal body weight and BMI of patients who developed a recurrent hernia, particularly following a prosthetic repa ir, were significantly greater than those of patients whose repairs remaine d intact. These data strongly support the use of prosthetic repairs for inc isional hernias, particularly in patients who are overweight.