Incisional hernia repair trends in the last decade (2013-2023): an ACHQC analysis.

aimThis study evaluates trends in incisional hernia repair techniques and their associated outcomes over 10 years. It hypothesizes that advancements in surgical techniques have led to an increase in minimally invasive procedures, resulting in a subsequent decrease in 30-day postoperative complications. MATERIAL &

methodsA retrospective review of prospectively collected data from the Abdominal Core Health Quality Collaborative (ACHQC) database was conducted from January 2013 to December 2023. Adult patients who underwent incisional ventral hernia repair via open, laparoscopic, or robotic approaches with mesh and 30-day follow-up were included. Data analysis focused on patient demographics, operative details, and postoperative outcomes.

results17,078 patients were included after applying the inclusion and exclusion criteria. Over time, a notable shift in surgical techniques was observed. The use of a robotic approach increased from 10% (259) (2013–2015) to 48% (1562) (2022–2023), while open surgeries decreased from 63% (n = 1542) to 46% (n = 1550) in the same period. Median hernia length increased from 10 cm to 11 cm (p < 0.001), while hernia width remained stable (p = 0.5). Both mesh length and width increased significantly (p < 0.001). TAP block use increased from 0% to 20% (p < 0.001). Mesh positioning shifted toward sublay placement (91% to 96%, p < 0.001), particularly retromuscular (43% to 62%, p < 0.001), while intraperitoneal mesh placement declined from 37% to 23% (p < 0.001). Mesh fixation techniques have also changed: use of tackers decreased (35% to 12%, p < 0.001), adhesive use increased (5% to 14%, p < 0.001), and suture use remained stable (p = 0.2). Myofascial release became more frequent (46% to 60%, p < 0.001), along with increased fascial closure (86% to 95%, p < 0.001). Transversus abdominis release increased (59% to 64%, p = 0.01), while external oblique release declined (9% to 2%, p < 0.001). 30-day readmission rates slightly decreased (5% to 4%, p = 0.005), while intraoperative complication rates remained low and stable (2–3%, p = 0.05).

conclusionThe findings of this study highlight a significant trend toward minimally invasive surgical techniques in the treatment of incisional hernias over the past 10 years. This shift is accompanied by consistently low early postoperative complications, despite larger hernial defect repairs and the larger mesh.