Midline incisional hernia guidelines: the European Hernia Society

Abstract

Since the introduction of anaesthesia by Morton in 1846, and as survivable abdominal surgery became more common, so did the incidence of incisional hernias. Since then, more than 4000 peer-reviewed articles have been published on the topic, many of which have tried to reduce the incidence or introduce techniques to improve outcomes from surgical repair. Despite this, the incidence of incisional hernias and the recurrence rates after repair remain high. A wide range of incisional hernia rates are reported. A meta-analysis including over 14 000 patients reported a weighted incidence of 12.8 per cent 2 years after a midline incision, and that one-third of patients with an incisional hernia undergo surgical repair. Recurrence rates after repair of incisional hernia range between 23 and 50 per cent, with increasing rates of complications and re-recurrence after each subsequent failed repair. Arguably, no other benign disease has seen so little improvement in terms of surgical outcome.