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Purpose <p>Ambulatory incisional hernia surgery has not been recommended in guidelines so far. An ambulatory procedure was considered only for small incisional hernias with maximum defect sizes of ≤ 4&#xa0;cm. From 2005, the first reports were then published on ambulatory incisional hernia repair. Surgeons from the French <i>Club Hernie</i> reported on 272 (19%) of 1,429 patients who had undergone ambulatory incisional hernia repair. To get a better estimate of the risks associated with ambulatory incisional hernia repair and set criteria for patient selection, this paper now explores the factors associated with an unfavorable outcome in incisional hernia repair based on data from the Herniamed Registry.</p> Methods <p>Between January 5, 2009 and July 1, 2025 data on 90,051 patients who had undergone primary incisional hernia repair were entered into the Herniamed Registry by hospitals and surgeons in Germany, Austria, and Switzerland participating on a voluntary basis in the registry. The main focus of this analysis was on logistic regression models taking confirmatory, defined patient- and procedure-related characteristics such as defect size into account as potential confounders of the outcome parameters (general, intraoperative and postoperative complications as well as complication-related reoperation).</p> Results <p>The defect size has the most unfavorable relationship with the outcome in inpatient incisional hernia repair. With an increasing defect size greater than W I (&lt; 4&#xa0;cm), there is a growing rate of intraoperative (W II ≥ 4–10&#xa0;cm; OR = 1.883 [1.608; 2.206]; W III &gt; 10&#xa0;cm; OR = 3.201 [2.682; 3.820]), general (W II ≥ 4–10&#xa0;cm; OR = 1.713 [1.537; 1.909]; W III &gt; 10&#xa0;cm; OR = 3.375 [3.004; 3.793]) and postoperative complications (W II ≥ 4–10&#xa0;cm; OR = 1.641 [1.531; 1.758]; W III &gt; 10&#xa0;cm; OR = 2.657 [2.459; 2.872]) as well as of complication-related reoperations (W II ≥ 4–10&#xa0;cm; OR = 1.621 [1.467; 1.792]; W III &gt; 10&#xa0;cm; OR = 2.701 [2.421; 3.015]).</p> Conclusion <p>When selecting patients for an ambulatory incisional hernia procedure, increasing perioperative complications must be expected for defect sizes greater than W I (&lt; 4 cm).</p>

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Main confounders associated with the outcome of inpatient incisional hernia repair for decision making in ambulatory surgery

  • 期刊论文

  • 发表日期：

    2026年2月11日

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  • F. Köckerling,
  • W. Uhl,
  • H. Witzigmann,
  • H. Niebuhr,
  • W. Reinpold,
  • K. Zarras,
  • R. Schwab,
  • B. Stechemesser,
  • A. Kuthe,
  • J. Conze,
  • D. Adolf,
  • R. Bartkowski,
  • H. Riediger

摘要

Purpose

Ambulatory incisional hernia surgery has not been recommended in guidelines so far. An ambulatory procedure was considered only for small incisional hernias with maximum defect sizes of ≤ 4 cm. From 2005, the first reports were then published on ambulatory incisional hernia repair. Surgeons from the French Club Hernie reported on 272 (19%) of 1,429 patients who had undergone ambulatory incisional hernia repair. To get a better estimate of the risks associated with ambulatory incisional hernia repair and set criteria for patient selection, this paper now explores the factors associated with an unfavorable outcome in incisional hernia repair based on data from the Herniamed Registry.

Methods

Between January 5, 2009 and July 1, 2025 data on 90,051 patients who had undergone primary incisional hernia repair were entered into the Herniamed Registry by hospitals and surgeons in Germany, Austria, and Switzerland participating on a voluntary basis in the registry. The main focus of this analysis was on logistic regression models taking confirmatory, defined patient- and procedure-related characteristics such as defect size into account as potential confounders of the outcome parameters (general, intraoperative and postoperative complications as well as complication-related reoperation).

Results

The defect size has the most unfavorable relationship with the outcome in inpatient incisional hernia repair. With an increasing defect size greater than W I (< 4 cm), there is a growing rate of intraoperative (W II ≥ 4–10 cm; OR = 1.883 [1.608; 2.206]; W III > 10 cm; OR = 3.201 [2.682; 3.820]), general (W II ≥ 4–10 cm; OR = 1.713 [1.537; 1.909]; W III > 10 cm; OR = 3.375 [3.004; 3.793]) and postoperative complications (W II ≥ 4–10 cm; OR = 1.641 [1.531; 1.758]; W III > 10 cm; OR = 2.657 [2.459; 2.872]) as well as of complication-related reoperations (W II ≥ 4–10 cm; OR = 1.621 [1.467; 1.792]; W III > 10 cm; OR = 2.701 [2.421; 3.015]).

Conclusion

When selecting patients for an ambulatory incisional hernia procedure, increasing perioperative complications must be expected for defect sizes greater than W I (< 4 cm).