Preoperative risk factors in hernia recurrence: a single-center study

Background and Objectives. Hernia recurrence is still a great challenge for surgeons regarding the optimal surgical technique, the best alloplastic material and the management of risk factors (advanced age, female sex, body mass index, smoking, diabetes, the presence of connective tissue disorders, chronic cough, etc.). The present study attempts to assess the impact of these factors in hernia recurrence, as well as the integration of the prosthetic material at the tissue level, in order to reduce possible postoperative complications. Material and Methods. A retrospective study was performed on 108 patients operated (between January 2012 and December 2022) for recurrence of inguinal, umbilical and incisional hernias. Demographic data and comorbidities were analyzed in relation to hernia recurrence. Fragments of unintegrated and well-fitted mesh were sampled and examined microscopically to assess tissue-level implications. Results. The strongest factors associated with hernia recurrence were obesity (p=0.001), diabetes mellitus (p=0.003), high blood pressure (p=0.003) and atrial fibrillation (p=0.044). Microscopic analysis of unintegrated mesh fragments revealed the presence of foreign body granulomas and predominance of thin fibrillar type 3 collagen, whereas well-integrated material showed thick type I collagen fibers and low inflammatory infiltrate. Conclusions. Insufficient oxygen supply, an altered inflammatory response, and diminished proliferative capacity during the wound healing stages resulted in abnormalities in the development of mature granulation tissue. Therefore, to reduce the risk of hernia recurrence, it is essential to have a surgical treatment that must manage all these possible factors.