Publications External Validation of the European Hernia Society
Incisional hernia remains a frequent complication after abdominal surgery, with incidence rates of 10% to 30% after midline laparotomies, depending on risk factors. This incidence leads to a high number of hernia repair operations. In the US alone, more than 300,000 repairs are performed annually. The associated costs of these hernia repairs are estimated to be US$3.2 billion per year. Incisional hernias can be surgically repaired for many reasons; patients can have cosmetic concerns, pain, bowel obstruction, mechanical symptoms, or incarceration.
There is a great variety of incisional hernias with different locations, widths, and lengths. To categorize these hernias, the European Hernia Society (EHS) developed and published the “Classification of Primary and Incisional Abdominal Wall Hernias” in 2009. One of the aims of this classification was to describe hernias in both scientific and clinical communication using a uniform method. It combines the location and size of the hernia. For location, differentiation is made among midline, lateral, or combined. For size, the width of the hernia is used, and is divided into 3 subgroups: W1 (<4 cm), W2 (4 to 10 cm), and W3 (>10 cm). The classification is based partly on the estimated risk of com- plications and recurrences. Although published several years ago, the EHS classification has not been externally validated thoroughly.
Several studies have addressed the issue of postoperative complications after incisional hernia repair, studies did not correct for any risk factors and did not use any size classification, such as the EHS classification.
The objective of this study was to evaluate the EHS classification among other factors, as a potential predictive tool for postoperative complications after incisional hernia surgery, by using a large-scale database. It was hypothesized that a higher hernia width class would lead to more postoperative complications.