Improving patient outcomes in complex ventral hernia repair: a narrative review

Complex ventral hernia repair refers to the repair of ventral hernias that are surgically challenging or time-consuming. The objective of this narrative review is to highlight the effect of postoperative complications on the health and quality of life (QoL) of patients after complex, open ventral hernia repair. Existing scientific literature on complex ventral hernia repair and treatment approaches to reduce postoperative complications were reviewed. Experience-based treatment considerations from two surgeons with expertise in the field are provided to complement the current literature. The current scientific literature support clinical observations that, compared with “noncomplex patients,” patients who have undergone complex ventral hernia repair tend to have more postoperative complications, including long-term infections, hernia recurrences, or mesh explantations, thus potentially affecting their QoL. Preoperative optimization, which involves counselling patients to determine modifiable risk factors, can help minimize the risk of postoperative complications. Several clinical studies also support the reinforcement of ventral hernia repairs with a surgical mesh to help maintain closure of the defect in the abdominal wall. Although conflicting data exist, the type of surgical mesh (synthetic, biologic, and biosynthetic) affects the incidence of postoperative complications and subsequent mesh explantations. Therefore, clinicians need to carefully select the appropriate mesh to optimize patient outcomes. Postoperative complications resulting from complex ventral hernia repair may negatively affect the QoL of patients. Individualized patient-centered approaches to treatment involving preoperative optimization and the use of surgical meshes may enhance overall patient QoL.