Operative vs non-operative management of ventral hernia: a population based study of long-term benefits and consequences

Abstract Purpose Ventral hernia (VH) management has progressed beyond simply physical repair of the defect. It now involves a strategy that purposefully restores abdominal core function and prevents future complications. This study investigates the association between ventral hernia repair (VHR) and functional disorders related to the abdominal core in addition to bowel obstruction, opioid misuse, and physical therapy utilization. Methods This retrospective cohort study used administrative codes from the TriNetX database. The outcomes of interest were spine and pelvic floor dysfunction, constipation, incontinence, genital prolapse, bowel obstruction, opioid misuse, and physical therapy utilization. Results A total of 587 384 patients were identified with diagnosis of VH. Of those, 81 830 (13.9%) underwent surgical repair. Surgery was associated with a significant reduction in the hazard for bowel obstruction (HR 0.65, 95% CI [0.63, 0.67]). There were no association between surgery and the hazard of opioid misuse (0.97, [0.93, 1.01]). The hazard ratios associated with surgery were 1.05 (1.02, 1.07) for spine and pelvic dysfunction, 1.03 (0.99, 1.05) for constipation, 0.97 (0.93, 1.01) for incontinence, and 0.88 (0.72, 1.07) for genital prolapse. The hazard ratio for physical therapy utilization after surgery was 1.76 (1.73, 1.80). Conclusions VHR is associated with reduction in the hazard of bowel obstruction, while having no significant effect on opioid misuse. Additionally, surgical patients had a higher utilization of physical therapy. While surgical management was not associated with a reduction in the hazard of functional disorders, further research is warranted to better understand these relationships.