Ventral hernia is a chronic disease: a systematic review of long-term outcomes beyond 5 years

Abstract

Purpose: To systematically evaluate the long-term outcomes of ventral hernia repair (VHR) and reassess its classification as a definitive surgical intervention. This review synthesizes evidence on postoperative complications including recurrence, chronic pain, and patient-reported outcomes to characterize the long-term burden of VHR and its impact on patient management. This study underscores the necessity of prolonged postoperative surveillance to accurately assess surgical efficacy and inform evidence-based follow-up trategies.

Methods: A systematic review was conducted in accordance with PRISMA guidelines, searching PubMed, Embase, and Web of Science for studies with a mean or median follow-up of ≥5 years. Eligible studies reported outcomes including recurrence, reoperation, mesh infection, chronic pain, and quality of life. A random-effects meta-analysis was performed using STATA MP 18 to pool event rates for each outcome.

Results: Among 2,721 patients followed for ≥5 years, 13% (95% CI: 9-17%) experienced recurrence. Long-term complications included seroma in 11% (95% CI: 6-17%, n = 1,778) and reoperation in 8% (95% CI: 5-11%, n = 1,833) of patients. Patient-reported outcomes, including chronic pain, were collected, with 15% (95% CI: 8-23%, n = 1,220) reporting its occurrence.

Conclusion: This systematic review evaluates the complexity of ventral hernia repair and proposes conceptual realignment in managing ventral hernias, viewing them through the lens of chronic disease to align treatment goals with long-term patient outcomes. The data suggests that ventral hernias exhibit characteristics of a chronic condition, requiring sustained medical oversight and potential reinterventions for chronic pain, recurrence, and other quality-of-life complications.

Keywords: Chronic disease; Long-term outcomes; Patient-reported outcomes; Quality of life; Ventral hernia.