Anders Gram-Hanssen

Objectives: The aim of this study was to investigate the association between mesh position and patient-reported outcomes, including prevalence of severe chronic pain, foreign body sensation, self-reported recurrence, and physical impact score in patients undergoing elective incisional hernia repair. Background: Patient-reported outcomes are increasingly recognized as important measures of treatment success following incisional hernia repair, yet the impact of mesh position remains uncertain. Methods: This nationwide Danish survey- and register-based cohort study was conducted within the AFTERHERNIA Project and based on the Abdominal Hernia questionnaire. All patients undergoing elective incisional hernia repair in Denmark between January 1, 2014, and March 31, 2024, were eligible for inclusion. Survey responses were linked with operative data from the Danish Ventral Hernia Database. Adjusted prevalences and means were estimated using g-computation. Results: Of 2827 eligible patients, 2348 patients responded, corresponding to a response rate of 83%. Among these, 28% of patients received onlay, 28% retromuscular, 13% preperitoneal, and 31% intraperitoneal mesh position with defect closure. Onlay was associated with a higher prevalence of foreign body sensation compared with retromuscular position (adjusted prevalence, 37.1% vs. 30.3%; difference, 6.8%; 95% CI, 0.9–12.8). No differences were observed across mesh positions regarding the prevalence of severe chronic pain, self-reported recurrence, and physical impact score. Conclusions: Onlay position was associated with a higher prevalence of foreign body sensation compared with retromuscular position, while no differences were observed regarding the prevalence of severe chronic pain, self-reported recurrence, or physical impact score.

Purpose The study aimed to assess patient-reported outcomes among patients undergoing elective open primary ventral hernia repair exclusively motivated by cosmetic concerns. Methods This Danish nationwide study included patients who underwent elective open ventral hernia repair from 2014 to 2024. Patients were identified through the Danish National Patient Register and invited to complete a digital survey. Survey data on surgical motivation and patient-reported outcomes were linked with data from the Danish Ventral Hernia Database. Outcomes included severe chronic pain, self-reported recurrence, cosmetic improvement, cosmetic satisfaction, and changes in quality of life. Targeted average treatment effects were estimated using g-computation. Results Among 14,263 eligible individuals, the survey response rate was 78%. Of respondents, 393 reported cosmetic-only motivation for surgery, and 8,016 reported physical symptoms as motivation. The population-averaged adjusted prevalence of severe chronic pain was 5.9% (95% CI 3.8–8.0) in the cosmetic-only motivation group versus 10.9% (95% CI 10.2–11.6) in the physical motivation group. Recurrence was likewise less frequent (7.0%, 95% CI 4.7–9.3 vs. 13.1%, 95% CI 12.3–13.8). The proportion reporting no improvement in quality of life did not differ significantly (8.6% vs. 6.1%; absolute difference − 2.6%, 95% CI -5.3–0.2), nor did Abdominal Hernia Questionnaire appearance scores (18.2 vs. 18.5; difference 0.3, 95% CI 0.0–0.5). Median follow-up was 6.8 and 5.2 years, respectively. Conclusion Most patients undergoing open repair of a small primary ventral hernia for cosmetic reasons experienced improved abdominal appearance and quality of life, while risks of chronic pain and recurrence remained relatively low.

Background: Minimally invasive approaches are increasingly used for primary ventral hernia repair, but comparative patient-reported outcome evidence remains limited. We examined long-term patient-reported outcomes after robotic, laparoscopic, and open elective primary ventral hernia repair. Study Design: This nationwide survey- and register-based study included adults (≥18 years) undergoing elective mesh repair of primary (umbilical or epigastric) ventral hernias with defect widths <10 cm. Patient-reported outcomes were assessed using the Abdominal Hernia-Q capturing the prevalence of severe chronic pain, foreign body sensation, scar dissatisfaction, and patient-reported recurrence, as well as physical impact and appearance scores. Of 12,040 eligible patients, 9,552 responded (79%). Results: Severe chronic pain, foreign body sensation, and physical impact scores did not differ across approaches. Scar dissatisfaction was lower after laparoscopic repair than open repair (5.7% vs 10.2%; difference, −4.5%; 95% CI, −5.8 to −3.2; P <.001) and after robotic repair than open repair (4.2% vs 10.2%; difference, −6.0%; 95% CI, −8.2 to −3.8; P <.001). Patient-reported recurrence was higher after laparoscopic than open repair (11.4% vs 9.2%; difference, 2.2%; 95% CI, 0.6 to 3.7; P =.006). Appearance scores were slightly higher after laparoscopic than open repair (18.8 vs 18.5; mean difference, 0.3; 95% CI, 0.2 to 0.5; P <.001). Conclusions: Long-term patient-reported outcomes were broadly comparable across approaches, but minimally invasive repair was associated with less scar dissatisfaction. Scar-related outcomes may inform approach selection when postoperative appearance is a patient priority.

Background: Reoperation is often used as an outcome measure after ventral hernia repair but may underestimate the true recurrence rate, potentially leading to biased interpretation of studies using reoperation for recurrence as an outcome. This study aimed to determine the proportion of patients with recurrence after ventral hernia repair who undergo reoperation for recurrence in a nationwide population. Methods: This nationwide survey‐ and register‐based study, part of the AFTERHERNIA Project, included patients ≥ 18 years undergoing primary ventral or incisional hernia repair between January 2014 and March 2024. Patients were identified in the Danish National Patient Register and invited to participate in an electronic survey. Survey responses were linked to the Danish Ventral Hernia Database. Recurrence was defined as either reoperation for recurrence or self‐reported recurrence. Prevalences were estimated and adjusted for using regression analyses with marginal standardization. Results: A total of 20,703 patients were included (16,904 primary ventral and 3799 incisional hernias; 80% response rate), with a median follow‐up of 5.5 years. Among primary ventral hernias, overall recurrence was 15.5% (95% CI, 15.0–16.1), of which 3.3% (95% CI, 3.1–3.6) had a reoperation and 12.2% (95% CI, 11.7–12.7) had self‐reported recurrence. Among incisional hernias, overall recurrence was 27.2% (95% CI, 25.8–28.6), of which 7.0% (95% CI, 6.3–7.7) had a reoperation and 20.2% (95% CI, 18.9–21.5) had self‐reported recurrence. Conclusion: The prevalence of reoperation for recurrence underestimated the overall prevalence of recurrence by approximately fivefold after primary ventral hernia repair and fourfold after incisional hernia repair.

Introduction: Good preoperative information is associated with reduced anxiety and improved postoperative pain, satisfaction, and quality of life. In the present study, we assessed sex-based disparities in perceived sufficiency of perioperative information among patients undergoing ventral hernia repair. Methods: This study was part of the AFTERHERNIA Project, which included patients ≥18 years undergoing ventral hernia repair between January 2014 and March 2024. Patients identified via the Danish National Patient Register completed the Abdominal Hernia-Q, with responses linked to the Danish Ventral Hernia Database. Perceived sufficiency of perioperative information was assessed using three Abdominal Hernia-Q items: prepared for surgery, postoperative emotions, and recovery concerns. Multivariable analyses were adjusted for age, severe chronic pain, suspicion of recurrence, hernia characteristics, and surgical factors. Results: Among 26,384 patients (10,108 females, 16,276 males; 79% [26,384 of 33,267] response rate), crude rates indicated that females were more often dissatisfied across all three items: prepared for surgery (14%vs9%), postoperative emotions (39%vs22%), and recovery concerns (34%vs22%). In adjusted analyses (n=23,201), females were also found to be more dissatisfied: prepared for surgery (OR 1.40;95%CI,1.28–1.53;P<0.001), postoperative emotions (OR 2.00;95%CI, 1.88–2.13;P<0.001), and recovery concerns (OR 1.61;95%CI,1.51–1.71;P<0.001). All three subgroup analyses showed similar patterns. Younger age, severe chronic pain, and suspicion of recurrence were independently associated with higher levels of dissatisfaction. Conclusion: These results show a possible sex-based disparity in perceived sufficiency of perioperative information, with higher dissatisfaction reported by females. These findings suggest that perioperative counselling may need to be tailored to better meet female patients’ informational needs.

Background: Mesh repair reduces recurrence risk, but evidence regarding patient-reported outcomes (PROs) across mesh placements remains limited. This study aimed to investigate the association between mesh placement and PROs in primary ventral hernia repair, and secondarily the prevalence of severe chronic pain and foreign body sensation. Methods: This nationwide survey- and register-based study, part of the AFTERHERNIA project in Denmark, linked electronic survey responses with operative data from the Danish Ventral Hernia Database. Adults (≥ 18 years) who underwent elective primary (umbilical or epigastric) ventral hernia repair with mesh between January 1, 2014, and March 31, 2024, were included, limited to defects < 10 cm. PROs were assessed using the validated, ventral hernia-specific Abdominal Hernia-Q (AHQ) questionnaire. Results: Out of 13,327 eligible patients, 10,869 (82%) responded (median age, 54 years; 71% male). Compared with onlay, preperitoneal repair had a better AHQ sum score (58.7 vs 57.7; mean difference, 0.9; 95% CI, 0.6 to 1.2; P < .001), lower prevalence of severe chronic pain (8.7% vs 11.3%; difference, −2.6%; 95% CI, −4.0% to −1.2%; P < .001), and lower prevalence of foreign body sensation (20.1% vs 23.9%; difference, −3.8%; 95% CI, −5.7% to −1.8%; P < .001). Findings were consistent across subgroups and sensitivity analyses. Conclusions: PROs were generally good across mesh placements. Preperitoneal mesh placement was associated with slightly better PROs compared with other placements, although the difference was small and unlikely to be clinically meaningful. However, it was associated with a lower prevalence of severe chronic pain and foreign body sensation compared with onlay and intraperitoneal mesh.

Purpose: This study aimed to explore patient motivations for undergoing elective repair of a primary ventral hernia and to estimate the proportion of patients who underwent surgery for indications that are not traditionally prioritized in surgical decision-making. Methods: This descriptive mixed-methods study was based on a nationwide survey of Danish patients who had undergone elective repair of an umbilical or epigastric hernia between 2014 and 2024. Data were collected through structured survey questions on predefined motivational factors and linked to national clinical registries. Qualitative free-text responses were analyzed using systematic text condensation to provide contextual understanding of patient motivations. The study forms part of the AFTERHERNIA Project, a series of nationwide studies investigating patient-reported outcomes after groin and ventral hernia surgery in Denmark. Results: A total of 18,753 participants completed the survey, corresponding to a response rate of 82%. The most frequently reported motivations for surgery were pain or discomfort (63%), concerns about hernia growth (39%), and doctors’ recommendations (34%). 12% of participants selected only reasons classified as motivations that are not traditionally prioritized in surgical decision-making. (cosmetic concerns, fear of growth, fear of incarceration, or emotional impact). The qualitative analysis supported these findings, identifying seven themes that reflected symptom burden, professional guidance, and contextual or practical factors as key drivers of patient decision-making. Conclusion: About one in eight patients underwent elective repair of a primary ventral hernia motivated by indications that are not traditionally prioritized in surgical decision-making. However, most respondents were motivated by physical symptoms or professional advice.