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J Reconstr Microsurg
DOI: 10.1055/s-0044-1788564
Original Article

A DIEP Dive into Patient Risk Factors for Hernia and Bulge Development: A Meta-regression

Nikki Rezania 
1   Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
,
Kelly A. Harmon 
1   Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
,
Reilly Frauchiger-Ankers 
1   Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
,
Okensama La-Anyane
1   Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
3   Frank H. Netter School of Medicine, Quinnipiac University, North Haven, Connecticut
,
Keid Idrizi
1   Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
,
Jocelyn To
2   Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
,
Ethan M. Ritz
4   Rush Biostatistics and Bioinformatics Core, Rush University Medical Center, Chicago, Illinois
,
David E. Kurlander
1   Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
,
Deana Shenaq
1   Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
,
George Kokosis
1   Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
› Author Affiliations Funding The authors received no funding for data collection or preparation of the manuscript.
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Abstract

Background This meta-regression aims to investigate risk factors for abdominal hernia and bulge in patients undergoing deep inferior epigastric perforator (DIEP) flaps and the effect of prophylactic mesh placement on postoperative complications.

Methods A systematic search was conducted in July of 2022 in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Seventy-four studies published between 2000 and 2022 met the inclusion criteria. Sixty-four studies were included in the analysis for bulge and 71 studies were included in the analysis for hernia. Meta-regressions were run on the proportion of patients experiencing hernia or bulge to assess for patient risk factors and the role of prophylactic mesh placement. Proportions were transformed using the Freeman–Tukey double arcsine method.

Results The average rates of hernia and bulge after DIEP flaps were found to be 0.18% and 1.26%, respectively. Increased age (β = 0.0059, p = 0.0117), prior abdominal surgery (β = 0.0008, p = 0.046), and pregnancy history (β = −0.0015, p = 0.0001) were significantly associated with hernia. Active smoking (β = 0.0032, p = 0.0262) and pregnancy history (β = 0.0019, p < 0.0001) were significantly associated with bulge. Neither the perforator vessel laterality nor the number of perforator vessels harvested had any association with hernia or bulge. Prophylactic mesh placement was not associated with hernia or bulge.

Conclusion Understanding the comorbidities associated with hernia or bulge following DIEP flap breast reconstruction, such as advanced age, prior abdominal surgery, pregnancy history, and active smoking status, allows surgeons to proactively identify and educate high-risk patients. Future studies may further explore whether prophylactic mesh placement offers patients any benefit.

Keywords

autologous breast reconstruction - deep inferior epigastric perforator flap - bulge - hernia

Authors' Contributions

N.R.: conceptualization, methodology, writing—original draft, writing—review and editing.


K.A.H.: conceptualization, methodology, writing—original draft, writing—review and editing.


R.F-A.: conceptualization, methodology, writing—original draft, writing—review and editing.


O.L-A.: conceptualization, methodology, writing—original draft, writing—review and editing.


K.I.: conceptualization, methodology, writing—original draft, writing—review and editing.


J.T.: conceptualization, methodology, writing—original draft, writing—review and editing.


E.M.R.: statistical analysis.


D.E.K.: conceptualization, methodology, writing—original draft, writing—review and editing, project administration.


D.S.: conceptualization, methodology, writing—original draft, writing—review and editing, project administration.


G.K.: conceptualization, methodology, writing—original draft, writing—review and editing, project administration.


Informed Consent

For this type of study, formal consent is not required.


Supplementary Material



Publication History

Received: 10 October 2023

Accepted: 22 June 2024

Article published online:
17 July 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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