Background: Our aim was to report the natural history of operative versus expectant management of patients with ventral hernias and co-morbidities at five years.
Methods: This was a prospective observational study. Patients were managed with elective repair or expectantly, based on co-morbidities and patient/surgeon choice. Primary outcome was functional status. Patients were matched using optimal matching. Outcomes were compared using multivariable regression.
Results: A total of 197 patients were included (78 operative, 119 expectant) with median follow-up of 5.1 (3.2-5.5) years. In the matched-cohort (n = 80), 58 vs 68% were obese, and 88% vs 95% had a major comorbidity. Both groups had similar baseline functional status (p = 0.788), but only those repaired initially had significantly improved scores at five years (p < 0.050). Half (20) of patients managed expectantly crossed over to repair, and 15% (3) were emergent/urgent.
Conclusion: Initial repair improves long-term functional status significantly compared to expectant management. Repair by hernia experts should be considered for high-risk patients.
Keywords: Expectant management; Non-operative management; Ventral hernia; Watchful waiting.
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