{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T17:04:06Z","timestamp":1793293446758,"version":"4.5.0"},"reference-count":34,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Recurrent incisional hernia remains a major challenge in abdominal wall surgery and is frequently associated with increased surgical complexity and adverse outcomes. However, its role as a distinct surgical entity and its cumulative operative impact remain insufficiently characterized. Methods: We conducted a retrospective cohort study including 1262 patients undergoing incisional hernia repair using the Rives\u2013Stoppa technique between 2013 and 2022. Patients were stratified into primary and recurrent hernia groups. Operative burden was assessed using operative time and length of hospital stay. Results: Recurrent hernia was associated with a more adverse clinical profile, increased structural complexity, longer operative time, prolonged hospitalization, and higher postoperative complication rates. It remained independently associated with postoperative complications after adjustment for the principal measured confounders. Conclusions: Recurrent incisional hernia was associated with increased structural complexity, longer operative time, prolonged hospitalization, and worse postoperative outcomes compared with primary incisional hernia in patients undergoing elective retromuscular repair. Moreover, recurrent hernia remained independently associated with postoperative complications after adjustment for the principal measured confounders. These findings should be interpreted within the context of elective Rives\u2013Stoppa repair and require external validation before broader clinical application.<\/jats:p>","DOI":"10.3390\/diagnostics16162486","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T08:01:36Z","timestamp":1786089696000},"page":"2486","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Surgical Complexity and Postoperative Outcomes in Recurrent Versus Primary Incisional Hernias Following Elective Retromuscular Repair: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-5822-8805","authenticated-orcid":false,"given":"Lauren\u021biu Augustus","family":"Barbu","sequence":"first","affiliation":[{"name":"Department of Surgery, Railway Clinical Hospital Craiova, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Street, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4196-1345","authenticated-orcid":false,"given":"Daniel Ioan","family":"Mihalache","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolae-Drago\u0219","family":"M\u0103rg\u0103ritescu","sequence":"additional","affiliation":[{"name":"Department of Surgery, Emergency County Hospital, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Street, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7018-5675","authenticated-orcid":false,"given":"Liviu","family":"Vasile","sequence":"additional","affiliation":[{"name":"Department of Surgery, Emergency County Hospital, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Street, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirela","family":"Coroescu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Faculty of Medicine, Titu Maiorescu University, 67A Gheorghe Petra\u0219cu Street, 031593 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2293-6013","authenticated-orcid":false,"given":"Ioan Sorin","family":"Tudorache","sequence":"additional","affiliation":[{"name":"Department of Anatomy, Faculty of Medicine, Titu Maiorescu University, 67A Gheorghe Petra\u0219cu Street, 031593 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiberiu Stef\u0103ni\u021b\u0103 \u021aenea","family":"Cojan","sequence":"additional","affiliation":[{"name":"Department of Surgery, Railway Clinical Hospital Craiova, University of Medicine and Pharmacy of Craiova, 2 Petru Rares Street, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7065-3708","authenticated-orcid":false,"given":"Marius P.","family":"Iordache","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurology, Faculty of Medicine, Titu Maiorescu University, 67A Gheorghe Petra\u0219cu Street, 031593 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1123-3974","authenticated-orcid":false,"given":"Anca","family":"Buliman","sequence":"additional","affiliation":[{"name":"Department of Radiology, Faculty of Medicine, Titu Maiorescu University, 67A Gheorghe Petra\u0219cu Street, 031593 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"ref_1","first-page":"e50568","article-title":"Incisional Hernia: A Surgical Complication or Medical Disease?","volume":"15","author":"Omar","year":"2023","journal-title":"Cureus"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"71","DOI":"10.20408\/jti.2025.0019","article-title":"Surgical site infections: A comprehensive review","volume":"38","author":"Rezaei","year":"2025","journal-title":"J. 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Epidemiol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/16\/2486\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T08:18:31Z","timestamp":1786090711000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/16\/2486"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,7]]},"references-count":34,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["diagnostics16162486"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16162486","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,7]]}}}