Surgical Complexity and Postoperative Outcomes in Recurrent Versus Primary Incisional Hernias Following Elective Retromuscular Repair: A Retrospective Cohort Study

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–Stoppa 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–Stoppa repair and require external validation before broader clinical application.