Preperitoneal Ventral Hernia Repair: A Decade-Long Prospective Observational Study with Analysis of Patient Outcomes

Background: Ventral hernia repair remains one of the most frequently performed operations in abdominal wall surgery, yet outcomes continue to be shaped by defect complexity, patient comorbidity, wound morbidity, and the chosen plane of mesh placement. Open preperitoneal repair offers wide mesh overlap in an extraperitoneal position while preserving the biomechanical advantages of fascial reconstruction. Aim: To evaluate perioperative, functional, and medium-term outcomes after open preperitoneal ventral hernia repair in a prospective cohort managed at a public-sector teaching hospital over ten years. Methods: This prospective observational study included 150 consecutive adults undergoing open preperitoneal ventral hernia repair at Government Medical College & Hospital, Purnea, Bihar, India, between January 2014 and December 2023, with follow-up through December 2024. Demographic variables, comorbidity burden, hernia morphology, operative details, 30-day morbidity, recurrence, pain, Carolinas Comfort Scale (CCS) scores, and satisfaction were prospectively recorded. Primary ventral and incisional hernias were compared, and multivariable logistic regression was performed for a composite unfavorable outcome defined as surgical-site occurrence (SSO) or recurrence. Results: The cohort had a mean age of 51.2 ± 13.4 years and was predominantly female (58.0%). Incisional hernias accounted for 36.0% of cases and recurrent hernias for 16.0%. Mean defect width was 6.1 ± 3.5 cm; 64.7% of defects exceeded 4 cm. Primary fascial closure was achieved in 97.3%, and mesh overlap ≥5 cm in 90.7%. Median hospital stay was 3 days, median return to routine activity was 20 days, and median follow-up was 34 months. Thirty-day SSO occurred in 14.0%, including seroma in 6.7% and superficial surgical-site infection in 4.0%. Readmission and reoperation rates were 3.3% and 1.3%, respectively. Recurrence was observed in 4.7% and chronic pain at 6 months in 4.7%. Mean VAS pain decreased from 5.8 at baseline to 1.0 at 6 months and 0.5 at 12 months; mean CCS summary score improved from 20.1 at baseline to 6.9 and 4.3 at 6 and 12 months, respectively. On multivariable analysis, obesity (adjusted OR 3.14, p=0.019), diabetes mellitus (adjusted OR 5.33, p=0.001), and smoking/tobacco use (adjusted OR 2.83, p=0.049) independently predicted the composite unfavorable outcome. Conclusion: In this decade-long prospective series, open preperitoneal ventral hernia repair was associated with high rates of fascial restoration, acceptable wound morbidity, low recurrence, and substantial improvement in pain and hernia-specific quality of life. The technique appears durable and pragmatic for complex ventral hernia care in a resource-conscious tertiary teaching hospital, although outcomes remain strongly influenced by modifiable metabolic and smoking-related risk factors.