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Primary (PH) and incisional ventral hernias (IH) are very common conditions. In the USA alone, over 300,000 ventral hernia repairs are performed annually . Around 75% of these hernia repairs are performed for primary ventral hernias (mainly epigastric and umbilical hernias) and around 25% are performed for incisional hernias . The associated costs of these hernia repairs are estimated to be US$3.2 billion a year . Currently, incisional hernias occur in 10–30% of all patients undergoing midline laparotomies, depending on risk factors [3–8].
Primary and incisional ventral hernias have many similarities. They are both abdominal wall defects predominantly located in the linea alba, and share similar symptoms like discomfort, pain, and potentially incarceration . However, despite these similarities, the etiology of both types of hernias is thought to be different. Primary hernias can be considered as a congenital condition, whereas incisional hernias represent an iatrogenic technical or wound healing problem.
Regardless of these potential differences, primary and incisional ventral hernias are most often pooled in publications reporting on hernia surgery outcomes [10–15]. Stirler et al.  and Köckerling et al.  addressed this issue of pooled data analysis. Stirler et al. compared the characteristics and outcomes of patients undergoing laparoscopic ventral hernia repair. Köckerling et al. compared surgical techniques and complication rates of primary and incisional hernia surgery. Both studies found statistically significant differences. These articles are an important first step in comparing both types of hernias, but unfortunately, almost no patient characteristics were included in the comparison between both groups. These characteristics are among the most important features to take into account because they are associated with postoperative outcomes: many patient characteristics, like age, American Society of Anesthesiologists (ASA) score, smoking, and steroid use, but also factors like operative time and emergency surgery, are associated with postoperative complications and recurrences [18–21].
The objective of this study was to compare primary and incisional hernias regarding patient characteristics, hernia characteristics, surgical characteristics, and postoperative complications after hernia re- pair surgery, by using a large-scale database.