Abstract
Background: Open ventral incisional hernia repairs with mesh reduce hernia recurrence rates to less than 10%. The Rives-Stoppa retrorectus hernia repair technique is becoming the standard of care for mesh repair of complex incisional hernias. In these hernia repairs, mesh has traditionally been fixated with transfascial sutures, but fibrin glue has been used as an alternative to reduce pain and may also reduce operative time and the risk of seroma formation. The primary objective of this study was to compare the rates of hernia recurrence and seroma formation in cancer patients who underwent Rives-Stoppa incisional hernia repair using transfascial sutures vs. fibrin glue for mesh fixation. Methods: We conducted a retrospective review of a prospectively maintained database of cancer patients at our free-standing cancer institution who underwent Rives-Stoppa ventral incisional hernia repair performed at our institution. Fisher’s exact test was used to assess differences in hernia recurrence and seroma formation rates between patients who underwent mesh fixation with transfascial sutures vs. fibrin glue. Using a neutral prior probability distribution, a Bayesian analysis was performed to evaluate the posterior probability of seroma formation requiring intervention and hernia recurrence after retrorectus repair with fibrin glue fixation. Log-rank test was used to assess the difference in overall survival between the two groups. Results: Forty-one patients (22 in the transfascial suture group and 19 in the fibrin glue group) were included in the analysis. The patient demographics were similar in both groups. There was no statistically significant difference in seroma formation requiring drainage by interventional radiology (IR) between the fibrin glue and the transfascial suture groups (5.3% vs. 9.1%; P=1.00). The odds of having a hernia recurrence was 4 times higher in the transfascial suture group than in the fibrin glue fixation group, but this was not statistically significant (18.2% vs 5.3%, p=0.35). The Bayesian analysis showed a 90% probability that the hernia recurrence rate would be higher in the transfascial suture than in the fibrin glue fixation group. Conclusion: Using fibrin glue instead of transfascial sutures may reduce hernia recurrences and seroma formation in cancer patients undergoing ventral incisional hernia repairs with retro rectus mesh. The high probability of reducing the odds of hernia recurrence with fibrin glue fixation warrants a prospective randomized, multi-institutional clinical trial.
Highlights
Incisional ventral hernias are a common complication of the approximately 2 million laparotomies performed in the United States each year, occurring in 2% to 10% of patients [1]
International Journal of Clinical Oncology and Cancer Research 2021; 6(1): 42-48 associated with seroma and intestinal fistula formation, chronic pain, infection, and intestinal obstruction. [4, 5] incisional hernia repair using the Rives-Stoppa technique, in which mesh is placed in the retro rectus space, has been shown to reduce the incidence of mesh-related complications [6]
After receiving approval from The University of Texas MD Anderson Cancer Center’s Institutional Review Board, we retrospectively identified all patients who had undergone ventral incisional hernia repairs using the Rives-Stoppa technique, in which polypropylene mesh was placed in a retromuscular position, between August 2016 and August 2018
Summary
Incisional ventral hernias are a common complication of the approximately 2 million laparotomies performed in the United States each year, occurring in 2% to 10% of patients [1]. The aim of our study was to compare the rates of hernia recurrence and seroma formation requiring intervention in cancer patients who underwent open Rives-Stoppa incisional hernia repair using transfascial sutures vs fibrin glue for mesh fixation. Rives-Stoppa retrorectus hernia repair technique is becoming the standard of care for mesh repair of complex incisional hernias In these hernia repairs, mesh has traditionally been fixated with transfascial sutures, but fibrin glue has been used as an alternative to reduce pain and may reduce operative time and the risk of seroma formation. The primary objective of this study was to compare the rates of hernia recurrence and seroma formation in cancer patients who underwent Rives-Stoppa incisional hernia repair using transfascial sutures vs fibrin glue for mesh fixation. Conclusion: Using fibrin glue instead of transfascial sutures may reduce hernia recurrences and seroma formation in cancer patients undergoing ventral incisional hernia repairs with retro rectus mesh. The high probability of reducing the odds of hernia recurrence with fibrin glue fixation warrants a prospective randomized, multi-institutional clinical trial
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