OC-039 PROPHYLACTIC NEGATIVE PRESSURE WOUND THERAPY FOR COMPLEX VENTRAL HERNIA REPAIR, A CASE SERIES

Abstract

Abstract Aims Presenting our 1-month results in 20 patients with prophylactic negative pressure (pNPWT) applied in complex ventral hernia repairs. Material & Methods pNPWT was applied when high surgical site occurrences (SSO) risk factors and when colorectal procedures, huge panniculectomies, active cutaneous/mesh infections or loss of domain are associated. Our results are compared with SSO incidence calculated with HW-RAT score. Results 10 men and 10 women with 67.55 (43–84) year-old. BMI 32.01 kg/m2 (24–55). 55% ASA III, 35% II, 10% I. Most relevant risk factors: 3 stoma closures, 3 loss of domain, 2 paraestomal, 2 peritonitis, 2 W3, 2 multi-recurrences, 1 infected mesh, 1 synchronic colonic fistula. HW-RAT SSO score (1-less risk- to 5 -maximum-): 3 II, 3 III, 12 IV and 2 V. pNPWT was applied to 17 midline wounds, 1 bilateral subcostal, 1 colostomy site and 1 midline+colostomy for 6–10 days (mode 7). 12 patients (60%) had 19 complications, 3 grade IIIB and one IVa. Only 1 patient (5%) had surgical site infection (SSI): 1 infected seroma presenting at 16th postoperative day requiring readmission, drainage, and negative pressure (grade IIIA). Global HW-RAT estimated SSI incidence: 15.76%. Two patients had other causes postoperative peritonitis, none of which affected the wound. At 1 month another 2 seromas (1 grade I, 1 grade III) and one 3cm haematoma appeared. Conclusions pNPWT in high-risk patients is safe and can significantly reduce SSI and SSO (in our series from 15% to 5%). Estimated NNT for preventing 1 SSI in the literature is 9 patients.