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Abstract
PurposeRepair of giant incisional hernia often requires complex surgery and the results of conventional methods using synthetic mesh as reinforcement are unsatisfactory, with high recurrence and complication rates. Our hypothesis was that full-thickness skin graft (FTSG) provides an alternative reinforcement material for giant incisional hernia repair and that outcome is improved. The aim of this study was to compare FTSG with conventional materials currently used as reinforcement in the repair of giant incisional hernia.MethodsA prospective randomised controlled trial was conducted, comparing FTSG with synthetic mesh as reinforcement in the repair of giant (> 10 cm minimum width) incisional hernia. One-year follow-up included a blinded clinical examination by a surgeon and objective measurements of abdominal muscle strength using the Biodex-4 system.Results52 patients were enrolled in the study: 24 received FTSG and 28 synthetic mesh. Four recurrences (7.7%) were found at 1-year follow-up, two in each group. There were no significant differences regarding pain, patient satisfaction or aesthetic outcome between the groups. Strength in the abdominal wall was not generally improved in the study population and there was no significant difference between the groups.ConclusionThe outcome of repair of giant incisional hernia using FTSG as reinforcement is comparable with repair using synthetic mesh. This suggests that FTSG may have a future place in giant incisional hernia repair.
Highlights
Incisional hernia is a common complication of abdominal surgery, often causing considerable suffering for the patient [1]
A 3-month follow-up with early surgical complication as the primary outcome has recently been reported [20]. In this 1-year follow-up of the same patient cohort, we investigated the following outcomes: hernia recurrence, pain, abdominal wall discomfort, experienced improvement, and abdominal wall muscle strength measured by the Biodex system
The results in this study indicate that there is little difference between using conventional synthetic mesh and full-thickness skin graft (FTSG) in the repair of giant incisional hernia
Summary
Incisional hernia is a common complication of abdominal surgery, often causing considerable suffering for the patient [1]. Repair using synthetic mesh material for reinforcement, as used for less complex hernia repairs with low recurrence rates, is unsatisfactory in giant incisional hernia repair where recurrence rates can exceed 30% and complications are more common and more serious [2, 5, 7,8,9]. Hernia (2019) 23:355–361 lower recurrence rates, better comfort and fewer side effects is highly desirable. Due to their extremely high cost, currently available biological prosthetic materials are mainly used as a last resort in cases such as repair in a contaminated surgical field, and results regarding recurrence have not lived up to expectations [11]
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