Abstract
ObjectiveTo assess clinical outcomes in patients that underwent open single-stage complex abdominal wall reconstruction (CAWR) with biosynthetic mesh.MethodsRetrospective observational study of two prospectively registered series of consecutive patients undergoing CAWR with either long-term degradable (LTD) Phasix™ or mid-term degradable (MTD) BIO-A® biosynthetic mesh in a single institution between June 2016 and December 2019.ResultsFrom 169 patients with CAWR, 70 consecutive patients were identified who underwent CAWR with either LTD or MTD biosynthetic mesh. More than 85% of patients had an incisional hernia that could be classified as moderately complex to major complex due to a previous wound infection (67%), one or more complicating comorbidities (87.1%), one or more complicating hernia characteristics (75.7%) or contaminated or dirty defects (37.1%). Concomitant component separation was performed in 43 of 70 patients (61.4%). Overall surgical site infection (SSI) rate in these CAWR patients was 45.7%. Seventeen of 70 patients (24.3%) had computed tomography (CT) - and culture-confirmed SSI in direct contact of mesh, suspicious of mesh infection. Mesh removal for persistent local infection occurred in 10% (7 of 70) after a median of 229 days since surgery. Salvage rate of mesh after direct contact with infection was 58.8%. All removed meshes were in the LTD group. Seven patients (10%) had a recurrence; four patients in the LTD group (10%) had a recurrence at a median follow-up of 35 months and three patients in the MTD group (10%) at a median follow-up of 11 months. Three of the seven recurrences occurred in patients with SSI in persistent and direct contact with mesh.ConclusionsComorbid patients undergoing open complex abdominal wall reconstruction are at high risk of postoperative wound complications regardless of which type of biosynthetic mesh is used. When in persistent and direct contact with infection, long-term biodegradable biosynthetic meshes may need to be removed, whereas mid-term biodegradable biosynthetic meshes can be salvaged.
Highlights
Ventral hernia development is one of the most common complications following laparotomy [1]
Baseline demographic data included age, gender, body mass index (BMI), smoking status, diabetes mellitus (DM), cardiac disease, chronic obstructive pulmonary disease (COPD), use of medication, number of previous abdominal surgeries and abdominal wall reconstructions, presence of stomata, intestinal fistulas and infected mesh, wound classification status according to the Centers for Disease and Control and Prevention [16], preoperative botulinum toxin A (BTA) injections, hernia width, and loss of domain measured as described by Sabbagh et al [17]
All operative procedures were tailored to the patient; all operations were performed in consistence with international guidelines and consensus [24]
Summary
Ventral hernia development is one of the most common complications following laparotomy [1]. Where suture repair is associated with unacceptably high recurrence rates, the use Jeroen J.M. Claessen and Allard S. Timmer shared first authorship as both have contributed to this manuscript. Biologic mesh serves as a temporary scaffold, facilitating revascularization and remodeling of the native abdominal wall [4]. It is proposed that these meshes can withstand or reduce bacterial contamination. Multiple studies investigating the use of biologic mesh in high-risk patients and/or contaminated hernia repair found that most postoperative wound
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