Abstract
BackgroundPrimary closure of post-operative facial dehiscence (FD) is associated with a high incidence of recurrence, revisional surgery, and incisional hernia. This retrospective study compares outcomes of implantation of non-absorbable intra-abdominal meshes with primary closure of FD. The outcomes of different mesh materials were assessed in subgroup analysis. MethodsA total of 119 consecutive patients with FD were operated (70 mesh group and 49 no mesh group) between 2001 and 2015. Primary outcome parameter was hernia-free survival. Secondary outcome parameters include re-operations of the abdominal wall, intestinal fistula, surgical site infections (SSI), and mortality. Kaplan-Meier analysis for hernia-free survival, adjusted Poisson regression analysis for re-operations and adjusted regression analysis for chronic SSI was performed. ResultsHernia-free survival was significantly higher in the mesh group compared to the no mesh group (P = 0.005). Fewer re-operations were necessary in the mesh group compared to the no mesh group (adjusted incidence risk ratio 0.44, 95% confidence interval [CI] 0.20–0.93, P = 0.032). No difference in SSI, intestinal fistula, and mortality was observed between groups. Chronic SSI was observed in 7 (10%) patients in the mesh group (n = 3 [6.7%] with polypropylene mesh and 4 [28.6%] with polyester mesh). The risk for chronic SSI was significantly higher if a polyester mesh was used when compared to a polypropylene mesh (adjusted odds ratio 8.69, 95% CI 1.30–58.05, P = 0.026). ConclusionImplantation of a polypropylene but not polyester-based mesh in patients with FD decreases incisional hernia with a low rate of mesh-related morbidity.
Highlights
Fascial dehiscence (FD) is a surgical complication in which the fascia dissociates along the surgical incision and potentially leads to evisceration
Different meshes used in our patient cohorts were in 54 (77.1%) patients a large-pore, mono-filamentous, duallayered polypropylene meshes (PP) mesh [in 50 (71.4%) patients Parietene Composite®, Medtronic, and in 4 (5.7%) patients Dynamesh®, FEG Textiltechnik mbH] and in 16 (22.9%) patients a large-pore, multi-filamentous, duallayered polyester meshes (PE) mesh (Parietex Composite®, Medtronic)
During surgery for facial dehiscence (FD), there was no difference in anastomotic leakage between the two groups
Summary
Fascial dehiscence (FD) is a surgical complication in which the fascia dissociates along the surgical incision and potentially leads to evisceration. Patients after FD are at high risk of re-rupture of the abdominal fascia following primary closure with an incidence of up to 44.4%.4 This recurrence might potentially end in an open abdomen requiring multiple revisional operations. Primary closure of post-operative facial dehiscence (FD) is associated with a high incidence of recurrence, revisional surgery, and incisional hernia. This retrospective study compares outcomes of implantation of non-absorbable intraabdominal meshes with primary closure of FD. The risk for chronic SSI was significantly higher if a polyester mesh was used when compared to a polypropylene mesh (adjusted odds ratio 8.69, 95% CI 1.30–58.05, P = 0.026). Conclusion Implantation of a polypropylene but not polyester-based mesh in patients with FD decreases incisional hernia with a low rate of mesh-related morbidity
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