Outcomes Of Ventral Hernia Repair Research Articles

Biologic mesh in ventral hernia repair: Outcomes, recurrence, and charge analysis

Biologic mesh choice in ventral hernia repair is challenging due to lack of prospective data. This study examines long-term, single-center biologic mesh outcomes. Prospective operative outcomes data was queried for open ventral hernia repair with biologic mesh. Univariate and multivariate analysis were used to compare mesh outcomes. In the study, 223 patients underwent open ventral hernia repair with biologic mesh, including 40 with Alloderm, 23 AlloMax, 70 FlexHD, 68 Strattice, and 22 Xenmatrix. Overall, 9.8% had an American Society of Anesthesiology classification of 4, 54.6% with a classification of 3, and 35.6% with a classification of 1 or 2. Operative time averaged 241minutes with estimated blood loss of 202mL. Hernia defects averaged 257±245cm2 with mesh size 384cm2. Biologic mesh was used as a fascial bridge in 19.6%, component separation was performed in 47.5%, and 82% had concomitant procedure. Inpatient mortality was 1.4%. Hernia recurrence varied significantly by mesh type: 35% Alloderm, 34.5% AlloMax, 37.1% FlexHD, 14.7% Strattice, and 59.1% Xenmatrix (P=.001). The mean follow-up was 18.2months. After multivariate analysis comparing to Strattice, AlloMax had a 3.4 higher odds ratio for recurrence, FlexHD a 2.9 odds ratio, and Xenmatrix a 7.8 odds ratio. The rate of mesh infections requiring explantation was <1%. Total hospital charges averaged $131,004±$143,320. Mean charges varied significantly between meshes; Xenmatrix was the most expensive and AlloMax was the least expensive (P<.05). In 223 ventral hernia repair performed with biologic mesh at a tertiary care institution, Strattice, a porcine acellular dermal mesh, had significantly lower odds of hernia recurrence compared with AlloMax, FlexHD, and Xenmatrix. Choice of biologic mesh affects long-term postoperative outcomes in ventral hernia repair.

A Propensity Matched Analysis of 58,889 Patients Comparing ADM to Synthetic Mesh Surgical Site Outcomes in Ventral Hernia Repair

A Propensity Matched Analysis of 58,889 Patients Comparing ADM to Synthetic Mesh Surgical Site Outcomes in Ventral Hernia Repair

Delayed repair of obstructing ventral hernias is associated with higher mortality and morbidity

BackgroundPatients presenting with ventral hernia-related obstruction are commonly managed with emergent ventral hernia repair (VHR). Selected patients with resolution of obstruction may be managed in a delayed manner. This study sought to assess the effect of delay on VHR outcomes. MethodsThe American College of Surgeons’ National Surgical Quality Improvement Program database from 2005 to 2011 was queried using diagnosis codes for ventral hernia with obstruction. Those who underwent repair over 24 hours after admission were classified as delayed repair. Preoperative comorbid conditions, American Society of Anesthesiology (ASA) scores, and 30-day outcomes were evaluated. ResultsWe identified 16,881 patients with a mean age of 58 ± 15 years and body mass index of 36 ± 10. Delayed repair occurred in 27.7% of the patients. After controlling for comorbidities and ASA score, delayed VHR was independently associated with mortality (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.41 to 2.48, P < .001), morbidity (OR 1.4, 95% CI 1.24 to 1.50, P < .001), surgical site infection (OR 1.2, 95% CI 1.03 to 1.35, P = .016), and concurrent bowel resection (OR 1.2, 95% CI 1.03 to 1.34, P = .016). ConclusionsVHR for obstructed patients is frequently performed over 24 hours after admission. After adjusting for comorbid conditions and ASA score, delayed VHR is independently associated with worse outcomes. Prompt repair after appropriate resuscitation should be the management of choice.

History of methicillin-resistant Staphylococcus aureus (MRSA) surgical site infection may not be a contraindication to ventral hernia repair with synthetic mesh: a preliminary report

A history of methicillin-resistant Staphylococcus aureus (MRSA) surgical site infection presents a significant surgical dilemma as to the risk of subsequent mesh infection, even if no active infection is present. We investigated the outcomes of ventral hernia repair with synthetic mesh in patients with prior MRSA surgical site infections (SSIs). All patients with a clean wound but prior MRSA SSI undergoing open ventral hernia repair with mesh by a single surgeon over a 3-year period were reviewed for the development of any major (need for readmission, operative debridement, or mesh removal) or minor SSI. All patients received peri-operative intravenous vancomycin and prolonged suppressive oral trimethoprim/sulfamethoxazole or doxycycline. Ten patients (male = 7, female = 3) with clean wounds and a history of MRSA SSI underwent open ventral hernia repair with retrorectus synthetic mesh placement. Mean follow-up was 13.5 ± 3.3 months. Overall, two patients (20 %) developed SSIs (minor = 2, major = 0). Both SSIs were successfully managed with therapeutic oral antibiotics and local wound care without need for surgical debridement or mesh removal. There have been no hernia recurrences in any of the patients. Preliminary results suggest that history of MRSA infection may not be a contraindication to the use of synthetic mesh for ventral hernia repair. Macroporous lightweight meshes, combined with use of prolonged suppressive antibiotics and sublay retromuscular mesh placement that provides complete tissue coverage, should be further investigated as an acceptable prosthetic choice when planning a complex ventral hernia repair in the setting of prior MRSA SSI.

Does laparoscopy reduce severe adverse outcomes in ventral hernia repair?

Nelson, Brook V. MD; Tang, Fengming MS; Jones, Philip MS; Spertus, John MD, MPH; Brown, Kimberly MD Author Information

Preoperative risk factors for severe adverse outcomes in ventral hernia repair

Nelson, Brook V. MD; Tang, Fengming MS; Jones, Philip MS; Spertus, John MD, MPH; Brown, Kimberly MD Author Information

Predictors of wound infection in ventral hernia repair

Background Postoperative wound infection is a significant risk factor for recurrence after ventral hernia repair (VHR). The current study examines patient- and procedure-specific variables associated with wound infection. Methods A cohort of subjects undergoing VHR from 13 regional Veterans Health Administration (VHA) sites was identified. Patient-specific risk variables were obtained from National Surgical Quality Improvement Program (NSQIP) data. Operative variables were obtained from physician-abstracted operative notes. Univariate and multivariable logistic regression analysis was used to model predictors of postoperative wound infection. Results A total of 1505 VHR cases were used for analysis; wound infection occurred in 5% ( n = 74). Best-fit logistic regression models demonstrated that steroid use, smoking, prolonged operative time, and use of absorbable mesh, acting as a surrogate marker for a more complex procedure, were significant independent predictors of wound infection. Conclusion Permanent mesh placement was not associated with postoperative wound infection. Smoking was the only modifiable risk factor and preoperative smoking cessation may improve surgical outcomes in VHR.