Impact of mesh use on morbidity following ventral hernia repair with a simultaneous bowel resection

Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
Archives of surgery (Chicago, Ill.: 1960) (Impact Factor: 4.3). 08/2010; 145(8):739-44. DOI: 10.1001/archsurg.2010.144
Source: PubMed

ABSTRACT To evaluate the impact of mesh use on outcomes following ventral hernia repairs and simultaneous bowel resection.
Retrospective review.
Teaching academic hospital.
We studied 177 patients who underwent a ventral hernia repair with a bowel resection between May 1, 1992, and May 30, 2007. A prosthesis was used in 51 repairs (mesh group), while 126 repairs were primary (mesh-free group).
Demographic characteristics, comorbidities, mesh type, bowel resection type (colon vs small bowel), defect size, drain use, and length of hospital stay were compared between groups with Fisher exact test and multivariate analysis.
There were no statistically significant differences between patient characteristics and relevant comorbidities. The incidence of postoperative infection (superficial or deep) was 22% in the mesh group vs 5% in the mesh-free group (P = .001). Other complications (fistula, seroma, hematoma, bowel obstruction) occurred in 24% of patients in the mesh group vs 8% of patients in the mesh-free group (P = .009). Focusing on the patients who developed an infection, prosthetic mesh use was the only significant risk factor on multivariate regression analysis, irrespective of drain use, defect size, and type of bowel resection.
We recommend caution in using mesh when performing a ventral hernia repair with a simultaneous bowel resection because of significantly increased postoperative infectious complications. Drain use, defect size, and bowel resection type did not influence outcomes.

Download full-text


Available from: Paolo Negro, Nov 17, 2014
1 Follower
  • [Show abstract] [Hide abstract]
    ABSTRACT: To analyze and compare postoperative occurrences following ventral hernia repairs (VHRs) using mesh in clean-contaminated and contaminated wounds. Ventral hernia repairs using mesh is one of the most common surgical procedures performed. However, guidelines and outcomes of repairs in clean-contaminated or grossly contaminated ventral hernias have not been established. Patients who underwent VHR with mesh between the dates January 1, 2005 and April 4, 2010 at all hospitals in the United States participating in the National Surgical Quality Improvement Program (NSQIP) were reviewed. Data from 33,832 patients were analyzed by field contamination level and then compared with data from patients who underwent VHR without mesh. Data were analyzed using the odds ratio test with a 95% confidence interval. The odds of having one or more postoperative occurrences were significantly greater in clean-contaminated and contaminated cases using mesh when compared with clean cases, with odds ratios of 3.56 (3.25-3.89) and 5.05 (1.78-12.41), respectively. There was a significantly increased risk of superficial surgical site infections (SSI) (2.53), deep SSI (3.09) and organ/space SSI (6.16), wound disruption (4.41), pneumonia (4.43), and sepsis (4.90) for clean-contaminated cases. Both clean-contaminated and contaminated cases had an increased risk of septic shock (5.82 and 26.74, respectively), and need for ventilator for more than 48 hours (5.59 and 26.76, respectively). In addition, there was a significantly increased odds ratio of complications in patients who underwent VHR with mesh (3.56) to nonmesh (2.52) in clean-contaminated cases. There is a significant increase in risk of postoperative occurrences following VHRs using mesh in clean-contaminated and contaminated cases relative to clean cases. We recommend avoiding the use of mesh in any level of contamination.
    Annals of surgery 06/2011; 255(1):176-80. DOI:10.1097/SLA.0b013e31822518e6 · 7.19 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The biologic materials currently available for hernia repairs are costly and there are limited statistics on recurrences and rates of infection in connection with their use in complex cases. We performed a retrospective review and comparison of two types of biologic mesh used at our institution for abdominal hernia repairs spanning a 1-year period. Demographic data and outcomes relating to surgical site infections, hernia recurrences, and mortality were analyzed. Of the 35 patients in the study, 23 patients (Group I) were managed with SurgiMend, a neonatal bovine mesh, and 12 patients (Group II) were managed with Flex HD, a human-derived mesh. The study cohorts met criteria for high-risk stratification based on body mass index, comorbid conditions, and a high prevalence of contaminated wounds. The overall surgical site infection rate was 17 % for Group I and 50 % for Group II. These differences reached statistical significance when comparing superficial infections but not for deep infections with mesh involvement. Hernia recurrences in Group I were 5 % compared to 33 % in Group II. No deaths were observed. These preliminary data demonstrate promising short-term outcomes for high-risk complex hernias repaired with biologic mesh, particularly SurgiMend, but the long-term durability of these biological materials is yet to be determined.
    World Journal of Surgery 03/2012; 36(8):1760-4. DOI:10.1007/s00268-012-1576-2 · 2.35 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Reconstruction of abdominal wall defects is a challenging problem. Often, the surgeon is presented with a patient having multiple comorbidities, who has already endured numerous unsuccessful operations, leaving skin and fascia that are attenuated and unreliable. Our study investigated preoperative, intraoperative, and postoperative factors and techniques during abdominal wall reconstruction to determine which variables were associated with poor outcomes. Data were collected on all patients who underwent ventral abdominal hernia repair by 3 senior-level surgeons at our institution during an 8-year period. In all cases, placement of either a synthetic or a biologic mesh was used to provide additional reinforcement of the repair. A total of 106 patients were included. Seventy-nine patients (75%) had preoperative comorbid conditions. Sixty-seven patients developed a postoperative complication (63%). Skin necrosis was the most common complication (n = 21, 19.8%). Other complications included seroma (n = 19, 17.9%), cellulitis (n = 19, 17.9%), abscess (n = 14 13.2%), pulmonary embolus/deep vein thrombosis (n = 3, 2.8%), small bowel obstruction (n = 2, 1.9%), and fistula (n = 8, 7.5%). Factors that significantly contributed to postoperative complications (P < 0.05) included obesity, diabetes, hypertension, fistula at the time of the operation, a history of >2 prior hernia repairs, a history of >3 prior abdominal operations, hospital stay for >14 days, defect size > 300 square cm, and the use of human-derived mesh allograft. Factors that significantly increased the likelihood of a hernia recurrence (P < 0.05) included a history of >2 prior hernia repairs, the use of human-derived allograft, using an overlay-only mesh placement, and the presence of a postoperative complication, particularly infection. Hernia recurrences were significantly reduced (P < 0.05) by using a "sandwich" repair with both a mesh overlay and underlay and by using component separation. A history of multiple abdominal operations is a major predictor of complications and recurrences. If needed, component separation should be used to achieve primary tension-free closure, which helps to reduce the likelihood of hernia recurrences. Our data suggest that mesh reinforcement used concomitantly in a "sandwich" repair with component separation release may lead to reduced recurrence rates and may provide the optimal repair in complex hernia defects.
    Annals of plastic surgery 04/2012; 68(4):382-8. DOI:10.1097/SAP.0b013e31823b68b1 · 1.46 Impact Factor
Show more