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: 4.93). 08/2010; 145(8):739-44. DOI: 10.1001/archsurg.2010.144
Source: PubMed


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.

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Available from: Paolo Negro, Nov 17, 2014
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    • "The advantage of this “two-step” procedure is the avoidance of a third general anesthesia (including possible peri- and postoperative complications), but of course, the combination of elective colorectal surgery and mesh implantation brings the risk of foreign material contamination with colonic bacteria. Whereas some authors found that concomitant mesh repair and colorectal surgery showed reasonable outcomes in most patients [12,13], others stated a clearly increased risk of infectious and noninfectious complications [14] and requested a critical case-by-case patient selection for simultaneous surgery. According to the decision model for biologics by the Italian Biological Prosthesis Work-Group (IBPWG), a high resistance to mechanical stress and to protease enzyme action favors the use of cross-linked biological prostheses in circumstances of high infection probability and/or large tissue defects [15]. "
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