Component separation and large incisional hernia: predictive factors of recurrence

Bueno-Lledó, José; Bonafé-Diana, S; Carbonell-Tatay, Fernando; Torregrosa-Gallud, Antonio; Pous‐Serrano, Salvador

doi:10.1007/s10029-021-02489-3

Cited by 14 publications

(6 citation statements)

References 32 publications

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“…This was achieved despite the complexity of the patient population and the large average defect size. Furthermore, despite high contamination levels and the presence of several risk factors for postoperative complications, we found a relatively low SSO rate of 24.8% compared to other SSO rates reported in the literature for contaminated cases with biologic mesh [9,15,21,22]. Only one patient (0.9%) in our study required mesh removal, and no mesh infection occurred, highlighting the protective ability of biologic mesh against infection and biofilm formation, most likely mediated by the ability to undergo rapid cellular infiltration and neovascularization [23][24][25].…”

Section: Discussioncontrasting

confidence: 50%

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Outcomes of Complex Abdominal Wall Reconstruction with Biologic Mesh in Patients with 8 Years of Follow‐Up

Hassan,

Franco,

Shah

et al. 2023

World j. surg.

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Background While many studies evaluated outcomes of abdominal wall reconstruction with biologic mesh, longterm data is lacking. In this study, we sought to analyze the outcomes of complex AWR with biologic mesh in a robust cohort of patients with a mean follow up of 8 years. Methods We conducted a longitudinal study of AWR patients from 2005 to 2019. Hernia recurrence was the primary outcome, and surgical site occurrence was the secondary outcome. Predictive/protective factors were identified using a Cox proportional hazards regression models. Results We identified 109 consecutive patients who met the inclusion criteria. Patient's mean (± SD) age was 57.5 ± 11.8 years, mean body mass index was 30.7 ± 7.2 kg/m 2 , and mean follow-up time was 96.2 ± 15.9 months. Fifty-six percent had clean defects, 34% had clean-contaminated defects, and 10% had contaminated/infected defects. Patients had a mean defect size of 261 ± 199.6 cm 2 and mean mesh size of 391.3 ± 160.2 cm 2 . Nineteen patients (17.4%) developed HR at the final follow-up date. Obesity was independently associated with a four-fold higher risk of HR (hazard ratio, 3.98; 95%CI, 1.34 to 14.60, p = 0.02). SSOs were identified in 24.8% of patients. A prior hernia repair was associated with a three-fold higher risk of SSOs (Odds ratio, 3.13; 95%CI, 1.10 to 8.94, p = 0.03). No patient developed mesh infection. Conclusion These longitudinal data demonstrate that complex AWR with biologic mesh provides long-term durable outcomes with acceptable HR and SSO rates despite high contamination levels, patients complexity, and large defect size.

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Section: Discussioncontrasting

confidence: 50%

“…While biologic mesh has advantages, some inherent patient dependent factors cannot be overcome. Obesity, is a well‐described risk factor for hernia recurrence in all comers undergoing AWR with synthetic mesh [21, 33, 34]. This appears to be true for biologic mesh as well, evidenced by the near fourfold higher risk of HR.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Complex Abdominal Wall Reconstruction with Biologic Mesh in Patients with 8 Years of Follow‐Up

Hassan,

Franco,

Shah

et al. 2023

World j. surg.

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“…With regard to immunosuppression, literature analyzing its effect on hernia recurrence is sparse and mixed. Retrospective studies have described immunosuppressants as associated with hernia recurrence, whereas a recent meta-analysis found no association. We found that immunosuppressants were associated with increased hernia recurrence in patients with mesh.…”

Section: Discussionmentioning

confidence: 97%

“…We found that immunosuppressants were associated with increased hernia recurrence in patients with mesh. Immunosuppressive agents reduce the body’s immune response, which may facilitate biofilm formation in patients with mesh, thus potentially weakening the mesh and predisposing to recurrence . We hypothesize that smoking may act as an indirect risk factor of hernia recurrence by predisposing patients to SSI, while immunosuppression may act as a direct risk factor.…”

Section: Discussionmentioning

confidence: 99%

Year-Over-Year Ventral Hernia Recurrence Rates and Risk Factors

Bhardwaj,

Huayllani,

Olson

et al. 2024

JAMA Surg

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ImportanceRecurrence is one of the most challenging adverse events after ventral hernia repair as it impacts quality of life, utilization of resources, and subsequent need for re-repair. Rates of recurrence range from 30% to 80% after ventral hernia repair.ObjectiveTo determine the contemporary ventral hernia recurrence rate over time in patients with previous hernia repair and to determine risk factors associated with recurrence.Design, Setting, and ParticipantsThis retrospective, population-based study used the Abdominal Core Health Quality Collaborative registry to evaluate year-over-year recurrence rates in patients with prior ventral hernia repair between January 2012 and August 2022. Patients who underwent at least 1 prior ventral hernia repair were included and categorized into 2 groups based on mesh or no-mesh use. There were 43 960 eligible patients; after exclusion criteria (patients with concurrent inguinal hernias as the primary diagnosis, nonstandard hernia procedure categories, American Society of Anesthesiologists class unassigned, or no follow-up), 29 834 patients were analyzed in the mesh group and 5599 in the no-mesh group.Main Outcomes and MeasuresVentral hernia recurrence rates. Risk factors analyzed include age, body mass index, sex, race, insurance type, medical comorbidities, American Society of Anesthesiologists class, smoking, indication for surgery, concomitant procedure, hernia procedure type, myofascial release, fascial closure, fixation type, number of prior repairs, hernia width, hernia length, mesh width, mesh length, operative approach, prior mesh placement, prior mesh infection, mesh location, mesh type, postoperative surgical site occurrence, postoperative surgical site infection, postoperative seroma, use of drains, and reoperation.ResultsAmong 29 834 patients with mesh, the mean (SD) age was 57.17 (13.36) years, and 14 331 participants (48.0%) were female. Among 5599 patients without mesh, the mean (SD) age was 51.9 (15.31) years, and 2458 participants (43.9%) were female. When comparing year-over-year hernia recurrence rates in patients with and without prior mesh repair, respectively, the Kaplan Meier analysis showed a recurrence rate of 201 cumulative events with 13 872 at risk (2.8%) vs 104 cumulative events with 1707 at risk (4.0%) at 6 months; 411 cumulative events with 4732 at risk (8.0%) vs 184 cumulative events with 427 at risk (32.6%) at 1 year; 640 cumulative events with 1518 at risk (19.7%) vs 243 cumulative events with 146 at risk (52.4%) at 2 years; 731 cumulative events with 670 at risk (29.3%) vs 258 cumulative events with 73 at risk (61.4%) at 3 years; 777 cumulative events with 337 at risk (38.5%) vs 267 cumulative events with 29 at risk (71.2%) at 4 years; and 798 cumulative events with 171 at risk (44.9%) vs 269 cumulative events with 19 at risk (73.7%) at 5 years. Higher body mass index; immunosuppressants; incisional and parastomal hernias; a robotic approach; greater hernia width; use of a biologic or resorbable synthetic mesh; and complications, such as surgical site infections and reoperation, were associated with higher odds of hernia recurrence. Conversely, greater mesh width, myofascial release, and fascial closure had lower odds of recurrence. Hernia type was the most important variable associated with recurrence.Conclusions and RelevanceIn this study, the 5-year recurrence rate after ventral hernia repair was greater than 40% and 70% in patients with and without mesh, respectively. Rates of ventral hernia recurrence increased over time, underscoring the importance of close, long-term follow up in this population.

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“…The exact global incidence of incisional hernias is uncertain, with 2–20% of all laparotomies developing incisional hernias, especially midline laparotomies 1 , 2 . The recurrence of these hernias in cases of complex repair ranges between 20–30%, with a 30% recurrence after a second repair in cases of a new recurrence 3 . These numbers are increasing due to the increasing number of patients undergoing laparotomies and major surgeries, older patients with connective tissue problems, and patients operated on with risk factors for hernia formation, such as obesity and diabetes 4 , 5 .…”

Section: Introductionmentioning

confidence: 99%

Experimental evaluation of the use of starch and carboxymethylcellulose in the prevention of intraperitoneal adhesions in hernia surgery with coated meshes

Santos Filho,

Hirano

2023

Acta Cir. Bras.

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Purpose: Laparoscopic hernia repair involves a risk of adhesion between coated mesh and viscera. Plant polysaccharides such as starch and carboxymethylcellulose (SC) make up a product that acts as a barrier and prevents intraperitoneal adhesions. This study aimed to evaluate whether topical SC can also reduce adhesions between mesh and intra-abdominal organs. Methods: Forty rats each received placement of two intraperitoneal mesh fragments, one on each side of the abdominal wall. Randomly, 20 animals received SC on the right and other 20 on the left, leaving the contralateral side as a control. Fourteen days after the surgery, the animals underwent an additional laparotomy in which macroscopic analysis was performed. Results: As for the percentage of the mesh area affected by adhesion, one (2.6%) animal had > 75% adhesion on the experimental side, and 11 animals (28.9%) on the control side. The adhesion intensity score showed firm adhesions in three (7.9%) animals on the experimental side and nine (23.7%) on the control side. Conclusion: The use of SC decreased the intensity of adhesions and the surface area of the mesh affected by adhesions. There was no negative interference of the product in the incorporation of the mesh into the abdominal wall.

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Component separation and large incisional hernia: predictive factors of recurrence

Cited by 14 publications

References 32 publications

Outcomes of Complex Abdominal Wall Reconstruction with Biologic Mesh in Patients with 8 Years of Follow‐Up

Outcomes of Complex Abdominal Wall Reconstruction with Biologic Mesh in Patients with 8 Years of Follow‐Up

Year-Over-Year Ventral Hernia Recurrence Rates and Risk Factors

Experimental evaluation of the use of starch and carboxymethylcellulose in the prevention of intraperitoneal adhesions in hernia surgery with coated meshes

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