Cost of ventral hernia repair using biologic or synthetic mesh

Totten, Crystal; Davenport, Daniel L.; Ward, Nicholas; Roth, J. Scott

doi:10.1016/j.jss.2016.02.040

Cited by 34 publications

(25 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Medium-sized ventral hernias pose a risk of small bowel incarceration, strangulation, and obstruction with potential proximal anastomotic or staple line leaks in patients with recent bariatric surgery 4,5. The available options for hernia management in medium-sized defects present either a substantial risk of bacterial contamination (prosthetic mesh)8 or have a prohibitive cost and significant recurrence rate (biologic mesh) 9…”

Section: Discussionmentioning

confidence: 99%

“…Medium-sized hernia defects that cannot be repaired primarily or deferred are usually considered for bridging mesh repair. The use of synthetic mesh is fraught with infection in clean-contaminated bariatric operations, while the biologic mesh is known to be expensive and temporary 8,9. Therefore, we explored an alternative to the use of mesh in this population and presented our experience with a novel approach of utilizing an omental plug for ventral hernia management during MBS.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Omental Plug: A Novel Management Approach of Concomitant Ventral Hernias During Bariatric Surgery

Portela

Mehta

Vahibe

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

View full text Add to dashboard Cite

Background: Severe obesity leads to a higher incidence of ventral hernias, thus complicating up to 8% of bariatric procedures. The optimal management of these hernias continues to be a controversial topic. We present our novel approach of utilizing an omental plug for concomitant ventral hernia management during metabolic surgery. Methods: To prevent early bowel incarceration and obstruction during bariatric surgery, we sutured the omentum circumferentially to the edges of the hernia defect and to the hernia sac itself with absorbable suture. Results: Four patients were managed with this novel omental plug technique. All patients were female. The mean age was 53 years (range 39 to 68 y), the mean body-mass index was 54.75 kg/m2 (range 49 to 59 kg/m2), and the mean follow-up was 4.6 months (range 1.5 to 6.5 mo). There were no hernia-related complications through the follow-up period. Conclusion: The omental plug technique is a feasible, inexpensive, and safe alternative for ventral hernias with the potential prevention of bowel incarceration during bariatric surgery. This approach allows deferring the definitive hernia repair for a later stage.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Omental Plug: A Novel Management Approach of Concomitant Ventral Hernias During Bariatric Surgery

Portela

Mehta

Vahibe

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

View full text Add to dashboard Cite

show abstract

“…Second, implementation and use of biological mesh in clinical practice depend on the cost, as biological meshes can be up to ten times more expensive than synthetic ones . Totten et al . demonstrated that use of biological mesh for hernia repair can cost $21 000 (€17 100; exchange rate 20 April 2018) in comparison with synthetic mesh, which costs $7100 (€5780) for minimal improvement in surgical outcomes such as SSI.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of the stage of innovation of biological mesh for complex or contaminated abdominal wall closure

et al. 2018

View full text Add to dashboard Cite

BackgroundAchieving stable closure of complex or contaminated abdominal wall incisions remains challenging. This study aimed to characterize the stage of innovation for biological mesh devices used during complex abdominal wall reconstruction and to evaluate the quality of current evidence.MethodsA systematic review was performed of published and ongoing studies between January 2000 and September 2017. Eligible studies were those where a biological mesh was used to support fascial closure, either prophylactically after midline laparotomy, or for reinforcement after repair of incisional hernia with midline incision. The primary outcome measure was the IDEAL framework stage of innovation. The key secondary outcome measure was the GRADE criteria for study quality.ResultsThirty‐five studies including 2681 patients were included. Four studies considered mesh prophylaxis, 23 considered hernia repair, and eight reported on both. There was one published randomized trial (IDEAL stage 3), none of which was of high quality; the others were non‐randomized studies (IDEAL stage 2a). A detailed description of surgical technique was provided in most studies (27 of 35); however, no study reported outcomes according to the European Hernia Society consensus statement and only two described quality control of surgical technique during the study. From 21 ongoing randomized trials and observational studies, 11 considered repair of incisional hernia and 10 considered prophylaxis (seven in elective settings).ConclusionThe evidence base for biological mesh is limited, and better reporting and quality control of surgical techniques are needed. Although results of ongoing trials over the next decade will improve the evidence base, further study is required in the emergency and contaminated settings.

show abstract

“…Theoretically, such products would harness naturally occurring growth factors and regenerative peptides to enhance tissue integration following IH repair (Costa et al, 2019). However, much research has demonstrated poor mechanical strength and cost effectiveness of biologic mesh products (Fang et al, 2015;Fischer et al, 2014;Sandvall et al, 2016;Schneeberger et al, 2019;Totten et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Platelet rich plasma concentration improves biologic mesh incorporation and decreases multinucleated giant cells in a dose dependent fashion

Araujo-Gutierrez

Eps

Scherba

et al. 2021

J Tissue Eng Regen Med

View full text Add to dashboard Cite

Platelet rich plasma (PRP) has been shown to improve incorporation and reduce inflammation in ventral hernia repair (VHR) with acellular dermal matrix (ADM). The concentration of platelets in PRP varies in clinical studies and an ideal concentration has yet to be defined. The effects of varied concentrations of PRP on ADM incorporation and inflammatory cell infiltration in a rat model of VHR. We hypothesized that increasing concentration of PRP would lead to improved incorporation, decreased CD8+ and multinucleated giant cell (MNGC) infiltrate. Lewis rats underwent ventral hernia creation and repair 30 days later with porcine noncrosslinked ADM. PRP was applied to the mesh prior to skin closure at concentrations of 1 � 10 4 plt/μL (PRP-LOW), 1 � 10 6 plt/μL (PRP-MID), or 1 � 10 7 plt/μL (PRP-HIGH) and tissue harvested at 2 and 4 weeks. Cellularization, tissue deposition, and mesh thickness using hematoxylin and eosin and Masson's trichrome, and neovascularization was assessed with VVG staining, to establish the relationship of PRP concentration to metrics of incorporation. MNGC and CD8+ T-cell infiltration were quantified to establish the relationship of inflammatory cell infiltration in response to PRP concentration. Lymphocyte infiltration was assessed using immunohistochemical staining for CD8. PRP-HIGH treated had significantly greater tissue deposition at 4 weeks. PRP-MID showed increasing mesh thickness at 2 weeks.Cell infiltration was significantly higher with PRP-HIGH at both 2 and 4 weeks while PRP-LOW showed increased cell infiltration only at 4 weeks. At both time points there was a trend towards a dose dependent response in cell infiltration to PRP concentration. Neovascularization was highest with MID-plt at 2 weeks, yet no significant differences were noted compared to controls. CD8+ cell infiltrate was significantly decreased at 2 and 4 weeks in PRP-LOW and PRP-MID treated groups.PRP at all concentrations significantly decreased MNGC infiltration at 2 weeks while only PRP-HIGH and PRP-MID had significant reductions in MNGC at 4 weeks.Both MNGC and CD8+ cell infiltration demonstrated dose dependent reduction in relation to PRP concentration. Increasing platelet concentrations of PRP correlated with improved incorporation, tissue deposition, and decreased scaffold degradation.

show abstract

Cost of ventral hernia repair using biologic or synthetic mesh

Cited by 34 publications

References 18 publications

The Omental Plug: A Novel Management Approach of Concomitant Ventral Hernias During Bariatric Surgery

The Omental Plug: A Novel Management Approach of Concomitant Ventral Hernias During Bariatric Surgery

Systematic review of the stage of innovation of biological mesh for complex or contaminated abdominal wall closure

Platelet rich plasma concentration improves biologic mesh incorporation and decreases multinucleated giant cells in a dose dependent fashion

Contact Info

Product

Resources

About