Hernia recurrence and infection rate in elective complex abdominal wall repair using biologic mesh

Abstract

BackgroundElective complex ventral hernia repairs, done using synthetic mesh in patients with comorbidities, can result in mesh related complications such as hernia recurrence or infection. We studied hernia recurrence and surgical site occurrences after elective complex repairs in predominately clean cases using biologic mesh and examined the impact of several comorbidities.MethodsA retrospective chart review was completed on patients who underwent elective repair with biologic mesh in clean/clean-contaminated settings between 2012 and 2015 with a minimum of 1-year follow-up. Multiple comorbid conditions, including diabetes, chronic obstructive pulmonary disease, steroid use, smoking history and previous hernia repairs were identified. Post-operative complications including recurrence and infections were ruled out by computed tomography, clinical exam, and/or by telephone survey.Results40 patients were identified. 85% (n = 34) had class 1 wounds. 25% (n = 10) experienced a hernia recurrence. 10% (n = 4) of patients developed postoperative infection, none required mesh explantation or re-operation. No statistically significant association was found between the comorbidities assessed and recurrence/infection rates.ConclusionsWe present the first study analyzing clinical outcomes of complex ventral hernia repairs using biologic mesh in predominately clean settings. This study being non-comparative limits definitive conclusions, but our aim is to add to the growing literature on biologic mesh to help future researchers performing comparative trials of synthetic versus biologic meshes.

Risks and Prevention of Surgical Site Infection After Hernia Mesh Repair and the Predictive Utility of ACS-NSQIP

“…9,11 The use of absorbable synthetic (polyglactin 910, (Vicryl: Ethicon Inc., Somerville, NJ)) or biological (acellular dermal matrix collagen) mesh in clean or contaminated wounds may be associated with less infection risk but higher rates of recurrent hernia. 35 Risk of hernia recurrence is increased in bridging VHR where no fascial closure or component separation is used, and a chimney effect of mesh eventration may be created in the fascial defect. 15,36 The choice of permanent synthetic mesh over biologic or biosynthetic mesh in a contaminated/dirty wound, or as a replacement mesh in an infected hernia wound is controversial.…”

An incisional hernia containing a gangrenous gallbladder: a case report and review of the literature

“…The decision to forgo repair of the ventral incisional hernia at the time of index operation was discussed in depth amongst our colleagues perioperatively. Permanent mesh placement is associated with the lowest rates of hernia recurrence; however, the risk of mesh infection leading to increased postoperative morbidity and subsequent operations when placed in a contaminated field is significant [ 6 ]. Complications including hernia recurrence and the need for mesh explant are both increased when permanent mesh is used for hernia repair during the same operation as a concomitant procedure at the same site [ 7 ].…”

The Use of Autologous Fenestrated Cutis Grafts in Hernia Repair

“…These results are comparable to postoperative complications of HR reported in the literature to date using biologic and synthetic mesh: 2.7%-25% for SSI, 2.7%-12.5% for seroma, and 0%-25% for hernia recurrence. [17][18][19][20][21][22][23][24][25] Almost 1 million ventral and inguinal HR operations are performed annually in the United States, costing up to 10 billion USD per year 1 Currently, there are many different brands of synthetic and biologic meshes on the market in the United States. The plethora of implant options emphasizes that the ideal prosthesis has yet to arrive for HR.…”