Outcomes of Retromuscular Approach for Abdominal Wall Reconstruction in Patients with Inflammatory Bowel Disease

Abstract

Ventral hernia repair (VHR) in patients with inflammatory bowel disease (IBD) presents unique surgical challenges including impaired wound healing, concomitant intestinal operations, along with likely future abdominal surgeries. Appropriate techniques and mesh choices in these patients remain under active debate. Herein we report our experience with using a retromuscular approach for major VHR in a consecutive cohort of IBD patients. We identified all patients with IBD undergoing open VHR with retrorectus mesh placement between 2007 and 2013 in our prospectively maintained database. Main outcomes included patient and hernia characteristics, perioperative details, wound complications, and hernia recurrence. A total of 38 patients with IBD met inclusion criteria. Mean hernia defect size was 338 cm2. Synthetic mesh was used in 16 patients and biologic mesh was used in 22 of patients. A surgical site occurrence (SSO) occurred in 13 (34.2%) patients, 7 (18.4%) of which were surgical site infections (SSIs). There were no instances of postoperative intestinal complications or enterocutaneous fistulae. At the mean follow-up 37 months, there were 3 (9.4%) recurrences. Our retromuscular repairs were associated with a low rate of wound morbidity and no intestinal complications. Furthermore, we report a relatively low rate of recurrences, especially in this series of complex multiply recurrent hernias. Overall, our retromuscular approach seems to be safe and effective in hernia patients with IBD.

Incisional hernia repair by synthetic mesh prosthesis in patients with inflammatory bowel disease: a comparative analysis

“…An often-described therapy option in potential contaminated situations is the implantation of a biological mesh [ 15 – 17 ]. A study by Wang et al compared the outcome of OVHR with synthetic and biological mesh in 38 IBD-patients and found a significantly inferior short term outcome in the biological mesh group [ 2 ], which contradicts the perception concerning the superiority of the use of biologic mesh [ 18 – 20 ]. We share the opinion that the implantation of a synthetic mesh is possible with acceptable complication rates even in complex, potentially contaminated cases like IBD patients, which is in line with the results of Carbonell et al, who demonstrated favorable complication and recurrence rates associated with the use of synthetic mesh in contaminated situation [ 21 ].…”

“…Incisional hernias (IH) are a common complication after abdominal surgery with an incidence of up to 20% [ 1 ]. A history of multiple laparotomies, immunosuppressive therapy or any degree of malnutrition are known risk factors for the development of IH over time [ 2 , 3 ]. Therefore, patients with inflammatory bowel disease (IBD) are at high risk for the development of IH as these individuals usually display a variety of risk factors.…”

“…While a variety of studies have already examined the efficacy of this technique, there are only a few studies focusing on IBD patients with heterogeneous patient cohorts over long periods of time [ 5 , 6 ]. Furthermore, various techniques with partly biological and partly synthetic mesh implants have also been included in some of the studies [ 2 ]. This limited data within in the literature allows only a limited analysis of the long-term outcome after IH repair in IBD patients.…”

Open Retromuscular Repair of Parastomal Hernias with Synthetic Mesh

“…It also creates a protected space for mesh placement in a well-vascularized compartment, separated from the peritoneal cavity. 10,12,13 The addition of a TAR to open retromuscular PH repair is often necessary to allow adequate mesh overlap lateral to the stoma, beyond the confines of the rectus sheath. Raigani et al 4 reported their experience with open retromuscular PH repair with a biologic or absorbable synthetic mesh.…”

“…This is an inherent disadvantage with the keyhole PH repair. Performing a retromuscular, modified Sugarbaker repair, as described by Pauli, 13 allows the use of a flat sheet of mesh and avoids the weakness imposed by cutting a slit or hole in the mesh. Two patients in our series were repaired in this manner, with no complications or recurrence to date.…”