Strategies for Mesh Fixation in Abdominal Wall Reconstruction: Concepts and Techniques

Rangwani, Shiva; Kraft, Casey T.; Schneeberger, Steven; Khansa, Ibrahim; Janis, Jeffrey E.

doi:10.1097/prs.0000000000007584

Cited by 18 publications

(16 citation statements)

References 55 publications

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“…Second, the sutures are thought to help keep the mesh flat between the layers of the abdominal wall to aid with tissue incorporation. Third, the placement of sutures is promoted to prevent mesh migration in the early postoperative period . Despite these purported advantages of TF suture fixation, we did not observe any clinically significant deleterious effects associated with the abandonment of TF sutures regarding fascial dehiscence or early wound morbidity, despite a median defect size of 15.0 cm.…”

Section: Discussionmentioning

confidence: 99%

“…The transfascial (TF) fixation of mesh with percutaneous sutures in open retromuscular ventral hernia repairs (RVHR) is a common practice and one currently under debate. Open RVHR with mesh was originally described with use of TF sutures for mesh fixation, which were purportedly necessary for keeping the mesh flat to allow ingrowth and to take tension off of the midline fascial closure . These theories led surgeons to believe mesh fixation may play a role in preventing hernia recurrence .…”

Section: Introductionmentioning

confidence: 99%

“…Open RVHR with mesh was originally described with use of TF sutures for mesh fixation, which were purportedly necessary for keeping the mesh flat to allow ingrowth and to take tension off of the midline fascial closure . These theories led surgeons to believe mesh fixation may play a role in preventing hernia recurrence . Despite this, there are some potential downsides to TF suture fixation, including increased time in surgery and greater postoperative pain, and little evidence supports the notion that TF sutures offload midline tension or improve mesh ingrowth .…”

Section: Introductionmentioning

confidence: 99%

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Transfascial Fixation vs No Fixation for Open Retromuscular Ventral Hernia Repairs

et al. 2023

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ImportanceTransfascial (TF) mesh fixation in open retromuscular ventral hernia repair (RVHR) has been advocated to reduce hernia recurrence. However, TF sutures may cause increased pain, and, to date, the purported advantages have never been objectively measured.ObjectiveTo determine whether abandonment of TF mesh fixation would result in a noninferior hernia recurrence rate at 1 year compared with TF mesh fixation in open RVHR.Design, Setting, and ParticipantsIn this prospective, registry-based, double-blinded, noninferiority, parallel-group, randomized clinical trial, a total of 325 patients with a ventral hernia defect width of 20 cm or less with fascial closure were enrolled at a single center from November 29, 2019, to September 24, 2021. Follow-up was completed December 18, 2022.InterventionsEligible patients were randomized to mesh fixation with percutaneous TF sutures or no mesh fixation with sham incisions.Main Outcome and MeasuresThe primary outcome was to determine whether no TF suture fixation was noninferior to TF suture fixation for open RVHR with regard to recurrence at 1 year. A 10% noninferior margin was set. The secondary outcomes were postoperative pain and quality of life.ResultsA total of 325 adults (185 women [56.9%]; median age, 33 [IQR, 50-67] years) with similar baseline characteristics were randomized; 269 patients (82.8%) were followed up at 1 year. Median hernia width was similar in the TF fixation and no fixation groups (15.0 [IQR, 12.0-17.0] cm for both). Hernia recurrence rates at 1 year were similar between the groups (TF fixation, 12 of 162 [7.4%]; no fixation, 15 of 163 [9.2%]; P = .70). Recurrence-adjusted risk difference was found to be −0.02 (95% CI, −0.07 to 0.04). There were no differences in immediate postoperative pain or quality of life.Conclusions and RelevanceThe absence of TF suture fixation was noninferior to TF suture fixation for open RVHR with synthetic mesh. Transfascial fixation for open RVRH can be safely abandoned in this population.Trial RegistrationClinicalTrials.gov Identifier: NCT03938688

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transfascial Fixation vs No Fixation for Open Retromuscular Ventral Hernia Repairs

et al. 2023

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“…Moreover, the large decrease in operating room time and hospital length of stay that was observed with self-adhering mesh use may translate to a more cost-effective option compared to sutured mesh and should be investigated in future studies. 29 Future studies should also focus on quality of life and the presence of chronic pain.…”

Section: Discussionmentioning

confidence: 99%

Abdominal Wall Reconstruction with Retrorectus Self-Adhering Mesh: A Single-Center Long-Term Follow-up

Bashian

Daoud

Khansa

et al. 2022

Plastic &Amp; Reconstructive Surgery

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In patients undergoing laparotomy, as many as 10% develop ventral hernias, and the risk increases with each additional repair. 1 One of the most important goals of hernia repair is achieving reliable and durable reconstruction. However, hernia repairs have 10-year recurrence rates as high as 54%. 2,3 Using mesh to reinforce each reconstruction during repair has been consistently shown to reduce the risk of recurrence by as much as 50%. [4][5][6] In addition, obtaining musculofascial reapproximation has been shown to reduce the risk of hernia recurrence compared to bridged repairs. 7 Therefore, mesh-reinforced primary repair is the standard for ventral hernias. 8,9 Synthetic mesh repair is frequently used for tissue reinforcement to help decrease recurrence rates, and the optimal position for placement is Background: Mesh repair has been demonstrated to be superior to suture alone in ventral hernia repair. In a previous short-term pilot study, the authors found lower postoperative narcotic requirements with self-adhering mesh. The aim of this study was to follow-up on that pilot study, using long-term data. Methods: This is a retrospective review of a prospectively collected database. All patients who underwent ventral hernia repair with retrorectus mesh and who had at least a 12-month follow-up were reviewed. Comparisons were performed between patients who received self-adhering mesh and those who received transfascially sutured mesh, using matched-pair analysis, examining perioperative outcomes, surgical-site occurrences, and hernia recurrence/bulge. Results: Forty-two patients were included in the study, with 21 patients undergoing repair with transfascially sutured mesh and 21 patients receiving self-adhering mesh. Average length of follow-up was 1078 days. There were no significant differences between the two groups in baseline characteristics. Patients receiving self-adhering mesh had significantly shorter surgery, and a shorter hospital length of stay. They also had a tendency toward lower narcotic requirements. There were no significant differences in the rate of surgical-site occurrences, hernia recurrences, or bulge between the two groups. Conclusions: This long-term study shows that self-adhering mesh in ventral hernia repair results in similar long-term outcomes to transfascially sutured mesh, with shorter surgery, shorter length of stay, and a tendency toward improved pain control. These findings mirror the known advantages of self-adhering mesh in inguinal hernia repair. Further research is needed to study the incidence of chronic pain and the cost-effectiveness of self-adhering mesh.

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“…With the expectation of weaker abdominal wall strength compared to use of a conventional onlay technique with primary fascial closure, the patient was taught to wear an abdominal binder for a longer duration in order to facilitate adequate integration of tissue around the mesh. Another important issue is the method used for fixating the mesh, and in which layer the mesh will be interposed [10]. Because the mesh was interposed as a single layer without autologous fascia, the TA was released as widely as possible and the mesh was placed in an underlay fashion.…”

Section: Discussionmentioning

confidence: 99%

Abdominal Wall Reconstruction in a Terminal-Stage Peritoneal Cancer Patient after Emergency Debulking Procedure: A Case Report

et al. 2022

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Late-stage peritoneal cancer is a grave disease with a high morbidity rate; palliative care is the mainstay of treatment. In this article, we present a case of a terminal-stage cancer patient with sustained growth of the tumor. The mass was large enough to invade into the abdominal wall, and cause bowel obstruction as well as major vessel compression. From supportive care, we made a rapid pivot to emergent en bloc resection of the mass with a significant portion of the abdominal wall in one piece. After resection, a major part of the abdominal layers was deficient and required reconstruction. Due to rapid deterioration of the patient’s condition, we changed our plan from autologous reconstruction to prosthesis-based reconstruction. Through this report, we share our decision-making process for reconstruction method selection, and practical considerations in the intraoperative setting.

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Strategies for Mesh Fixation in Abdominal Wall Reconstruction: Concepts and Techniques

Cited by 18 publications

References 55 publications

Transfascial Fixation vs No Fixation for Open Retromuscular Ventral Hernia Repairs

Transfascial Fixation vs No Fixation for Open Retromuscular Ventral Hernia Repairs

Abdominal Wall Reconstruction with Retrorectus Self-Adhering Mesh: A Single-Center Long-Term Follow-up

Abdominal Wall Reconstruction in a Terminal-Stage Peritoneal Cancer Patient after Emergency Debulking Procedure: A Case Report

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