Abdominal Wall Reconstruction Utilizing the Combination of Absorbable and Permanent Mesh in a Retromuscular Position: A Multicenter Prospective Study

García-Ureña, Miguel Ángel; López-Monclús, Javier; Cuccurullo, Diego; Hernando, Luis Alberto Blázquez; García-Pastor, Providencia; Reggio, Stefano; Cubedo, Elena Jiménez; Méndez, Carlos San Miguel; Cidoncha, Arturo Cruz; Lersundi, Álvaro Robín Valle de

doi:10.1007/s00268-018-4765-9

Cited by 32 publications

(29 citation statements)

References 57 publications

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“…Only one patient developed a bulging. We did not consider a bulge as a recurrence because, even if the midline is not closed over the biological mesh, there is no interruption between the mesh and the abdominal wall layer 21,25 . Rather, we consider that for patients requiring CAWD repair, the onset of a postoperative bulging or abdominal wall weakness is an acceptable result and does not represent complete failure of the procedure.…”

Section: Discussionmentioning

confidence: 99%

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A retrospective, Italian multicenter study of complex abdominal wall defect repair with a Permacol biological mesh

Russello

Miceli

Conti³

et al. 2020

Sci Rep

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Complex abdominal wall defects (CAWDs) can be difficult to repair and using a conventional synthetic mesh is often unsuitable. A biological mesh might offer a solution for CAWD repair, but the clinical outcomes are unclear. Here, we evaluated the efficacy of a cross-linked, acellular porcine dermal collagen matrix implant (Permacol) for CAWD repair in a cohort of 60 patients. Here, 58.3% patients presented with a grade 3 hernia (according to the Ventral Hernia Working Group grading system) and a contaminated surgical field. Permacol was implanted as a bridge in 46.7%, as an underlay (intraperitoneal position) in 38.3% and as a sublay (retromuscolar position) in 15% of patients. Fascia closure was achieved in 53.3% of patients. The surgical site occurrence rate was 35% and the defect size significantly influenced the probability of post-operative complications. The long-term (2 year) hernia recurrence rate was 36.2%. This study represents the first large multi-centre Italian case series on permacol implants in patients with a cAWD. our data suggest that permacol is a feasible strategy to repair a CAWD, with acceptable early complications and long-term (2 year) recurrence rates.

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Section: Discussionmentioning

confidence: 99%

“…Recurrence was defined as a fascial defect at the surgical site. Bulging was defined as a relaxing of the abdominal wall at the mesh site due to stretching of the mesh, without any interruption between the mesh and the abdominal wall layer 21,25 . Bulging was considered in the SSO group and was not considered as a recurrence.…”

Section: Study Outcomesmentioning

confidence: 99%

A retrospective, Italian multicenter study of complex abdominal wall defect repair with a Permacol biological mesh

Russello

Miceli

Conti³

et al. 2020

Sci Rep

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“…1). Of these, three (25%) examined bioabsorbable mesh for prophylaxis [14][15][16] and nine (75%) reported repair after incisional hernia/abdominal wall reconstruction [17][18][19][20][21][22][23][24][25]. Studies for prophylaxis included a total of 201 patients with a median follow-up of 11 months (range 9-24 months) and those for repair included 1086 patients with a median follow-up of 23 months (range 1-26 months).…”

Section: Resultsmentioning

confidence: 99%

“…Gore-BioA® (WL Gore, Arizona, USA) was the most used mesh for prophylaxis of the abdominal wall used in two studies [15,16], followed by TIGR® (Novus Scientific, Uppsala, Sweden) in one study [14]. In papers reporting bioabsorbable mesh for repair only, Phasix™ (BD Bard, Rhode Island, USA) [18,19,24,25] was the most commonly reported followed by Gore-BioA® (n = 3) [20,22,23]. One study [21] reported use of Phasix™, TIGR®, Gore-BioA®, and another study [17] did not report type of bioabsorbable mesh used.…”

Section: Resultsmentioning

confidence: 99%

Bioabsorbable mesh use in midline abdominal wall prophylaxis and repair achieving fascial closure: a cross-sectional review of stage of innovation

Kamarajah

Smart

Daniels

et al. 2020

Hernia

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Background Achieving stable closure of complex or contaminated abdominal wall incisions remains challenging. This study aimed to characterise the stage of innovation for bioabsorbable mesh devices used during both midline closure prophylaxis and complex abdominal wall reconstruction and to evaluate the quality of current evidence. Methods A systematic review of published and ongoing studies was performed until 31st December 2019. Inclusion criteria were studies where bioabsorbable mesh was used to support fascial closure either prophylactically after midline laparotomy or for repair of incisional hernia with midline incision. Exclusion criteria were: (1) study design was a systematic review, meta-analysis, letter, review, comment, or conference abstract; (2) included less than p patients; (3) only evaluated biological, synthetic or composite meshes. The primary outcome measure was the IDEAL framework stage of innovation. The key secondary outcome measure was the risk of bias in non-randomised studies of interventions (ROBINS-I) criteria for study quality. Results Twelve studies including 1287 patients were included. Three studies considered mesh prophylaxis and nine studies considered hernia repair. There were only two published studies of IDEAL 2B. The remainder was IDEAL 2A studies. The quality of the evidence was categorised as having a risk of bias of a moderate, serious or critical level in nine of the twelve included studies using the ROBINS-I tool. Conclusion The evidence base for bioabsorbable mesh is limited. Better reporting and quality control of surgical techniques are needed. Although new trial results over the next decade will improve the evidence base, more trials in emergency and contaminated settings are required to establish the limits of indication.

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“…2020 Oct;7(10): [3348][3349][3350][3351][3352][3353] International Surgery Journal | October 2020 | Vol 7 | Issue 10 Page 3349 limitation in medialization of rectus muscles causing large surfaces of mesh to be located under the skin flaps, hence resulting in surgical site events (SSE) and recurrences. [2][3][4] AWR has been recently revolutionized by minimally invasive reconstructive techniques, exponential growth of bioprosthetic have revolutionized. And, introduction of components separation has facilitated closure of both posterior and anterior layers in wide defects, and location of large meshes in a completely preperitoneal space.…”

Section: Introductionmentioning

confidence: 99%

Ventral hernia from routine repairs to abdominal wall reconstruction: our initial experience

Ishwarappagol¹,

Kumar²

2020

Int Surg J

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Background: Loss of continuity of abdominal wall significantly affects the functions of protection of viscera, postural stabilization, and maintenance of intra-abdominal pressure. The newer understanding of abdominal wall reconstruction (AWR) aims at restoring abdominal wall anatomy and function, instead of simply patching the defect. We want to showcase the changing trends and results in hernia repair at a Medical Institution.Methods: This is an observational retrospective study conducted in RRMCH, Bengaluru from July 2018-2019 including all patients with ventral hernia undergoing the specified hernia repairs.Results: A total of 54 patients with ventral hernias undergoing routine hernia repairs/AWR surgeries were retrospectively analysed. The overall mean age was 46.62±12.44 year. Majority subjects were females (n=37; 68.5%), and overweight (Mean BMI=28.07±3.01/m2). 14 patients (25.92%), all males, had history of tobacco consumption. There were 38 (70.37%) primary ventral hernias and 7 recurrent hernias. Overall mean defect size was 10.2±0.4 cm. Most frequently performed was open retro rectus Hernioplasty (n=18; 33.33%), followed by open Preperitoneal Hernioplasty (n=17; 31.48%), laparoscopic intraperitoneal onlay mesh (IPOM) (n=16; 29.62%) and open transversus abdominis release (TAR) (n=3; 5.5%). On statistical analysis, it was found that Open repairs had higher post-operative pain (p=0.0005), longer hospitalization (p=0.0002) and higher incidence of surgical site events (p=0.0134) when compared to Laparoscopic repairs.Conclusion: As known already, minimally invasive techniques of hernia surgeries are shown to have acceptable outcomes when compared to radical open surgeries. Newer techniques of AWR are being employed to routine cases in larger numbers, and not just for complex reconstruction, at most centres with acceptable outcomes.

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Abdominal Wall Reconstruction Utilizing the Combination of Absorbable and Permanent Mesh in a Retromuscular Position: A Multicenter Prospective Study

Cited by 32 publications

References 57 publications

A retrospective, Italian multicenter study of complex abdominal wall defect repair with a Permacol biological mesh

A retrospective, Italian multicenter study of complex abdominal wall defect repair with a Permacol biological mesh

Bioabsorbable mesh use in midline abdominal wall prophylaxis and repair achieving fascial closure: a cross-sectional review of stage of innovation

Ventral hernia from routine repairs to abdominal wall reconstruction: our initial experience

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