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

Abstract

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.

Contemporary Abdominal Wall Reconstruction: Emerging Techniques and Trends

“…Though longer-term data is not available, the principle of approaching mesh in the same way as other permanent implants is warranted. A related study by the same group, which also used the "no-touch" technique investigated outcomes of using permanent self-adhering mesh, found a shorter surgery and length of stay with no differences in surgical-site occurrences or hernia recurrence [29].…”

Suturing Versus Adhesion for Mesh Fixation in Ventral Hernia Repair and Abdominal Wall Reconstruction: A Systematic Review and Network Meta-Analysis

“…Currently, two main methods are utilized for mesh fixation: suturing and the use of adhesives [ 2 ]. The history of suturing for mesh fixation in AWR can be traced back to the pioneering work of surgeons in the field of hernia repair.…”

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

“…T he authors should be commended on a wellwritten report of their study comparing outcomes of the use of retrorectus self-adhering mesh and transfascially sutured mesh in abdominal wall reconstruction. 1 In their study of 42 patients with at least 12 months of follow-up, Bashian and colleagues reported that use of self-adhering mesh resulted in rates of hernia recurrence and surgical-site occurrence (SSO) similar to those with use of transfascially sutured mesh but with shorter surgery times and lengths of stay.…”