Biological mesh is a safe and effective method of abdominal wall reconstruction in cytoreductive surgery for peritoneal malignancy

Abstract

BackgroundPatients with peritoneal malignancy often have multiple laparotomies before referral for cytoreductive surgery (CRS). Some have substantial abdominal wall herniation and tumour infiltration of abdominal incisions. CRS involves complete macroscopic tumour removal and hyperthermic intraperitoneal chemotherapy (HIPEC). Abdominal wall reconstruction is problematic in these patients. The aim of this study was to establish immediate and long‐term outcomes of abdominal wall reconstruction with biological mesh in a single centre.MethodsA dedicated peritoneal malignancy database was searched for all patients who had biological mesh abdominal wall reconstruction between 2004 and 2015. Short‐ and long‐term outcomes were reviewed. All patients had annual abdominal CT as routine peritoneal malignancy follow‐up.ResultsSome 33 patients (22 women) with a mean age of 53·4 (range 19–82) years underwent abdominal wall reconstruction with biological mesh. The majority (23) had CRS for pseudomyxoma (19 low grade), six for colorectal peritoneal metastasis and four for appendiceal adenocarcinoma; 18 had undergone CRS and HIPEC previously. Twenty‐five of the 33 patients had abdominal wall tumour involvement and eight had concurrent hernias. The mean duration of surgery was 486 (range 120–795) min and the mean mesh size used was 345 (50–654) cm2. Ten patients developed wound infections and four had a seroma. Two developed early enterocutaneous fistulas. Mean follow‐up was 48 months. Five patients developed an incisional hernia. Four died from progressive malignancy. A further 15 patients had disease recurrence, but only one had isolated abdominal wall recurrence.ConclusionBiological mesh was safe and effective for abdominal wall reconstruction in peritoneal malignancy. Postoperative wound infections were frequent but nevertheless incisional hernia rates were low with no instances of mesh‐related bowel erosion or fistulation.

Incisional hernias post cytoreductive surgery/peritonectomy and hyperthermic intraperitoneal chemotherapy: a systematic review and meta-analysis

“…The use of meshes in patients with peritoneal metastases has been questioned [ 62 ]. However, the use of mesh reconstruction in patients post CRS/HIPEC/laparotomy has been shown to be safe and effective [ 46 , 63 , 64 ]. Only a small cohort of patients in one study included in this analysis reported mesh use [ 32 ], however, ongoing studies (ClinicalTrials.gov identifier: NCT03953365) relating to the outcomes regarding mesh use post CRS/HIPEC may further enhance patient outcomes regarding IH.…”

Hernia and Cancer: The Points Where the Roads Intersect

“…Some groups have used biological meshes for abdominal wall closure after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. They reported that this technique might prevent subsequent incisional development, but at a cost of high infection rates and even enterocutaneous fistula formation (190, 191).…”

Pseudomyxoma peritonei originating from low grade mucinous neoplasm of the urachus

“…If a mesh repair is thought necessary, consideration could be given to a biologic mesh. 7 In this case the patient had PMP originating from a low-grade mucinous neoplasm of the urachus with PMP. It is important when the diagnosis of PMP is made, that all potential primary sites are considered, although PMP originating from the urachus is rare.…”

“…The mucin and sac should be sent for histopathology and a CT scan of the abdomen performed. If a mesh repair is thought necessary, consideration could be given to a biologic mesh 7 . In this case the patient had PMP originating from a low‐grade mucinous neoplasm of the urachus with PMP.…”