Health-Related Quality of Life After Ventral Hernia Repair With Biologic and Synthetic Mesh

Nissen, Andreas; Henn, Dominic; Moshrefi, Shawn; Gupta, Deepak; Nazerali, Rahim; Lee, Gordon K.

doi:10.1097/sap.0000000000001768

Cited by 21 publications

(8 citation statements)

References 26 publications

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“…Importantly, in that study, there was no differentiation based on number of prior repairs. 32 Our findings build on that result to show that patients with three or more prior repairs do in fact have significantly lower baseline quality of life when compared to patients with fewer prior repairs. We attribute this finding to the likely increased functional limitations that patients experience with each successive recurrence, in addition to the increased psychological burden of living with a seemingly chronic medical issue.…”

Section: Discussionsupporting

confidence: 74%

Law of Diminishing Returns in Ventral Hernia Repair: Fact or Fiction?

Patel

Jia

Rios-Diaz

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Repeated ventral hernia repair is associated with increased risk of complications and recurrence. The authors present the first study looking at how repeated ventral hernia repair affects quality of life, and whether there is a relationship between the number of prior repairs and quality-of-life improvement after surgery. Methods: A retrospective chart review was conducted of patients undergoing ventral hernia repair between August of 2017 and August of 2019, who completed at least one preoperative and postoperative Abdominal Hernia-Q. Patients were split into four cohorts based on number of prior repairs (zero, one, two, or three or more). Categorical data were compared using chi-square and Fisher’s exact tests, and continuous data were analyzed using Kruskal-Wallis tests. Results: Ninety-three patients met inclusion criteria, with 19 (20 percent), 45 (48 percent), 15 (16 percent), and 14 patients (15 percent) in each cohort, ranging from zero to three or more prior repairs. Patients with more prior repairs were significantly more likely to be readmitted and undergo reoperation (p = 0.04 and p = 0.01, respectively), in addition to significantly higher cost of care (p = 0.004). Patients with three or more prior repairs had significantly lower preoperative quality of life when compared to patients with two or fewer prior repairs (p = 0.04). However, all patients reported a similar absolute level of quality of life postoperatively, irrespective of prior repairs (p = 0.34). Conclusions: Treatment of recurrent hernia remains a challenge because of poor clinical outcomes and higher risk of recurrence. This study shows that patients with multiple prior ventral hernia repairs report similar postoperative quality of life as patients undergoing primary repair. This information is valuable in determining appropriate surgical candidates and improving preoperative counseling. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

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Section: Discussionsupporting

confidence: 74%

Law of Diminishing Returns in Ventral Hernia Repair: Fact or Fiction?

Patel

Jia

Rios-Diaz

et al. 2022

Plastic &Amp; Reconstructive Surgery

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“…The main factors negatively affecting the quality of life of these patients were hernias greater than 50 cm 2 , obesity, tobacco use, previous abdominal surgery, hernia recurrence, and postoperative complications. The quality of life was lower for patients treated with ECM biomaterials than for those treated with synthetic meshes for grade 2 hernias (Modified ventral hernia working group grading system) [56], while there was no significant difference between the two types of mesh for grade 1 hernias [57]. Schneeberger et al built up a cost-utility analysis model based on published studies, health care costs, utilization project data, and Americas Hernia Society Quality Collaborative data.…”

Section: Biological Scaffolds For Abdominal Wall Repairmentioning

confidence: 99%

Biological Scaffolds for Abdominal Wall Repair: Future in Clinical Application?

et al. 2019

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Millions of abdominal wall repair procedures are performed each year for primary and incisional hernias both in the European Union and in the United States with extremely high costs. Synthetic meshes approved for augmenting abdominal wall repair provide adequate mechanical support but have significant drawbacks (seroma formation, adhesion to viscera, stiffness of abdominal wall, and infection). Biologic scaffolds (i.e., derived from naturally occurring materials) represent an alternative to synthetic surgical meshes and are less sensitive to infection. Among biologic scaffolds, extracellular matrix scaffolds promote stem/progenitor cell recruitment in models of tissue remodeling and, in the specific application of abdominal wall repair, have enough mechanical strength to support the repair. However, many concerns remain about the use of these scaffolds in the clinic due to their higher cost of production compared with synthetic meshes, despite having the same recurrence rate. The present review aims to highlight the pros and cons of using biologic scaffolds as surgical devices for abdominal wall repair and present possible improvements to widen their use in clinical practice.

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“…Moreover, approximately 55,000 patients underwent emergent ventral hernia repair in 2006 [40]. CAWD may be associated with impaired quality of life, increased pain, decreased mobility and self-care capacity, poor body image, impaired social relationships, anxiety and depression [41][42][43][44][45][46]. More often than not, these defects require complex abdominal wall reconstruction (CAWR), which may be associated with significant rates of postoperative morbidity including and not limited to postoperative wound-related complications and less frequently, hernia recurrence.…”

Section: Introductionmentioning

confidence: 99%

Biologic Mesh in Surgery: A Comprehensive Review and Meta‐Analysis of Selected Outcomes in 51 Studies and 6079 Patients

2021

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Background In recent decades, biologic mesh (BM) has become an important adjunct to surgical practice. Recent evidence‐based clinical applications of BM include but are not limited to: reconstruction of abdominal wall defects; breast reconstruction; face, head and neck surgery; periodontal surgery; other hernia repairs (diaphragmatic, hiatal/paraesophageal, inguinal and perineal); hand surgery; and shoulder arthroplasty. Prior systematic reviews of BM in complex abdominal wall hernia repair had several shortcomings that our comprehensive review seeks to address, including exclusion of laparoscopic repair, assessment of risk of bias, use of an acceptable meta‐analytic method and review of risk factors identified in multivariable regression analyses. Materials and methods We sought articles of BM for open ventral hernia repair reporting on early complications, late complications or recurrences and included minimum of 50. We used the quality in prognostic studies risk of bias assessment tool. Random effects meta‐analysis was applied. Results This comprehensive review selected 62 articles from 51 studies that included 6,079 patients. Meta‐analytic pooling found that early complications are present in about 50%, surgical site occurrences (SSOs) in 37%, surgical site infections (SSIs) in 18%, reoperation in 7%, readmission in 20% and mortality in 3%. Meta‐analytic estimates of late outcomes included overall complications (42%), SSOs (40%) and SSIs (22%). Specific SSOs included seroma (14%), hematoma (4%), abscess (10%), necrosis (5%), dehiscence (8%) and fistula formation (5%). Reoperation occurred in about 17%, mesh explantation in 9% and recurrence in 36%. Conclusion Estimates of nearly all outcomes from individual studies were highly heterogeneous and sensitivity analyses and meta‐regressions generally failed to explain this heterogeneity. Recurrence is the only outcome for which there are consistent findings for risk factors. Bridge placement of BM is associated with higher risk of recurrence. Prior hernia repair, history of reintervention and history of mesh removal were also risk factors for increased recurrence.

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Health-Related Quality of Life After Ventral Hernia Repair With Biologic and Synthetic Mesh

Cited by 21 publications

References 26 publications

Law of Diminishing Returns in Ventral Hernia Repair: Fact or Fiction?

Law of Diminishing Returns in Ventral Hernia Repair: Fact or Fiction?

Biological Scaffolds for Abdominal Wall Repair: Future in Clinical Application?

Biologic Mesh in Surgery: A Comprehensive Review and Meta‐Analysis of Selected Outcomes in 51 Studies and 6079 Patients

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