Intraperitoneal versus retromuscular mesh placement for open incisional hernias: an analysis of the Americas Hernia Society Quality Collaborative

Abstract

Background Incisional hernia repair with mesh improves long-term outcomes, but the ideal mesh position remains unclear. This study compared intraperitoneal versus retromuscular or preperitoneal sublay (RPS) mesh positions for open incisional hernia repairs. Methods All patients who had elective open incisional hernia repairs were identified retrospectively in the Americas Hernia Society Quality Collaborative database. The primary outcome was the rate of 30-day surgical-site infection (SSI). Other outcomes of interest included 30-day surgical-site occurrences requiring procedural intervention (SSOPI), hernia-related quality-of-life survey (HerQLes) scores and long-term recurrence. A logistic model was used to generate propensity scores for mesh position using several clinically relevant co-variables. Regression models adjusting for propensity score and baseline characteristics were developed to assess the effect of mesh placement. Results A total of 4211 patients were included in the study population: 587 had intraperitoneal mesh and 3624 had RPS mesh. Analysis with propensity score adjustment provided no evidence for differences in SSOPI (odds ratio (OR) 0·79, 95 per cent c.i. 0·49 to 1·26) and SSI (OR 0·91, 0·50 to 1·67) rates or HerQLes scores at 30 days (OR 1·20, 0·79 to 1·82), or recurrence rates (hazard ratio 1·28, 0·90 to 1·82). Conclusion Mesh position had no effect on short- or long-term outcomes, including SSOPI and SSI rates, HerQLes scores and long-term recurrence rates.

A Prospective, Single Arm, Multi-Center Study Evaluating the Clinical Outcomes of Ventral Hernias Treated with OviTex® 1S Permanent Reinforced Tissue Matrix: The BRAVO Study 12-Month Analysis

“…Some publications have found that the retromuscular sublay position, primarily used in other clinical studies, exhibits fewer complications and recurrences than other locations [26]. However, a recent analysis based on the Abdominal Core Health Quality Collaborative (ACHQC) registry found that, while confirming the trend towards more retromuscular placements, there was no significant difference in the incidence of complications and recurrences between these locations [23]. The data described here so far support that conclusion.…”

“…One underwent a surgical repair during which the RTM was found to be well vascularized and integrated and the other did not require surgical treatment. The incidence of recurrence of 2.6% at 12 months is lower than that reported in publications describing prospective studies for other materials, whether permanent synthetic, resorbable synthetic, or biologic [12,15,21,23,24]. The range of recurrence rates in these studies spanned from 9% to 28% [12,15,21,23,24].…”

“…The incidence of recurrence of 2.6% at 12 months is lower than that reported in publications describing prospective studies for other materials, whether permanent synthetic, resorbable synthetic, or biologic [12,15,21,23,24]. The range of recurrence rates in these studies spanned from 9% to 28% [12,15,21,23,24].…”

Comparative Effectiveness Analysis of Resorbable Synthetic Onlay and Biologic Intraperitoneal Mesh for Abdominal Wall Reconstruction: A 2-Year Match-Paired Analysis

“…In recent years, growing evidence suggests that the retromuscular sublay plane may be a preferable option in preventing complications and recurrence, [8][9][10][11] although some have called for a shift in this paradigm. 12,13 Regardless, the ability to adequately establish this space is not always feasible, given extensive fibrosis or loss of tissue integrity that develops in a chronically devolved abdominal wall, particularly in recurrent defects or concurrent intraabdominal procedures. In such cases, the onlay and intraperitoneal planes are both well-described alternatives.…”