Long-term outcomes after contaminated complex abdominal wall reconstruction

Abstract

Purpose Complex abdominal wall repair (CAWR) in a contaminated operative field is a challenge. Available literature regarding long-term outcomes of CAWR comprises studies that often have small numbers and heterogeneous patient populations. This study aims to assess long-term outcomes of modified-ventral hernia working group (VHWG) grade 3 repairs. Because the relevance of hernia recurrence (HR) as the primary outcome for this patient group is contentious, the need for further hernia surgery (FHS) was also assessed in relation to long-term survival. Methods A retrospective cohort study with a single prospective follow-up time-point nested in a consecutive series of patients undergoing CAWR in two European national intestinal failure centers. Results In long-term analysis, 266 modified VHWG grade 3 procedures were included. The overall HR rate was 32.3%. The HR rates for non-crosslinked biologic meshes and synthetic meshes when fascial closure was achieved were 20.3% and 30.6%, respectively. The rates of FHS were 7.2% and 16.7%, and occurred only within the first 3 years. Bridged repairs showed poorer results (fascial closure 22.9% hernia recurrence vs bridged 57.1% recurrence). Overall survival was relatively good with 80% en 70% of the patients still alive after 5 and 10 years, respectively. In total 86.6% of the patients remained free of FHS. Conclusions In this study of contaminated CAWR, non-crosslinked biologic mesh shows better results than synthetic mesh. Bridging repairs with no posterior and/or anterior fascial closure have a higher recurrence rate. The overall survival was good and the majority of patients remained free of additional hernia surgery.As 80% of patients are still alive at 5-year follow-up and 86.6% of the patients remained free of additional surgery, the initial higher costs of a non-crosslinked biologic mesh seem trivial.

Outcomes of mid-term and long-term degradable biosynthetic meshes in single-stage open complex abdominal wall reconstruction

“…Multiple studies investigating the use of biologic mesh in high-risk patients and/or contaminated hernia repair found that most postoperative wound complications can indeed be managed conservatively, and the number of patients that develop mesh infection requiring removal is as low as 0% in non-crosslinked biologic mesh [ 3 , 5 – 7 ]. However, reported hernia recurrence rates could be as high as 30% after 3 years [ 7 , 8 ]. These results combined with the high purchase costs of biologic meshes have led to a search in alternative meshed to be used in complex AWR (CAWR).…”

Bowel obstruction secondary to gallstone ileus within an inguinoscrotal hernia: a rare diagnosis in an elderly patient

“…Recent studies have reported safe use of biologic mesh reinforcements in contaminated ventral hernia repair. 15,16 Our patient underwent open inguinal hernia repair with removal of the gallstone via an enterotomy, that was subsequently closed. The hernia was reduced and following an orchidectomy, the posterior wall of the inguinal canal was reinforced with a biological mesh.…”

Tratamiento quirúrgico en hernia ventral compleja en un paciente con estatus de colostomía (restitución intestinal y reparación de pared abdominal)

“…En nuestro caso se obtuvieron adecuados resultados en el paciente, por lo que pudo egresar sin complicaciones, y si bien se requieren estudios más grandes para emitir algún tipo de recomendación en este tipo de casos, se conoce que el 32.2% en que se realiza alguna otra cirugía adicional presentan recurrencia al realizar alguna cirugía adicional abdominal 9 , por lo que es necesario tener un adecuado protocolo de selección de pacientes, que deben tener un adecuado control de cualquier comorbilidad, como en el caso expuesto, y la corrección de cualquier factor modificable que pudiera aumentar el riesgo quirúrgico per se.…”