Long-term outcomes after contaminated complex abdominal wall reconstruction

Abstract Aim Simultaneous intestinal resection increases infective risks following abdominal wall reconstruction. We investigated the frequency of those risks and its impact on long-term outcomes. Material and Methods Analysis of prospectively accrued data from patients undergoing AWR by a single surgeon (01/01/2014–31/12/2020). Comparison between AWR with (IR-AWR) and without (AWR) concomitant intestinal resection. Clinical review was undertaken 6 monthly for 24 months with ongoing telephone follow-up thereafter. Results 101 repairs were performed within the study period (46 AWR,55 IR-AWR). IR-AWR patients underwent 129 gastrointestinal procedures including 30 gastrointestinal fistula,33 small bowel,19 colonic and 2 gastric resections. Both groups were similar in terms of smoking status, diabetes, but obesity (BMI>30) was more prevalent in AWR(23/46(50%)vs.16/55(29%); p=0.03). Hernia defects were the same for both groups; AWR median area (range) 511cm2(47–2171 cm2) and IR+AWR 471cm2(50–2827cm2) (p = 0.7). Post-operative wound infection was more frequent following IR-AWR (20/55(36%) (Superficial incisional=13,deep incisional=6, cavity=1) vs. 6/46(13%)(N = 5,0,1 respectively);Odds ratio(OR)=3.8 (95% CI1.4-10.6); p=0.01). Patients undergoing IR-AWR were also more likely to experience ileus necessitating short-term postoperative parenteral nutrition (OR 3.3(1–10.8); p=0.05) and Clavien Dindo>2 complications (OR4.4 (1.2–16.7); p=0.03). Within IR-AWR cohort there was a single anastomotic complication requiring re-laparotomy and one mesh infection treated with antibiotics. Median follow-up= 25.2 months(range 1.2–88.8). 14 patients died during follow-up (AWR 7/46(15%), IR-AWR 7/55(13%); p=0.7). 5 were lost to follow-up (3AWR, 2 IR-AWR). 12(26%) AWR and 8(15%) IR-AWR reported either persistent or delayed onset chronic abdominal wall pain post repair(P = 0.14). Recurrent hernias occurred in 7/46(15%) AWR compared with 10/55(18%)IR-AWR(p = 0.5). Conclusions Despite more frequent short-term complications in IR-AWR patient outcomes are comparable at 2 years.

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The long-term outcomes of early abdominal wall reconstruction by bilateral anterior rectus abdominis sheath turnover flap method in critically ill patients requiring open abdomen

World Journal of Emergency Surgery ◽

10.1186/s13017-018-0200-7 ◽

2018 ◽

Vol 13 (1) ◽

Author(s):

Masatoku Arai ◽

Shiei Kim ◽

Hiromoto Ishii ◽

Jun Hagiwara ◽

Shigeki Kushimoto ◽

...

Keyword(s):

Abdominal Wall ◽

Critically Ill ◽

Critically Ill Patients ◽

Open Abdomen ◽

Abdominal Wall Reconstruction ◽

Rectus Abdominis ◽

Long Term Outcomes

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Long-Term Outcomes of Abdominal Wall Reconstruction. What are the Real Numbers?

World Journal of Surgery ◽

10.1007/s00268-012-1454-y ◽

2012 ◽

Vol 36 (3) ◽

pp. 534-538 ◽

Cited By ~ 15

Author(s):

Ruben Peralta ◽

Rifat Latifi

Keyword(s):

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Real Numbers ◽

Long Term Outcomes ◽

The Real

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Long-Term Clinical Outcomes of an Antibiotic-Coated Non–Cross-linked Porcine Acellular Dermal Graft for Abdominal Wall Reconstruction for High-Risk and Contaminated Wounds

The American Surgeon ◽

10.1177/00031348211023392 ◽

2021 ◽

pp. 000313482110233

Author(s):

Jordan Robinson ◽

Jesse K. Sulzer ◽

Benjamin Motz ◽

Erin H. Baker ◽

John B. Martinie ◽

...

Keyword(s):

High Risk ◽

Abdominal Wall ◽

Clinical Outcomes ◽

Open Abdomen ◽

Abdominal Wall Reconstruction ◽

Dermal Graft ◽

Elective Repair ◽

Acellular Dermal

Background Abdominal wall reconstruction in high-risk and contaminated cases remains a challenging surgical dilemma. We report long-term clinical outcomes for a rifampin-/minocycline-coated acellular dermal graft (XenMatrix™ AB) in complex abdominal wall reconstruction for patients with a prior open abdomen or contaminated wounds. Methods Patients undergoing abdominal wall reconstruction at our institution at high risk for surgical site occurrence and reconstructed with XenMatrix™ AB with intent-to-treat between 2014 and 2017 were included. Demographics, operative characteristics, and outcomes were collected. The primary outcome was hernia recurrence. The secondary outcomes included length of stay, surgical site occurrence, readmission, morbidity, and mortality. Results Twenty-two patients underwent abdominal wall reconstruction using XenMatrix™ AB during the study period. Two patients died while inpatient from progression of their comorbid diseases and were excluded. Sixty percent of patients had an open abdomen at the time of repair. All patients were from modified Ventral Hernia Working Group class 2 or 3. There were a total of four 30-day infectious complications including superficial cellulitis/fat necrosis (15%) and one intraperitoneal abscess (5%). No patients required reoperation or graft excision. Median clinical follow-up was 38.2 months with a mean of 35.2 +/− 18.5 months. Two asymptomatic recurrences and one symptomatic recurrence were noted during this period with one planning for elective repair of an eventration. Follow-up was extended by phone interview which identified no additional recurrences at a median of 45.5 and mean of 50.5 +/−12.7 months. Conclusion We present long-term outcomes for patients with high-risk and contaminated wounds who underwent abdominal wall reconstruction reinforced with XenMatrix™ AB to achieve early, permanent abdominal closure. Acceptable outcomes were noted.

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