Abdominal wall reconstruction with biosynthetic absorbable mesh after infected prosthesis explantation: single stage is better than two-stage approach of chronic mesh infection

Hernia ◽  
2020 ◽  
Author(s):  
J. Bueno-Lledó ◽  
M. Ceno ◽  
C. Pérez-Alonso ◽  
J. Martinez-Hoed ◽  
S. Pous-Serrano
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Single Stage ◽  
Mesh Infection ◽  
Two Stage ◽  
Absorbable Mesh ◽  
Better Than

Prevention and Treatment Strategies for Mesh Infection in Abdominal Wall Reconstruction

2018 ◽  
Vol 142 ◽  
pp. 149S-155S ◽  
Author(s):  
Angela M. Kao ◽  
Michael R. Arnold ◽  
Vedra A. Augenstein ◽  
B. Todd Heniford
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Treatment Strategies ◽  
Mesh Infection ◽  
Prevention And Treatment

Factors Predicting Increased Length of Stay in Abdominal Wall Reconstruction

2021 ◽  
pp. 000313482110475
Author(s):  
Sharbel A. Elhage ◽  
Sullivan A. Ayuso ◽  
Eva B. Deerenberg ◽  
Jenny M. Shao ◽  
Tanushree Prasad ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Length Of Stay ◽  
Abdominal Wall ◽  
Operative Time ◽  
Enhanced Recovery ◽  
Abdominal Wall Reconstruction ◽  
Mesh Infection ◽  
Inclusion Criteria ◽  
Increased Risk ◽  
Eras Protocol

Background Enhanced recovery after surgery (ERAS) programs have become increasingly popular in general surgery, yet no guidelines exist for an abdominal wall reconstruction (AWR)–specific program. We aimed to evaluate predictors of increased length of stay (LOS) in the AWR population to aid in creating an AWR-specific ERAS protocol. Methods A prospective, single institution hernia center database was queried for all patients undergoing open AWR (1999-2019). Standard statistical methods and linear and logistic regression were used to evaluate for predictors of increased LOS. Groups were compared based on LOS below or above the median LOS of 6 days (IQR = 4-8). Results Inclusion criteria were met by 2,505 patients. On average, the high LOS group was older, with higher rates of CAD, COPD, diabetes, obesity, and pre-operative narcotic use (all P < .05). Longer LOS patients had more complex hernias with larger defects, higher rates of mesh infection/fistula, and more often required a component separation (all P < .05). Multivariate analysis identified age (β0.04,SE0.02), BMI (β0.06,SE0.03), hernia defect size (β0.003,SE0.001), active mesh infection or mesh fistula (β1.8,SE0.72), operative time (β0.02,SE0.002), and ASA score >4 (β3.6,SE1.7) as independently associated factors for increased LOS (all P < .05). Logistic regression showed that an increased length of stay trended toward an increased risk of hernia recurrence ( P = .06). Conclusions Multiple patient and hernia characteristics are shown to significantly affect LOS, which, in turn, increases the odds of AWR failure. Weight loss, peri-operative geriatric optimization, prehabilitation of comorbidities, and operating room efficiency can enhance recovery and shorten LOS following AWR.

scholarly journals Second Look After Retromuscular Repair With the Combination of Absorbable and Permanent Meshes

2021 ◽  
Vol 7 ◽  
Author(s):  
Alvaro Robin Valle de Lersundi ◽  
Joaquín Munoz-Rodriguez ◽  
Javier Lopez-Monclus ◽  
Luis Alberto Blazquez Hernando ◽  
Carlos San Miguel ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Histological Analysis ◽  
Fibrous Tissue ◽  
Abdominal Wall Reconstruction ◽  
Fibrous Layer ◽  
Blunt Dissection ◽  
Prospective Multicenter Study ◽  
Absorbable Mesh ◽  
Retromuscular Repair

Objective: The aim of this study is to describe the macroscopic features and histologic details observed after retromuscular abdominal wall reconstruction with the combination of an absorbable mesh and a permanent mesh.Methods: We have considered all patients that underwent abdominal wall reconstruction (AWR) with the combination of two meshes that required to be reoperated for any reason. Data was extracted from a prospective multicenter study from 2012 to 2019. Macroscopic evaluation of parietal adhesions and histological analysis were carried out in this group of patients.Results: Among 466 patients with AWR, we identified 26 patients that underwent a reoperation after abdominal wall reconstruction using absorbable and permanent mesh. In eight patients, the reoperation was related to abdominal wall issues: four patients were reoperated due to recurrence, three patients required an operation for chronic mesh infection and one patient for symptomatic bulging. A miscellanea of pathologies was the cause for reoperation in 18 patients. During the second surgical procedures made after a minimum of 3 months follow-up, a fibrous tissue between the permanent mesh covering and protecting the peritoneum was identified. This fibrous tissue facilitated blunt dissection between the permanent material and the peritoneum. Samples of this tissue were obtained for histological examination. No case of severe adhesions to the abdominal wall was seen. In four cases, the reoperation could be carried out laparoscopically with minimal adhesions from the previous procedure.Conclusions: The reoperations performed after the combination of absorbable and permanent meshes have shown that the absorbable mesh acts as a protective barrier and is replaced by a fibrous layer rich in collagen. In the cases requiring new hernia repair, the layer between peritoneum and permanent mesh could be dissected without special difficulty. Few intraperitoneal adhesions to the abdominal wall were observed, mainly filmy, easy to detach, facilitating reoperations.

Biosynthetic Resorbable Prosthesis is Useful in Single-Stage Management of Chronic Mesh Infection After Abdominal Wall Hernia Repair

2020 ◽  
Vol 45 (2) ◽  
pp. 443-450
Author(s):  
José Bueno-Lledó ◽  
Marsela Ceno ◽  
Carla Perez-Alonso ◽  
Jesús Martinez-Hoed ◽  
Antonio Torregrosa-Gallud ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Abdominal Wall ◽  
Abdominal Wall Hernia ◽  
Single Stage ◽  
Mesh Infection ◽  
Stage Management ◽  
Abdominal Wall Hernia Repair

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

Hernia ◽  
2021 ◽  
Author(s):  
J. J. M. Claessen ◽  
A. S. Timmer ◽  
J. J. Atema ◽  
M. A. Boermeester
Keyword(s):  
Abdominal Wall ◽  
Direct Contact ◽  
Abdominal Wall Reconstruction ◽  
Single Stage ◽  
Wound Complications ◽  
Mesh Removal ◽  
Group 10 ◽  
Salvage Rate

Abstract Objective To assess clinical outcomes in patients that underwent open single-stage complex abdominal wall reconstruction (CAWR) with biosynthetic mesh. Methods Retrospective observational study of two prospectively registered series of consecutive patients undergoing CAWR with either long-term degradable (LTD) Phasix™ or mid-term degradable (MTD) BIO-A® biosynthetic mesh in a single institution between June 2016 and December 2019. Results From 169 patients with CAWR, 70 consecutive patients were identified who underwent CAWR with either LTD or MTD biosynthetic mesh. More than 85% of patients had an incisional hernia that could be classified as moderately complex to major complex due to a previous wound infection (67%), one or more complicating comorbidities (87.1%), one or more complicating hernia characteristics (75.7%) or contaminated or dirty defects (37.1%). Concomitant component separation was performed in 43 of 70 patients (61.4%). Overall surgical site infection (SSI) rate in these CAWR patients was 45.7%. Seventeen of 70 patients (24.3%) had computed tomography (CT) - and culture-confirmed SSI in direct contact of mesh, suspicious of mesh infection. Mesh removal for persistent local infection occurred in 10% (7 of 70) after a median of 229 days since surgery. Salvage rate of mesh after direct contact with infection was 58.8%. All removed meshes were in the LTD group. Seven patients (10%) had a recurrence; four patients in the LTD group (10%) had a recurrence at a median follow-up of 35 months and three patients in the MTD group (10%) at a median follow-up of 11 months. Three of the seven recurrences occurred in patients with SSI in persistent and direct contact with mesh. Conclusions Comorbid patients undergoing open complex abdominal wall reconstruction are at high risk of postoperative wound complications regardless of which type of biosynthetic mesh is used. When in persistent and direct contact with infection, long-term biodegradable biosynthetic meshes may need to be removed, whereas mid-term biodegradable biosynthetic meshes can be salvaged.

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