Concomitant Panniculectomy Affects Wound Morbidity but Not Hernia Recurrence Rates in Abdominal Wall Reconstruction

Abstract Aims To compare post-operative outcomes in patients undergoing elective complex abdominal wall reconstruction (CAWR) alone vs. CAWR plus simultaneous intestinal surgery. Methods All patients undergoing elective CAWR over a 10-year period in our unit were identified from a prospectively maintained database and divided into those who had concomitant intestinal surgery (resection, ileoanal-pouch formation, stoma reversal, etc) and those who did not. Simple adhesiolysis, cholecystectomy and gynaecological procedures were not classed as ‘intestinal surgery’. Differences between groups were determined using the paired-t test and the (n-1) Chi-squared test. Results 59 patients underwent elective CAWR, 16 with intestinal surgery and 43 without. The two groups had similar baseline demographics with no significant differences in age, BMI, sex or hernia size. The commonest post-operative complications were pneumonia (33.9%) and wound infections (25.4%) but there were no significant differences in any complication between groups. There was zero 30 and 90 day mortality in either group. The mean operating time in the intestinal group (IG) was significantly longer compared to the CAWR-only group (5.4 +/- 1.3hrs vs 4.1 +/- 1.8hrs, p = <0.05). There was no statistically significant difference between groups in rates of surgical site occurrence (37.5% IG vs 55.81% CAWR-only), mesh infections (0% IG vs 6.98% CAWR-only) or recurrent hernia (6.24% IG vs 9.30% CAWR-only) over a median follow up of 3.0 (0.1-7.8) years. Conclusion Performing simultaneous intestinal surgery during complex abdominal wall repair is safe and does not increase the risk of recurrence or mesh infections in a specialist abdominal reconstruction unit.

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SP7.2.4 Evaluation of Non-crosslinked Acellular Porcine Dermal Mesh – A Single Centre Experience

British Journal of Surgery ◽

10.1093/bjs/znab361.153 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Rama Karri ◽

Amaar Aamery ◽

Deepak Singh-Ranger

Keyword(s):

Chronic Pain ◽

Incisional Hernia ◽

Abdominal Wall ◽

Parastomal Hernia ◽

Abdominal Wall Reconstruction ◽

Hernia Recurrence ◽

Biological Mesh ◽

Ease Of Use ◽

Secondary Outcome ◽

Retrospective Case

Abstract Aims We report our experience with a cellular porcine dermal non-crosslinked biological mesh (EGIS®). We conducted a review of indications and outcomes of patients requiring the mesh for incisional hernia/complex abdominal wall reconstruction with component separation, parastomal hernia repairs and ELAPE. Patients were followed for a minimum of 6 and assessed for recurrence, seroma formation and chronic pain. Secondary outcome was the assessment of ease of use by the Surgeon – suturing and pliability. Method A retrospective case notes review of patients requiring biological mesh (EGIS®) from 2016 to present. A qualitative survey about ease of use of EGIS® for operations studied was sent to all Consultant Surgeons. Results EGIS® mesh was used in 38 patients: 23 Hernia repairs – 13 Incisional, 8 Parastomal, 2 Paraumbilical; 12 Pelvic floor repairs after ELAPE; and 3 abdominal wall reconstructions. Hernia recurrence occurred in 12 (32%), seroma 7 (18%) and chronic pain 7 (18%). The highest complications occurred in the incisional and parastomal hernia groups. Incisional hernia: recurrence in 5 (38%), seroma in 5 (38%) and chronic pain in 3 (23%). Parastomal hernia: recurrence in 3 (38%), chronic pain 2 (25%), seroma 1 (13%). Consultants scored the mesh 4.3 to 4.5 out of 10 for pliability, ease of use and suturing. Conclusion Biological mesh is used to reinforce hernia repairs in contaminated or potentially contaminated fields. Non-crosslinked meshes are preferred for their greater cellular infiltration from host tissue with improved integration. Our experience with this mesh shows a high complication rate and requires re-evaluation.

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Abdominal Wall Expanding System Obviates the Need for Lateral Release in Giant Incisional Hernia and Laparostoma

Surgical Innovation ◽

10.1177/1553350617718065 ◽

2017 ◽

Vol 24 (5) ◽

pp. 455-461 ◽

Cited By ~ 2

Author(s):

Dietmar Eucker ◽

Andreas Zerz ◽

Daniel C. Steinemann

Keyword(s):

Abdominal Wall ◽

Operative Time ◽

Abdominal Wall Reconstruction ◽

Hernia Recurrence ◽

Lateral Release ◽

Promising Alternative ◽

Hernia Defect ◽

Incisional Hernias ◽

Onlay Mesh ◽

Midline Closure

Background:In large incisional hernias and after laparostoma midline closure may be impossible. A novel abdominal wall expander system (AWEX) is proposed and evaluated. Methods: In patients with large incisional hernias and laparostoma where primary midline closure was impossible, AWEX was used. Patients undergoing abdominal wall reconstruction using AWEX between May 2012 and December 2015 were included. Intraoperative the abdominal wall was stretched by attaching the midline fascia borders to a retraction system under tension for 30 minutes. Length and width of the hernia defect were measured in preoperative computed tomography. Width gain after AWEX procedure, operative time, morbidity, and presence of remaining midline gap was evaluated. Patients were followed for hernia recurrence. Results: Ten patients with incisional hernias (N = 4) and grafted laparostoma (N = 6) underwent abdominal wall reconstruction using AWEX. Median (interquartile range) length and width of the hernia defect was 18.0 (15.0-20.5) and 12.0 (11.8-13.3) cm. Width gain after AWEX was 8.5 (8.0-10.5) cm. Operative time was 270 (135-379) minutes. The major morbidity was 20%. In 4 patients a gap of 4 (4-5) cm was bridged by intraperitoneal onlay mesh. After a median follow-up of 21 (7-36) months no hernia recurrence was observed. Conclusions: Stretching of the abdominal wall that has been shown successful using progressive restressed retention sutures and progressive preoperative pneumoperitoneum is reduced from days and weeks to 30 minutes in AWEX. AWEX is a promising alternative to component separation in repair of large incisional hernias. After refinement of the system prospective evaluation is required.

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Performance of biological mesh materials in abdominal wall reconstruction: study protocol for a randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2018-024091 ◽

2019 ◽

Vol 9 (2) ◽

pp. e024091 ◽

Cited By ~ 3

Author(s):

David A Carver ◽

Andrew W Kirkpatrick ◽

Tammy L Eberle ◽

Chad G Ball

Keyword(s):

Informed Consent ◽

Randomised Controlled Trial ◽

Abdominal Wall ◽

Controlled Trial ◽

Abdominal Wall Reconstruction ◽

Hernia Recurrence ◽

Biological Mesh ◽

Common Source ◽

Porcine Dermis ◽

Randomised Controlled

IntroductionAbdominal wall hernias are a common source of morbidity and mortality. The use of biological mesh has become an important adjunct in successful abdominal wall reconstruction. There are a variety of biological mesh products available; however, there is limited evidence supporting the use of one type over another. This study aims to compare the performance (eg, the rate of hernia recurrence) of either a crosslinked biological mesh product or a non-crosslinked product in patients undergoing abdominal wall reconstruction.Methods and analysisThis is a single-centre, dual arm randomised controlled trial. Patients requiring abdominal wall reconstruction will be assessed for eligibility. Eligible patients will then undergo an informed consent process following by randomisation to either (1) crosslinked porcine dermis mesh (Permacol); or (2) non-crosslinked porcine dermis mesh (Strattice). These groups will be compared for the rate of hernia recurrence at 1 and 2 years as well as the rate of postoperative complications (eg, surgical site infections).Ethics and disseminationThis study has been approved by the institution’s research ethics board and registered with clinicaltrials.gov. All eligible participants will provide informed consent prior to randomization. The results of this study may help guide the choice of biologic mesh for this population. The results of this study will be published in peer-reviewed journals as well as national and international conferences.Trial registration numberNCT02703662.

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Posterior Components Separation With Transversus Abdominis Release (TAR) Versus Alternative Techniques of Components Separation: Systematic Review

International Surgery ◽

10.9738/intsurg-d-16-00242.1 ◽

2018 ◽

Vol 103 (7-8) ◽

pp. 355-365

Author(s):

Aseel Sleiwah ◽

Sandra McAllister

Keyword(s):

Abdominal Wall ◽

Primary Repair ◽

Abdominal Wall Reconstruction ◽

Hernia Recurrence ◽

Transversus Abdominis ◽

Wound Complications ◽

Cochrane Central Register ◽

Components Separation ◽

Abdominal Hernias ◽

Wall Components

The aim of this study is to assess the clinical effectiveness of posterior abdominal wall components separation with transversus abdominis muscle release (PCS-TAR) in the management of ventral abdominal hernias. Ventral abdominal hernias complicate up to 11% of laparotomy wounds. Surgical management includes primary repair, hernioplasty, flaps, and components separation. A technique has been described to close large abdominal defects by releasing bilateral myofascial flaps of rectus abdominis from external oblique and advancing these flaps to the midline. Minimally invasive and endoscopic techniques were subsequently developed to reduce complications. A recently described method is PCS-TAR. The hypothesis is that PCS-TAR for abdominal wall reconstruction is associated with lower rates of wound complications and hernia recurrence than other components separation techniques. A comprehensive search of databases including Medline, Embase, Cochrane Central Register of Controlled Trials, and Scopus was conducted in accordance with PRISMA guidelines, looking for the primary outcomes of hernia recurrence and wound complications following different techniques of components separation. Inclusion and exclusion criteria were defined. The quality of studies was examined independently by 2 assessors. A total of 363 studies were identified. Three retrospective comparative studies met the inclusion criteria. No randomized control trial comparing different techniques of abdominal wall components separation was identified. No technique could be identified as superior to others, due to a paucity of the literature. However, based on a few retrospective cohort studies, PCS-TAR emerges as a well-tolerated new technique, with a low incidence of wound complications and hernia recurrence.

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Value Improvement and Resource Utilization in Complex Abdominal Wall Reconstruction

The American Surgeon ◽

10.1177/000313481908501008 ◽

2019 ◽

Vol 85 (10) ◽

pp. 1113-1117 ◽

Cited By ~ 1

Author(s):

Cory K. Mayfield ◽

Daniel J. Gould ◽

Alex Wong ◽

Ketan M. Patel ◽

Joseph Carey

Keyword(s):

Abdominal Wall ◽

Recurrence Rate ◽

Abdominal Wall Reconstruction ◽

Synthetic Mesh ◽

Low Risk ◽

Biologic Mesh ◽

Institutional Pressures ◽

Recurrence Rates ◽

Significant Difference ◽

Risk Patients

Although recommendations help guide surgeons’ mesh choice in abdominal wall reconstruction (AWR), financial and institutional pressures may play a bigger role. Standardization of an AWR algorithm may help reduce costs and change mesh preferences. We performed a retrospective review of high- and low-risk patients who underwent inpatient AWR between 2014 and 2016. High risk was defined as immunosuppression and/or history of infection/contamination. Patients were stratified by the type of mesh as biologic/biosynthetic or synthetic. These cohorts were analyzed for outcome, complications, and cost. One hundred twelve patients underwent complex AWR. The recurrence rate at two years was not statistically different between high- and low-risk cohorts. No significant difference was found in the recurrence rate between biologic and synthetic meshes when comparing both high- and low-risk cohorts. The average cost of biologic mesh was $9,414.80 versus $524.60 for synthetic. The estimated cost saved when using synthetic mesh for low-risk patients was $295,391.20. In conclusion, recurrence rates for complex AWR seem to be unrelated to mesh selection. There seems to be an excess use of biologic mesh in low-risk patients, adding significant cost. Implementing a critical process to evaluate indications for biologic mesh use could decrease costs without impacting the quality of care, thus improving the overall value of AWR.

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