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A 5-Year Clinical Experience With Single-Staged Repairs of Infected and Contaminated Abdominal Wall Defects Utilizing Biologic Mesh

Rosen, Michael J. MD; Krpata, David M. MD; Ermlich, Bridget RN; Blatnik, Jeffrey A. MD

Annals of Surgery:
doi: 10.1097/SLA.0b013e3182849871
Feature
Abstract

Objective: Our objective was to evaluate the safety and durability of biologic mesh for single-staged reconstruction of contaminated fields.

Introduction: The presence of contamination during ventral hernia repair (VHR) poses a significant challenge. Some advocate for a multistaged reconstructive approach with delayed definitive repair, whereas others perform definitive repair at the initial operation.

Methods: Patients undergoing single-staged VHR in a contaminated field with biologic mesh over a 5-year period were retrospectively reviewed from a prospectively maintained database. Outcome measures included wound complication and hernia recurrence.

Results: A total of 128 patients (76 F, 52 M) were identified, with a mean age of 58.2 years, mean American Society of Anesthesiologist (ASA) score 3.1, and mean body mass index (BMI) 34.1 ± 9.7 kg/m2. Comorbidities included COPD (n = 29), diabetes (n = 65), smoking (n = 29), and immunosuppression (n = 8). Mean hernia defect size was 431 cm2 (range 40–2450 cm2). Reasons for contamination included the presence of infected mesh (n = 45), stoma (n = 24), concomitant gastrointestinal (GI) surgery (n = 17), enterocutaneous fistula (n = 25), open nonhealing wound(s) (n = 6), enterotomy/colotomy (n = 5), and chronic draining sinus (n = 6). Postoperative wound complications were identified in 61 (47.7%) patients. Predictors of wound complications included ASA score, diabetes, smoking, number of previous abdominal surgeries or hernia repairs, hernia defect size, and operative time. With a mean follow-up time of 21.7 months, hernia recurrence was identified in 40 (31.3%) patients. The majority of recurrent hernias were asymptomatic and 7 patients underwent repair.

Conclusions: Despite the high rate of wound morbidity associated with single-staged reconstruction of contaminated fields, it can safely be performed with biologic mesh reinforcement. Although biologic mesh in these situations is safe, the long-term durability seems to be less favorable.

In Brief

This is a retrospective review of all single-staged reconstructions of contaminated fields using biologic mesh over a 5-year period evaluating the safety and durability of biologic meshes. Although postoperative wound morbidity was high at nearly 50%, biologic mesh was safe in these cases, as there were no long-term infectious complications. The overall hernia recurrence rate was 31.3% with a mean follow-up time of 21.7 months.

Author Information

Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Cleveland, OH.

Reprints: Michael J. Rosen, MD, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH. E-mail: michael.rosen@uhhospitals.org

Disclosure: David Krpata, Bridget Ermlich, and Jeffrey Blatnik have nothing to disclose.

Michael Rosen discloses being a speaker for LifeCell, with research support from LifeCell, Davol, W.L. Gore, and Cook.

© 2013 Lippincott Williams & Wilkins, Inc.