High rate of hernia recurrence with biologic mesh repair

Image: PD

1. Single-stage ventral hernia repair (VHR) using biologic mesh in the setting of a contaminated field results in a high rate of infection-related morbidity. 

2. Closing a ventral defect with biologic mesh does not decrease the rate of hernia recurrence as previously thought. 

Evidence Rating Level: 2 (Good) 

Study Rundown: A conservative approach to repairing contaminated hernias is a multi-stage operation involving two surgeries over the course of 6-12 months. Although there is limited evidence, biologic mesh has been increasingly used to repair contaminated hernias in a single-stage operation. This study provided evidence that the latter approach results in significant wound morbidity and high rate of hernia recurrence. Though well-designed and demonstrating good follow-up, this analysis was limited to a single center and surgeon. Additionally, the research group switched operative techniques mid-way through the study.

Click to read the study in Annals of Surgery

Click to read the accompanying editorial in Annals of Surgery

Relevant Reading: Use of mesh during ventral hernia repair in clean-contaminated and contaminated cases: outcomes of 33,832 cases

In-Depth [retrospective analysis]: This study reviewed prospectively collected data from 128 patients who underwent a single-staged contaminated ventral hernia repair with a biologic mesh. The cases reviewed were limited to wounds classified as clean-contaminated, contaminated or dirty. Slightly more than half of the patients were female. Most were middle age with a mean ASA score of 3.1. The patients have had a significant number of previous abdominal operations (mean of 5 prior surgeries) and most had hernia repairs in the past (mean of 2.5). Their wounds were considered contaminated by a variety of reasons, including major infection risk factors such as previously placed mesh that was now infected and concurrent gastrointestinal intervention. Almost half of the patients had wound-related complications; a third of those required reoperation, readmission, or an interventional radiology procedure. However, all wound-related complications resolved within 60 days. A third of all patients had a hernia recurrence within a mean follow-up duration of 21.7 months.    

By Asya Ofshteyn and Allen Ho

More from this author:  Patient satisfaction a poor surgical quality indicator, Liver transplant prolongs life in metastatic colorectal cancerPediatric post-operative intussusception more common in open surgeryCTA as an alternative to angiography for blunt cerebrovascular trauma detection, Low infection risk with neurologic endovascular procedures, Post-operative PTSD intervention improves physical outcomes in trauma patients

© 2013 2minutemedicine.com. All rights reserved. No works may be reproduced without written consent from 2minutemedicine.com. Disclaimer: We present factual information directly from peer reviewed medical journals. No post should be construed as medical advice and is not intended as such by the authors or by 2minutemedicine.com. PLEASE SEE A HEALTHCARE PROVIDER IN YOUR AREA IF YOU SEEK MEDICAL ADVICE OF ANY SORT. Content is produced in accordance with fair use copyrights solely and strictly for the purpose of teaching, news and criticism. No benefit, monetary or otherwise, is realized by any participants or the owner of this domain.