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
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