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Abdominal wall reconstruction with large polypropylene mesh: is bigger better?

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Abstract

Purpose

Hernia repair for large and complex hernias presents challenges related to the availability of larger mesh sizes. When sizes beyond those manufactured are required, multiple meshes (MM) may be sutured to create a larger graft. With the availability of large polypropylene mesh up to 50 × 50 cm (LM), abdominal wall reconstruction (AWR) may be accomplished with a single mesh. This study evaluates clinical and economic outcomes following AWR with component separation utilizing MM and LM.

Methods

A retrospective study was performed with review of health records and cost accounting data. Patients that underwent AWR with LM were case matched 1:1 with patients undergoing MM repair based upon comorbidities, defect size and wound class.

Results

Twenty-four patients underwent AWR with LM. Twenty patients (10F, 10 M) who underwent AWR with LM were matched with 20 MM AWR (11F, 9 M). Age, BMI, ASA 3 + , never smoker, diabetes, and hernia characteristics were similar between LM and MM. Operative cost ($4295 vs $3669, p = 0.127), operative time (259 min vs 243 min, p = 0.817), length of stay (5.5 vs 6.2, p = 0.484), wound complication (30% vs 20%, p = 0.716), infected seroma (5% vs 5%, p = 1), and readmission (5% vs 15%, p = 0.605) were similar between LM and MM, respectively.

Conclusions

This is the first report of patients undergoing AWR with a large 50 × 50 cm prolene mesh. In this small cohort, clinical outcomes were similar between those undergoing repair with multiple sutured mesh sheets and a single large mesh.

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Authors and Affiliations

  1. University of Kentucky College of Medicine, Lexington, KY, USA

    M. Nisiewicz

  2. Division of General Surgery, Department of Surgery, C 222, Chandler Medical Center, University of Kentucky, 800 Rose Street, Lexington, KY, 40536, USA

    T. Hughes, M. A. Plymale & J. S. Roth

  3. Department of Surgery, University of Kentucky, Lexington, KY, USA

    D. L. Davenport

Authors
  1. M. Nisiewicz
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  2. T. Hughes
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  3. M. A. Plymale
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  4. D. L. Davenport
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  5. J. S. Roth
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Corresponding author

Correspondence to J. S. Roth.

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Conflict of interest

Authors MN, TH, MP, DP report no conflict of interest related to this study. JR has received grant funding from Becton Dickinson/CR Bard, is a consultant for Becton Dickinson/CR Bard, Allergan, and Johnson and Johnson and is a shareholder with Miromatrix.

Ethical approval

This study was approved by the University of Kentucky Institutional Review Board and meets all human rights and ethical standards.

Human and animal rights

This article does not contain any studies directly involving human participants as it is a review of previously collected data.

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lndividual patient consent was not required.

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Nisiewicz, M., Hughes, T., Plymale, M.A. et al. Abdominal wall reconstruction with large polypropylene mesh: is bigger better?. Hernia 23, 1003–1008 (2019). https://doi.org/10.1007/s10029-019-02026-3

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  • DOI: https://doi.org/10.1007/s10029-019-02026-3

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