, Volume 17, Issue 1, pp 31–35 | Cite as

Evaluation of surgical outcomes of retro-rectus versus intraperitoneal reinforcement with bio-prosthetic mesh in the repair of contaminated ventral hernias

  • M. J. Rosen
  • G. DeNoto
  • K. M. F. Itani
  • C. Butler
  • D. Vargo
  • J. Smiell
  • R. Rutan
Original Article



Hernia repairs in contaminated fields are often reinforced with a bioprosthetic mesh. When choosing which of the multiple musculofascial abdominal wall planes provides the most durable repair, there is little guidance. We hypothesized that the retro-rectus plane would reduce recurrence rates versus intraperitoneal placement due to greater surface area contact of mesh with well-vascularized tissue.


Forty-nine of the 80 patients in an ongoing, prospective, multicenter study of contaminated ventral hernia repairs (RICH study, NCT00617357) achieved fascial closure after musculofascial centralization and reinforcement with non-crosslinked porcine acellular dermal matrix (Strattice™, LifeCell, Branchburg, NJ) and were retrospectively analyzed. The Strattice was placed in the retro-rectus position in 23 patients and in the intraperitoneal position in 26.


Subjects were comparable in age, obesity, prior wound infection, presence of a stoma, and infected mesh removal (p > 0.05). More smokers were present in the intraperitoneal group (p = 0.02). Retro-rectus defects were significantly wider and had larger area than the intraperitoneal repairs. At the 1-year follow-up, 44 (90%) of patients were available for review. There was no difference in wound infections, seromas, or hematomas. Recurrent hernias were identified in 10% of retro-rectus repairs and 30% of intraperitoneal repairs (p = 0.14).


In this retrospective analysis of a prospective multicenter study of large, contaminated ventral hernias, despite a larger hernia defect in the retro-rectus group, placement of the mesh in the retro-rectus compartment resulted in a similar recurrence rate to intraperitoneal mesh placement. Ongoing evaluation is important to establish longer-term outcomes and the validity of these findings.


Contaminated hernia repair Sublay mesh Retro-rectus mesh Biologic mesh 



This study was funded by Lifecell.

Conflict of interest

Jan Smiell is Chief Medical Officer of Lifecell, and Randi Rutan is Chief Clinical Officer of Lifecell.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • M. J. Rosen
    • 1
  • G. DeNoto
    • 1
  • K. M. F. Itani
    • 1
  • C. Butler
    • 1
  • D. Vargo
    • 1
  • J. Smiell
    • 1
  • R. Rutan
    • 1
  1. 1.Division of GI and General Surgery, Case Medical CenterUniversity Hospitals of ClevelandClevelandUSA

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