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Hernia

, 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

Abstract

Introduction

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

Contaminated hernia repair Sublay mesh Retro-rectus mesh Biologic mesh 

Notes

Acknowledgments

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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