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Abdominal Wall Reconstruction Utilizing the Combination of Absorbable and Permanent Mesh in a Retromuscular Position: A Multicenter Prospective Study

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Abstract

Background

Optimal mesh reinforcement for abdominal wall reconstruction (AWR) in complex hernias remains questionable. Use of biologic, absorbable and synthetic meshes has been described. The idea of using an absorbable mesh (AM) under a permanent mesh (PM) in a retromuscular position may help in these challenging situations.

Methods

Between 2011 and 2016, consecutive patients undergoing open AWR utilizing an AM as posterior layer reinforcement and configuration of a large PM were identified in a multicenter prospectively maintained database in four hospitals. Main outcomes included demographics, ventral hernia classifications, perioperative data, complications and recurrences.

Results

A total of 169 complex incisional hernias were analyzed. Mean age was 60.9, with mean body mass index 30.7 (range: 20–46). Location of incisional hernias (IH) was: 80 midline, 59 lateral and 30 midline and lateral. 78% were grade I and II in Ventral Hernia Working Group classification. 52% of patients were discharged with no complication. There were 19% seromas, 13% hematomas, 12% surgical-site infection and 10% skin dehiscence. Only partial mesh removal was necessary in one patient. After a mean follow-up of 26 months (range 15–59), there were five (3.2%) recurrences. Reoperations on patients showed a band of fibrosis separating the peritoneum from the PM.

Conclusion

The combination of AM with very large PM in the same retromuscular position in AWR seems to be safe. The efficacy with recurrence rates below 4% in complex midline and lateral IH may be explained by the use of larger PMs that are extended and configured with the support of AMs. Reoperations on patients have confirmed the previous experimental reports on the use of the AM.

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References

  1. Bower C, Roth JS (2013) Economics of abdominal wall reconstruction. Surg Clin North Am 93:1241–1253

    Article  PubMed  Google Scholar 

  2. Slater NJ, Montgomery A, Berrevoet F et al (2014) Criteria for definition of a complex abdominal wall hernia. Hernia 18:7–17

    Article  CAS  PubMed  Google Scholar 

  3. Iqbal CW, Pham TH, Joseph A, Mai J, Thompson GB, Sarr MG (2007) Long-term outcome of 254 complex incisional hernia repairs using the modified Rives-Stoppa technique. World J Surg 31:2398–2404. https://doi.org/10.1007/s00268-007-9260-7

    Article  PubMed  Google Scholar 

  4. Mehrabi M, Jangjoo A, Tavoosi H, Kahrom M, Kahrom H (2010) Long-term outcome of Rives-Stoppa technique in complex ventral incisional hernia repair. World J Surg 34:1696–1701. https://doi.org/10.1007/s00268-010-0426-3

    Article  PubMed  Google Scholar 

  5. Carbonell AM, Cobb WS, Chen SM (2008) Posterior components separation during retromuscular hernia repair. Hernia 12:359–362

    Article  CAS  PubMed  Google Scholar 

  6. Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ (2012) Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg 204:709–716

    Article  PubMed  Google Scholar 

  7. Posielski NM, Yee ST, Majumder A, Orenstein SB, Prabhu AS, Novitsky YW (2015) Repair of massive ventral hernias with “quilted” mesh. Hernia 19:465–472

    Article  CAS  PubMed  Google Scholar 

  8. Gibreel W, Sarr MG, Rosen M, Novitsky Y (2016) Technical considerations in performing posterior component separation with transverse abdominis muscle release. Hernia 20:449–459

    Article  CAS  PubMed  Google Scholar 

  9. Pauli EM, Wang J, Petro CC, Juza RM, Novitsky YW, Rosen MJ (2015) Posterior component separation with transversus abdominis release successfully addresses recurrent ventral hernias following anterior component separation. Hernia 19:285–291

    Article  CAS  PubMed  Google Scholar 

  10. Winder JS, Behar BJ, Juza RM, Potochny J, Pauli EM (2016) Transversus abdominus release for abdominal wall reconstruction: early experience with a novel technique. J Am Coll Surg 223:271–278

    Article  PubMed  Google Scholar 

  11. Petro CC, Como JJ, Yee S, Prabhu AS, Novitsky YW, Rosen MJ (2015) Posterior component separation and transversus abdominis muscle release for complex incisional hernia repair in patients with a history of an open abdomen. J Trauma Acute Care Surg 78:422–429

    Article  PubMed  Google Scholar 

  12. Petro CC, Orenstein SB, Criss CN et al (2015) Transversus abdominis muscle release for repair of complex incisional hernias in kidney transplant recipients. Am J Surg 210:334–339

    Article  PubMed  Google Scholar 

  13. Novitsky YW, Fayezizadeh M, Majumder A, Neupane R, Elliott HL, Orenstein SB (2016) Outcomes of posterior component separation with transversus abdominis muscle release and synthetic mesh sublay reinforcement. Ann Surg 264:226–232

    Article  PubMed  Google Scholar 

  14. Rosen MJ, Bauer JJ, Harmaty M et al (2017) Multicenter, prospective, longitudinal study of the recurrence, surgical site infection, and quality of life after contaminated ventral hernia repair using biosynthetic absorbable mesh: the COBRA study. Ann Surg 265:205–211

    Article  PubMed  Google Scholar 

  15. Liu L, Petro C, Majumder A, Fayezizadeh M, Anderson J, Novitsky YW (2016) The use of Vicryl mesh in a porcine model to assess its safety as an adjunct to posterior fascial closure during retromuscular mesh placement. Hernia 20:289–295

    Article  CAS  PubMed  Google Scholar 

  16. Winder JS, Majumder A, Fayezizadeh M, Novitsky YW, Pauli EM (2018) Outcomes of utilizing absorbable mesh as an adjunct to posterior sheath closure during complex posterior component separation. Hernia 22:303–309

    Article  CAS  PubMed  Google Scholar 

  17. Augenstein VA, Colavita PD, Wormer BA et al (2015) CeDAR: Carolinas equation for determining associated risks. J Am Coll Surg 221:S65–S66

    Article  Google Scholar 

  18. Muysoms FE, Miserez M, Berrevoet F et al (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13:407–414

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Ventral Hernia Working G, Breuing K, Butler CE et al (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148:544–558

    Article  Google Scholar 

  20. Petro CC, O’Rourke CP, Posielski NM et al (2016) Designing a ventral hernia staging system. Hernia 20:111–117

    Article  CAS  PubMed  Google Scholar 

  21. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR, Guideline for Prevention of Surgical Site Infection (1999) Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1999(27):97–132

    Article  Google Scholar 

  22. Bueno-Lledo J, Torregrosa A, Ballester N et al (2017) Preoperative progressive pneumoperitoneum and botulinum toxin type A in patients with large incisional hernia. Hernia 21:233–243

    Article  CAS  PubMed  Google Scholar 

  23. Stoppa RE (1989) The treatment of complicated groin and incisional hernias. World J Surg 13:545–554. https://doi.org/10.1007/BF01658869

    Article  CAS  PubMed  Google Scholar 

  24. Stoppa RE (2003) Wrapping the visceral sac into a bilateral mesh prosthesis in groin hernia repair. Hernia 7:2–12

    PubMed  Google Scholar 

  25. Robin A, Blazquez Hernando L, López-Monclús J et al (2018) How we do it: down to up posterior components separation. Langenbecks Arch Surg 403(4):539–546

    Article  Google Scholar 

  26. von Elm E, Altman DG, Egger M et al (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 147:573–577

    Article  Google Scholar 

  27. Muysoms FE, Deerenberg EB, Peeters E et al (2013) Recommendations for reporting outcome results in abdominal wall repair: results of a consensus meeting in Palermo, Italy, 28–30 June 2012. Hernia 17:423–433

    Article  CAS  PubMed  Google Scholar 

  28. Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  Google Scholar 

  29. Petro CC, Nahabet EH, Criss CN et al (2015) Central failures of lightweight monofilament polyester mesh causing hernia recurrence: a cautionary note. Hernia 19:155–159

    Article  CAS  PubMed  Google Scholar 

  30. Booth JH, Garvey PB, Baumann DP et al (2013) Primary fascial closure with mesh reinforcement is superior to bridged mesh repair for abdominal wall reconstruction. J Am Coll Surg 217:999–1009

    Article  PubMed  Google Scholar 

  31. Giordano S, Garvey PB, Baumann DP, Liu J, Butler CE (2017) Primary fascial closure with biologic mesh reinforcement results in lesser complication and recurrence rates than bridged biologic mesh repair for abdominal wall reconstruction: a propensity score analysis. Surgery 161:499–508

    Article  PubMed  Google Scholar 

  32. Garvey PB, Giordano SA, Baumann DP, Liu J, Butler CE (2017) Long-term outcomes after abdominal wall reconstruction with acellular dermal matrix. J Am Coll Surg 224:341–350

    Article  PubMed  Google Scholar 

  33. Garcia-Urena M, Lopez-Monclus J, Blazquez Hernando L, et al (2016) Giant bilateral subcostal incisional hernia solved by rectromuscular repair and transversus abdomins release. In: Ciné-Med, Inc. https://cine-med.com/acsonline/ Accessed 15 May 2018

  34. Ross SW, Oommen B, Huntington C et al (2015) National outcomes for open ventral hernia repair techniques in complex abdominal wall reconstruction. Am Surg 81:778–785

    PubMed  Google Scholar 

  35. Lopez-Cano M, Armengol M, Quiles MT et al (2013) Preventive midline laparotomy closure with a new bioabsorbable mesh: an experimental study. J Surg Res 181:160–169

    Article  PubMed  Google Scholar 

  36. Veyrie N, Poghosyan T, Corigliano N, Canard G, Servajean S, Bouillot JL (2013) Lateral incisional hernia repair by the retromuscular approach with polyester standard mesh: topographic considerations and long-term follow-up of 61 consecutive patients. World J Surg 37:538–544. https://doi.org/10.1007/s00268-012-1857-9

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, Henares University Hospital, Francisco de Vitoria University, Avenida de Marie Curie, s/n, 28822, Coslada, Madrid, Spain

    Miguel Ángel García-Ureña, Luis Alberto Blázquez Hernando, Carlos San Miguel Méndez, Arturo Cruz Cidoncha & Alvaro Robin Valle de Lersundi

  2. Department of Surgery, Puerta de Hierro University Hospital, Madrid, Spain

    Javier López-Monclús & Elena Jiménez Cubedo

  3. Department of Surgery, La Fe University Hospital, Valencia, Spain

    Providencia García-Pastor

  4. Department of Surgery, Monaldi Azienda Ospedaliera dei Colli, Naples, Italy

    Diego Cuccurullo & Stefano Reggio

Authors
  1. Miguel Ángel García-Ureña
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  2. Javier López-Monclús
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  3. Diego Cuccurullo
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  4. Luis Alberto Blázquez Hernando
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  5. Providencia García-Pastor
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  6. Stefano Reggio
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  7. Elena Jiménez Cubedo
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  8. Carlos San Miguel Méndez
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  9. Arturo Cruz Cidoncha
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  10. Alvaro Robin Valle de Lersundi
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Corresponding author

Correspondence to Miguel Ángel García-Ureña.

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Conflict of interest

García-Urena has received speaker fees for symposium organized by Dynamesh, Braun, and Gore. Lopez-Monclús has received speaker fees for symposium organized by Gore.

Electronic supplementary material

Below is the link to the electronic supplementary material.

3D-configuration of a large PM with the support of AM after a left TAR and right Rives in a large iliac incisional hernia (MP4 55,539 kb)

Stoppa configuration and extension of a large PM after a bilateral TAR in a complex midline incisional hernia (MP4 28,417 kb)

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García-Ureña, M.Á., López-Monclús, J., Cuccurullo, D. et al. Abdominal Wall Reconstruction Utilizing the Combination of Absorbable and Permanent Mesh in a Retromuscular Position: A Multicenter Prospective Study. World J Surg 43, 149–158 (2019). https://doi.org/10.1007/s00268-018-4765-9

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  • DOI: https://doi.org/10.1007/s00268-018-4765-9

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