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Right Colectomy with Absorbable Mesh Repair as a Salvage Solution for the Management of Giant Incisional Hernia with Loss of Domain: Results of a Bicentric Study

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Abstract

Background

Incisional hernia (IH) may occur in 20% of patients after laparotomy. The hernia sac volume may be of significance, with reintegration of visceral contents potentially leading to repair failure or abdominal compartment syndrome. The present study aimed to evaluate a two-step surgical strategy comprising right colectomy for hernia reduction with synchronous absorbable mesh repair followed by definitive non-absorbable mesh repair in recurrence.

Methods

Patients operated between 2012 and 2017 at two university centers were retrospectively included. Volumetric evaluation of the IH was performed by CT imaging.

Results

Eleven patients were included. The mean BMI was 43 kg/m2 (23–52 kg/m2). Progressive preoperative pneumoperitoneum was performed in 82% of patients, with complications in 22%. The mean volumetric ratio of the volume of the hernia to the volume of the abdominal cavity was 70% (48–100%). The first parietal repair was performed using an synthetic absorbable mesh (36%), a biologic mesh (27%), or a slowly absorbable mesh (36%). No patients died as a result of the procedure. Seven (64%) patients developed grade III–IV complications, including one case of an anastomotic fistula. Recurrence occurred in eight (73%) patients after the first repair. Of these, four (50%) patients were reoperated using a non-absorbable mesh, leading to solid repair in 75% of cases. After 27 ± 18 months of follow-up, the residual IH rate was 46%.

Conclusions

Right colectomy for volume reduction in IH with loss of domain potentially represents an appropriate salvage option, supporting bowel reintegration and temporary hernia repair with absorbable material.

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Authors and Affiliations

  1. AP-HP, Department of Digestive, Oncologic and Metabolic Surgery, Ambroise Paré Hospital, Boulogne-Billancourt, France

    Olivier Benoit, David Moszkowicz, Dominique Cabral, Frédérique Peschaud & Jean-Luc Bouillot

  2. Versailles St-Quentin-en-Yvelines/Paris Saclay University, UFR des sciences de la santé Simone Veil, 78180, Montigny-le-Bretonneux, France

    Olivier Benoit, David Moszkowicz, Dominique Cabral, Frédérique Peschaud & Jean-Luc Bouillot

  3. Department of Digestive and Bariatric Surgery, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France

    Laurent Milot & Maud Robert

  4. CarMeN Laboratory, INSERM 1060, Université Claude Bernard Lyon 1, Lyon, France

    Laurent Milot & Maud Robert

  5. Department of General, Visceral and Endocrine Surgery, Clinique de la Sauvegarde, Lyon, France

    Marie-Cécile Blanchet

Authors
  1. Olivier Benoit
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  2. David Moszkowicz
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  3. Laurent Milot
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  7. Jean-Luc Bouillot
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Correspondence to David Moszkowicz.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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I hereby undersign and certificate that this article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all patients prior to their inclusion in the study.

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Benoit, O., Moszkowicz, D., Milot, L. et al. Right Colectomy with Absorbable Mesh Repair as a Salvage Solution for the Management of Giant Incisional Hernia with Loss of Domain: Results of a Bicentric Study. World J Surg 44, 1762–1770 (2020). https://doi.org/10.1007/s00268-020-05395-4

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