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Biologic mesh for repair of ventral hernias in contaminated fields: long-term clinical and patient-reported outcomes

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Abstract

Background

Guidelines recommend biologic prosthetics for ventral hernia repair (VHR) in contaminated fields, yet long-term and patient-reported data are limited. We aimed to determine the long-term rate of hernia recurrence, and other clinical and patient-reported outcomes following the use of porcine small intestine submucosa (PSIS) for VHR in a contaminated field.

Methods

Consecutive patients undergoing open VHR with PSIS mesh in a contaminated field from 2004 to 2014 were prospectively evaluated for hernia recurrence and other post-operative complications. Multivariate logistic and Cox regression analyses identified predictors of hernia recurrence and surgical site infection. Patient-reported outcomes were evaluated using SF-36, Hernia-Related Quality-of-Life Survey (HerQLes) and Body Image Questionnaire instruments.

Results

Forty-six hernias were repaired in clean-contaminated [16 (35 %)], contaminated [11 (24 %)] and dirty [19 (41 %)] fields. Median follow-up was 47 months [interquartile range: 31–79] and all patients had greater than 12-month follow-up. Sixteen patients (35 %) were not re-examined. Incidence of surgical site events and surgical site infection were 43 % (n = 20) and 56 % (n = 25), respectively. American Society of Anesthesiologists score 3 or greater was an independent predictor of surgical site infection (odds ratio 5.34 [95 % confidence interval 1.01–41.80], p = 0.04). Hernia recurrence occurred in 61 % (n = 28) with a median time to diagnosis of 16 months [interquartile range 8–26]. After bridged repair, 16 of 18 patients (89 %) recurred, compared to 12 of 28 (43 %) when fascia was approximated (p < 0.01). Bridged repair was an independent predictor of recurrence (odds ratio 10.67 [95 % confidence interval 2.42–76.08], p < 0.01). Patients with recurrences had significantly worse scores on the SF-36 mental health component and self-perceived body image, whereas HerQLes scores were similar.

Conclusions

Hernia recurrences and wound infections are high with the use of biologic PSIS mesh in contaminated surgical fields. Careful consideration is warranted using this approach.

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Acknowledgments

Dr. Amin Madani is supported by the Quebec Health Science Research Scholarship (FRQ-S) and the McGill Surgeon-Scientist Program.

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Authors and Affiliations

  1. Department of Surgery, McGill University Health Centre, 1650 Cedar Avenue, Rm D6-257, Montreal, QC, H3G 1A4, Canada

    Amin Madani, Melina C. Vassiliou, Kosar Khwaja, Paola Fata, Gerald M. Fried & Liane S. Feldman

  2. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Canada

    Amin Madani, Petru Niculiseanu, Wanda Marini, Pepa A. Kaneva, Benjamin Mappin-Kasirer, Melina C. Vassiliou, Kosar Khwaja, Gerald M. Fried & Liane S. Feldman

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  1. Amin Madani
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Correspondence to Amin Madani.

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Conflict of interest

AM is supported by a Quebec Health Science Research (FRQ-S) scholarship and the McGill Surgeon-Scientist Program. The Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation is supported by an unrestricted educational grant from Medtronic.

Disclosures

There was no financial and material support for this work. Drs. Amin Madani, Petru Niculiseanu, Wanda Marini, Pepa A. Kaneva, Benjamin Mappin-Kasirer, Melina Vassiliou, Kosar Khwaja, Paola Fata, Gerald M. Fried and Liane S. Feldman have no conflicts of interest or financial ties to disclose. The Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation is supported by an unrestricted educational grant from Medtronic.

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Madani, A., Niculiseanu, P., Marini, W. et al. Biologic mesh for repair of ventral hernias in contaminated fields: long-term clinical and patient-reported outcomes. Surg Endosc 31, 861–871 (2017). https://doi.org/10.1007/s00464-016-5044-1

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  • DOI: https://doi.org/10.1007/s00464-016-5044-1

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