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Retro-rectus placement of bio-absorbable mesh improves patient outcomes

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Abstract

Background

There is little consensus on the ideal anatomical placement of bio-absorbable mesh. We hypothesized that retro-rectus placement of bio-absorbable mesh would significantly reduce recurrence rates when compared to intraperitoneal mesh placement.

Methods

A retrospective review was conducted of patients who underwent open complex ventral hernia repair using bio-absorbable mesh (Bio-A, Gore, Flagstaff, AZ). Patient demographics and Centers for Disease Control wound type were collected.

Results

A total of 81 patients were included. Seventy-four (91.4%) of these hernia repairs had mesh in the retro-rectus position, while 7 (8.6%) had intraperitoneal mesh placement. Patient demographics, including preoperative comorbidities, did not differ between groups. The retro-rectus group trended to have larger hernia defects (156.2 cm2) compared to the intraperitoneal group (63.9 cm2) (p = 0.058). Overall complications (e.g., dehiscence, wound drainage, cellulitis, sepsis) were also similar in both groups of patients. Recurrence rates in the retro-rectus and intraperitoneal group were 8.1% and 42.9%, respectively (p = 0.005). When evaluating only patients with CDC class 1 wounds, the recurrence rate in the retro-rectus group was 8.2% and the intraperitoneal group was 50% (p = 0.02). Overall, the average patient follow-up was 22 months and did not differ between groups. Both the retro-rectus and intraperitoneal groups indicated a significant (p < 0.05) improvement in quality of life from baseline. No long-term (> 7 days) antibiotics were used and no mesh implants were removed during the study.

Conclusion

Patients who underwent open complex ventral hernia repairs with bio-absorbable mesh in the retro-rectus position experienced lower overall complication rates than those with intraperitoneal mesh placement. Despite a larger hernia defect in the retro-rectus group, recurrence rates were significantly reduced with retro-rectus placement of mesh compared to intraperitoneal placement. In addition, recurrence rates using bio-absorbable mesh in clean wounds are comparable to previously published recurrence rates with permanent mesh.

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Authors and Affiliations

  1. Department of Anesthesia, University of California Davis, Davis, CA, USA

    Juliann E. Cho

  2. Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, USA

    Melissa C. Helm, Joseph H. Helm, Neil Mier, Andrew S. Kastenmeier, Jon C. Gould & Matthew I. Goldblatt

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  1. Juliann E. Cho
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  2. Melissa C. Helm
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  3. Joseph H. Helm
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  4. Neil Mier
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  5. Andrew S. Kastenmeier
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  6. Jon C. Gould
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  7. Matthew I. Goldblatt
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Corresponding author

Correspondence to Matthew I. Goldblatt.

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Disclosures

Andrew Kastenmeier, MD has received personal fees from WL Gore. Jon Gould, MD has received personal fees from WL Gore and Grant funding and personal fees from Torax Medical. Matthew Goldblatt, MD has received personal fees from WL Gore, grant funding and personal fees from Medtronic, grant funding from Merck, personal fees from Allergan, and grant funding from BD. Juliann Cho, Melissa Helm, Joseph Helm and Neil Mier no conflicts of interest or financial ties to disclose.

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Cho, J.E., Helm, M.C., Helm, J.H. et al. Retro-rectus placement of bio-absorbable mesh improves patient outcomes. Surg Endosc 33, 2629–2634 (2019). https://doi.org/10.1007/s00464-018-6560-y

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  • DOI: https://doi.org/10.1007/s00464-018-6560-y

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