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Absorbable mesh in a contaminated field: hernia repair outcomes

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Abstract

Hernia repair mesh aids in the stability of incisional hernia repair and can reduce the need for subsequent operations. There is, however, debate among surgeons over which type of hernia mesh—synthetics, biologics, or biosynthetics—is indicated as best for specific patients. A retrospective case review comparing surgical outcomes based on wound class and mesh materials may provide insights into this question. This study evaluates patient outcomes using biosynthetic mesh based upon CDC wound classification. Following Institutional Review Board approval, the local National Surgery Quality Improvement (NSQIP) databases were queried for open ventral hernia repaired with absorbable mesh implants from January 2013–December 2017. Factors for comparison included patient demographics, operative details, and an analysis of clinical outcomes. Our study identified 112 ventral hernia repair cases with absorbable mesh placement, 32% (n = 36) were wound classes II–IV. Higher wound class correlated statistically with diabetes (33.3%), prior hernia repair (61.1%), and parastomal hernia (44.4%). Higher wound classes were associated with more emergent presentations, involved bowel resection more frequently, required larger mesh implants, increased post-operative surgical site infections, and wound disruption. Increasing wound class was also associated with longer hospital stays and greater need for readmission (38.9% vs. 11.8%). Compared to patients with clean wounds, biosynethic mesh repair patients with contaminated wounds exhibited more emergent presentations, increased incidence of bowel resection, increased mesh size, and more readmissions. Despite these peri-operative outcomes, hernia recurrence rates among biosynethic mesh hernia repair were similar in CDC class II–IV patients as class I.

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This research received no grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgery, University of Kentucky College of Medicine, 780 Rose Street, Lexington, KY, 40536, USA

    Victoria Wagner, Brittany E. Levy, Jennifer T. Castle, Margret Plymale, John S. Roth & Crystal Totten

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  1. Victoria Wagner
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  2. Brittany E. Levy
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  3. Jennifer T. Castle
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  4. Margret Plymale
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  5. John S. Roth
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  6. Crystal Totten
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Correspondence to Brittany E. Levy.

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Conflict of interest

The authors declare there are no conflicts of interest associated with the content of this manuscript. Brittany Levy, MD has served as a consultant to Ethicon, Johnson and Johnson. Crystal Totten, MD has served as a consultant to Becton Dickinson John S. Roth, MD has received research grants from Becton Dickinson, Advanced Medical Solutions, and W.L. Gore. He also served as consultant to Becton Dickinson, Medtronic, and Abbvie.

Research involving human participants and/or animals, and Informed consent

This retrospective cohort study was approved under an expedited status with a waiver of informed consent, due to no more than minimal risk to the study participants. 

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Wagner, V., Levy, B.E., Castle, J.T. et al. Absorbable mesh in a contaminated field: hernia repair outcomes. Updates Surg 75, 1337–1342 (2023). https://doi.org/10.1007/s13304-022-01433-z

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  • DOI: https://doi.org/10.1007/s13304-022-01433-z

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