Abstract
Introduction
In the Transversus Abdominis Release (TAR) procedure, ideally, the posterior sheath is completely reapproximated to establish an interface isolating the polypropylene mesh from visceral contents. When primary closure of the posterior sheath is unachievable, Vicryl mesh is commonly used to supplement the posterior sheath closure and an uncoated polypropylene mesh is placed superficial to the Vicryl mesh. The long-term implications of utilizing Vicryl mesh as an antiadhesive barrier are poorly understood. In this study, we aimed to assess our outcomes when utilizing Vicryl mesh to supplement the posterior sheath defects when placed underneath polypropylene mesh in patients undergoing posterior component separation.
Methods
Adult patients who underwent VHR with concurrent TAR procedure with a permanent synthetic mesh and posterior sheath supplementation with Vicryl mesh in the Cleveland Clinic Center for Abdominal Core Health between January 2014 and December 2022 were queried retrospectively from a prospectively collected database in the Abdominal Core Health Quality Collaborative. We evaluated 30-day wound morbidity, perioperative complications, long-term mesh-related complications, and pragmatic hernia recurrence.
Results
53 patients who underwent TAR procedure with posterior sheath supplementation using Vicryl mesh and had a minimum 12-month follow-up were identified. Of the 53 patients, 94.3% presented with recurrent hernias, 73.6% had a midline hernia, 7.5% had a flank hernia, and 18.9% had concurrent parastomal hernia. The mean hernia width was 24.9 cm (± 8.8 cm). No Vicryl mesh-related operative complications were identified in our study, with no instances of mesh erosion, fistulas, or interventions for small bowel obstruction. Skin necrosis requiring reoperations was observed in three patients (5.7%), leading to permanent mesh excision in two cases (3.8%) without intraabdominal visceral involvement. Throughout the 12-month follow-up, 23 incidences (43.4%) of surgical site occurrences (SSOs) and surgical site occurrences requiring procedural intervention (SSOPI) were documented.
Conclusions
Our findings suggest that posterior sheath supplementation with Vicryl mesh is a feasible approach to achieve posterior sheath closure in challenging abdominal wall reconstruction cases. Given the absence of notable mesh-related complications and a similar hernia recurrence rate to cases without posterior sheath supplementation, Vicryl mesh can be used to safely achieve posterior sheath closure in complex reconstructions with insufficient native tissue.
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Data availability
The data supporting this study's findings are available upon reasonable request from the corresponding author. Restrictions apply to the availability of these data, which were used under license for this study, and so are not publicly available. However, data are available from the authors upon reasonable request and with permission of the data custodian.
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All the authors contributed to the study's conception and design. Material preparation and data collection were performed by RCE and NM. The manuscript was written by NM and MJR. All the authors commented on and revised the manuscript. All the authors read and approved the final manuscript. The study was supervised by MJR.
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I declare that there are no conflicts of interest related to this manuscript. The study was conducted impartially, and the findings presented in the manuscript are based solely on the analysis and interpretation of the data. M.J.R receives salary support for his position in the leadership of the Abdominal Core Health Quality Collaborative (ACHQC), which is the data source for the present submission, and he receives board member support and stock options from Ariste Medical. He also has a research grant paid to his institution by Tela Bio for a clinical trial. A.S.P. has received funding paid to her institution from Intuitive Surgical Inc. and personal fees from Medtronic, Intuitive Surgical, CMR Surgical, and Verb Surgical. L.R.B has received an honorarium from Intuitive.
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The present article does not incorporate studies directly involving human participants, as it constitutes a review of preexisting data sourced from a hernia database.
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Messer, N., Miller, B.T., Beffa, L.R.A. et al. Outcomes of posterior sheath supplementation with Vicryl mesh in TAR—a single-center study. Hernia (2024). https://doi.org/10.1007/s10029-024-03054-4
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DOI: https://doi.org/10.1007/s10029-024-03054-4