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Mesh Repair in Crohn’s Disease: A Case-Matched Multicenter Study in 234 Patients

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Abstract

Background

There are no specific guidelines for ventral hernia management in Crohn’s disease (CD) patients. We aimed to assess the risk of septic morbidity after mesh repair in CD.

Methods

This was a retrospective multicentre study comparing CD and non-CD patients undergoing mesh repair for ventral hernia (primary or incisional hernia). Controls were matched 1:1 for the presence of a stoma, history of surgical sepsis, hernia size and Ventral Hernia Working Group (VHWG) score. All demographic, pre-, intra- and postoperative data were retrieved, including long-term data.

Results

We included 234 patients, with 114 CD patients. Both groups had comparable VHWG scores (p = 0.12), hernia sizes (p = 0.11), ASA scores ≥ 3 (p = 0.70), body mass index values (p = 0.14), presence of stoma (CD 21.9% vs. controls 15%, p = 0.16), history of sepsis (14% vs. 6.7%, p = 0.23), rates of malnutrition (4.4% vs. 1.7%, p = 0.46), rates of incisional hernia (93% vs. 95%, p = 0.68) and concomitant procedures (18.4% vs. 11.7%, p = 0.12). CD patients carried a higher risk of postoperative septic morbidity (18.4% vs. 5%, p = 0.001), entero-prosthetic fistula (7% vs. 0, p < 0.01) and mesh withdrawals (5.3% vs. 0, p = 0.011). Ventral hernia recurrence rates were similar (14% vs. 8.3%, p = 0.15). In the univariate analysis, the risk factors for septic morbidity were CD (p = 0.001), malnutrition (p = 0.004), use of biological mesh (p < 0.0001) and concomitant procedure (p = 0.004). The mesh position, the means used for mesh fixation as well as the presence of a stoma were not identified as risk factors.

Conclusions

CD seems to be a risk factor for septic morbidity after mesh repair.

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Acknowledgements

To the GETAID Chirurgie Group collaborators, for their valuable help in this work.

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Authors and Affiliations

  1. Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Univ, Chemin des Bourrely, 13015, Marseille, France

    Laura Beyer-Berjot & Stéphane Berdah

  2. Department of Digestive, Oncologic and Metabolic Surgery, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, UVSQ/Université Paris Saclay, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France

    David Moszkowicz

  3. Department of Digestive Surgery, Hôpital Charles-Nicolle, CHU de Rouen, 1 rue de Germont, 76000, Rouen, France

    Valérie Bridoux & Jean-Jacques Tuech

  4. Department of Digestive Surgery, Hôpital Claude Huriez, CHRU de Lille, rue Michel Polonowski, 59037, Lille, France

    Lucil Schneider & Philippe Zerbib

  5. Department of Digestive Surgery, Hôpital Saint Eloi, CHU de Montpellier, 80 Avenue Augustin Fliche, 34000, Montpellier, France

    Luca Theuil & François-Régis Souche

  6. Department of Gastrointestinal Surgery, Hospices Civils de Lyon, Université de Lyon, Centre Hospitalier Lyon-Sud, 165 chemin du grand Revoyet, 69495, Pierre Bénite, France

    Yves François & Eddy Cotte

  7. Department of Digestive and Oncologic Surgery, Hôpital Bicêtre, APHP, Université Paris Sud, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France

    Solafah Abdalla & Antoine Brouquet

  8. Department of Colorectal Surgery, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université Paris VII Diderot, 100 Boulevard du Général Leclerc, 92110, Clichy, France

    Léon Maggiori & Yves Panis

Authors
  1. Laura Beyer-Berjot
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  2. David Moszkowicz
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  3. Valérie Bridoux
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  4. Lucil Schneider
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  15. Stéphane Berdah
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Consortia

The GETAID Chirurgie Group

Corresponding author

Correspondence to Laura Beyer-Berjot.

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Annex 1: Types of mesh included in the study

Annex 1: Types of mesh included in the study

Synthetic mesh

  • Polypropylene: Promesh® (Peters Surgical, Bobigny, France), Ventralight™ (Bard, Warwick, RI, USA) Prolene® (Ethicon, Somerville, NJ, USA), Proceed® (Ethicon, Somerville, NJ, USA), Physiomesh™ (Ethicon, Somerville, NJ, USA);

  • Composite polypropylene and ePTFE: Composix™ (Bard, Warwick, RI, USA), Ventralex™ (Bard, Warwick, RI, USA), C.A.B.S.’air® (Cousin, Werwicq-Sud, France);

  • Composite polypropylene and hydrogel: Sepramesh™ (Bard, Warwick, RI, USA);

  • Polyester: Parietex™ (Medtronic, Minneapolis, MN, USA).

Biological mesh

  • Biological: Strattice™ (Allergan, Dublin, Ireland), Meccellis® (Meccellis Biotech, La Rochelle, France), Permacol™ (Medtronic, Minneapolis, MN, USA), Protexa® (Tecnoss, Giaveno, Italy)

  • Biosynthetic absorbable: Gore-Bio A® (Gore, Newark, DE, USA).

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Beyer-Berjot, L., Moszkowicz, D., Bridoux, V. et al. Mesh Repair in Crohn’s Disease: A Case-Matched Multicenter Study in 234 Patients. World J Surg 44, 2394–2400 (2020). https://doi.org/10.1007/s00268-020-05436-y

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  • DOI: https://doi.org/10.1007/s00268-020-05436-y

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