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Closed-incision negative-pressure therapy decreases complications in ventral hernia repair with concurrent panniculectomy

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Abstract

Purpose

Ventral hernia repair with concurrent panniculectomy (VHR-PAN) is associated with high wound complication rates despite reported increased patient satisfaction. Some surgeons believe negative-pressure therapy after primary closure of the surgical incision (ciNPT) may lower wound complications in high-risk abdominal wounds. This study aims to evaluate if ciNPT improves outcomes in patients undergoing VHR-PAN.

Methods

An 8-year retrospective cohort study was performed on patients who underwent VHR-PAN. Patients were divided into two groups: those who received closed-incision negative-pressure therapy (“ciNPT”) and those who received standard sterile dressings (“SSD”). The primary outcome of interest was the rate of postoperative complications between these groups. Complications were subdivided into surgical site occurrences (which included surgical site occurrences that required an intervention), return to the operating room, and hernia recurrence.

Results

A total of 104 patients were analyzed: 62 in the ciNPT group and 42 in the SSD group. Median follow-up duration was similar between both groups (182 days vs 195 days, p = 0.624). Patients in the ciNPT group had fewer total complications (57% vs. 83%, p = 0.004) and fewer SSO (47% vs. 69%, p = 0.025). However, no differences were noted when comparing individual complications (SSI, wound dehiscence, skin necrosis, chronic wound, seroma, and hematoma). There was no difference in return to the operating room (27% vs. 26%, p = 0.890) or hernia recurrence (21% vs 19%, p = 0.811). Multivariate analysis showed that ciNPT decreased the risk of SSOPI nearly fourfold (odds ratio 0.28, 95% CI = 0.09–0.87, p = 0.027).

Conclusions

This study showed that closed-incision negative-pressure therapy in ventral hernia repair with concurrent panniculectomy may decrease the rate of wound complications in this high-risk population.

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Author information

Authors and Affiliations

  1. Division of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, 110 S. Paca St., 21201, Baltimore, MD, USA

    S. C. Diaconu, M. P. Grant & A. J. Nam

  2. Division of Plastic and Reconstructive Surgery, University of Maryland Medical Center, 22 South Greene St., S8D18, 21201, Baltimore, MD, USA

    C. H. L. McNichols, L. M. Ngaage, Y. Liang, E. Ikheloa, J. Bai & Y. M. Rasko

Authors
  1. S. C. Diaconu
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  2. C. H. L. McNichols
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  3. L. M. Ngaage
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  4. Y. Liang
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  5. E. Ikheloa
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  6. J. Bai
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  7. M. P. Grant
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  8. A. J. Nam
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  9. Y. M. Rasko
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Contributions

SCD: study concept, data acquisition, data analysis, data interpretation, manuscript writing. CHM: data acquisition, data analysis, data interpretation, manuscript writing. LMN: data analysis, data interpretation, manuscript writing. YL: data analysis, data interpretation, manuscript writing. EI: data acquisition, data analysis, manuscript writing. MPG: data interpretation, final manuscript review. AJN: study concept, data interpretation, final manuscript review. YMR: study concept, data analysis, data interpretation, final manuscript review.

Corresponding author

Correspondence to Y. M. Rasko.

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Conflict of interest

YMR, SCD, CHM, YL, EL, MPG and AJN have an investigator-initiated study grant from Acelity to support this study.

Ethical approval

This retrospective study was reviewed and received ethical approval from University of Maryland Institutional Review Board.

Human and animal rights

This article does not contain any studies directly involving human participants, as it is a review of data already collected in a hernia database.

Informed consent

For this retrospective study, formal consent was not necessary.

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Diaconu, S.C., McNichols, C.H.L., Ngaage, L.M. et al. Closed-incision negative-pressure therapy decreases complications in ventral hernia repair with concurrent panniculectomy. Hernia 24, 49–55 (2020). https://doi.org/10.1007/s10029-018-1865-2

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  • DOI: https://doi.org/10.1007/s10029-018-1865-2

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