Skip to main content
SpringerLink
Log in

Short-term outcomes and healthcare resource utilization following incisional hernia repair with synthetic mesh in patients with Crohn’s disease

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Purpose

While the use of synthetic mesh for incisional hernia repair reduces recurrence rates, little evidence exists regarding the impact of this practice on the disease burden of a Crohn’s patient. We aimed to describe the post-operative outcomes and healthcare resource utilization following incisional hernia repair with synthetic mesh in patients with Crohn’s disease.

Methods

A retrospective review of adult patients with Crohn’s disease who underwent elective open incisional hernia repair with extra-peritoneal synthetic mesh from 2014 to 2018 at a single large academic hospital with surgeons specializing in hernia repair was conducted. Primary outcomes included 30-day post-operative complications and long-term rates of fistula formation and hernia recurrence. The secondary outcome compared healthcare resource utilization during a standardized fourteen-month period before and after hernia repair.

Results

Among the 40 patients included, six (15%) required readmission, 4 (10%) developed a surgical site occurrence, 3 (7.5%) developed a surgical site infection, and one (2.5%) required reoperation within the first 30 days. The overall median follow-up time was 42 months (IQR = 33–56), during which time one (2.5%) patient developed an enterocutaneous fistula and eight (20%) experienced hernia recurrence. Healthcare resource utilization remained unchanged or decreased across every category following repair.

Conclusion

The use of extra-peritoneal synthetic mesh during incisional hernia repair in patients with Crohn’s disease was not associated with a prohibitively high rate of post-operative complications or an increase in healthcare resource utilization to suggest worsening disease during the first 4 years after repair. Future studies exploring the long-term outcomes of this technique are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Kokotovic D, Bisgaard T, Helgstrand F (2016) Long-term recurrence and complications associated with elective incisional hernia repair. JAMA 316(15):1575–1582. https://doi.org/10.1001/jama.2016.15217

    Article  PubMed  Google Scholar 

  2. Heimann TM, Swaminathan S, Greenstein AJ, Steinhagen RM (2018) Incidence and factors correlating with incisional hernia following open bowel resection in patients with inflammatory bowel disease: a review of 1000 patients. Ann Surg 267(3):532–536. https://doi.org/10.1097/SLA.0000000000002120

    Article  PubMed  Google Scholar 

  3. Vidovic D, Jurisic D, Franjic BD, Glavan E, Ledinsky M, Bekavac-Beslin M (2006) Factors affecting recurrence after incisional hernia repair. Hernia 10(4):322–325. https://doi.org/10.1007/s10029-006-0097-z

    Article  CAS  PubMed  Google Scholar 

  4. Losanoff JE, Richman BW, Jones JW (2002) Entero-colocutaneous fistula: A late consequence of polypropylene mesh abdominal wall repair: Case report and review of the literature. Hernia 6(3):144–147. https://doi.org/10.1007/s10029-002-0067-z

    Article  CAS  PubMed  Google Scholar 

  5. Kaufman Z, Engelberg M, Zager M (1981) Fecal fistula: A late complication of marlex mesh repair. Dis Colon Rectum 24(7):543–544

    Article  CAS  PubMed  Google Scholar 

  6. Haskins IN, Voeller GR, Stoikes NF et al (2017) Onlay with adhesive use compared with sublay mesh placement in ventral hernia repair: Was chevrel right? an americas hernia society quality collaborative analysis. J Am Coll Surg 224(5):962–970

    Article  PubMed  Google Scholar 

  7. Warren J, Desai SS, Boswell ND et al (2020) Safety and efficacy of synthetic Mesh for Ventral hernia repair in a Contaminated Field. J Am Coll Surg 230(4):405–413

    Article  PubMed  Google Scholar 

  8. Carbonell AM, Cobb WS, Chen SM (2008) Posterior components separation during retromuscular hernia repair. Hernia 12(4):359–362. https://doi.org/10.1007/s10029-008-0356-2

    Article  CAS  PubMed  Google Scholar 

  9. Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ (2012) Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg 204(5):709–716. https://doi.org/10.1016/j.amjsurg.2012.02.008

    Article  PubMed  Google Scholar 

  10. Wang J, Majumder A, Fayezizadeh M, Criss CN, Novitsky YW (2016) Outcomes of retromuscular approach for abdominal wall reconstruction in patients with inflammatory bowel disease. Am Surg 82(6):565–570

    Article  PubMed  Google Scholar 

  11. Heimann TM, Swaminathan S, Greenstein AJ, Greenstein AJ, Steinhagen RM (2017) Outcome of incisional hernia repair in patients with inflammatory bowel disease. Am J Surg 214(3):468–473

    Article  PubMed  Google Scholar 

  12. von Elm E, Altman DG, Egger M et al (2014) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Int J Surg 12(12):1495–1499

    Article  Google Scholar 

  13. Muysoms FE, Miserez M, Berrevoet F et al (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13(4):407–414. https://doi.org/10.1007/s10029-009-0518-x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Holubar S, Cima R, Pemberton J, et al. An economic analysis of medical and surgical therapy for chronic ulcerative colitis: A population-based study in Olmsted county, Minnesota. [Masters in Biomedical Sciences]. Mayo Graduate School College of Medicine; 2011.

  15. Holubar SD, Long KH, Loftus EV Jr, Wolff BG, Pemberton JH, Cima RR (2009) Long-term direct costs before and after proctocolectomy for ulcerative colitis: A population-based study in Olmsted county. Minnesota Dis Colon Rectum 52(11):1815–1823. https://doi.org/10.1007/DCR.0b013e3181b327a6

    Article  PubMed  Google Scholar 

  16. Holubar SD, Pendlimari R, Loftus EV Jr et al (2012) Drivers of cost after surgical and medical therapy for chronic ulcerative colitis: A nested case-cohort study in Olmsted county Minnesota. Dis Colon Rectum 55(12):1258–1265. https://doi.org/10.1097/DCR.0b013e31826e4f49

    Article  PubMed  PubMed Central  Google Scholar 

  17. Major MR, Wong VW, Nelson ER, Longaker MT, Gurtner GC (2015) The foreign body response: At the interface of surgery and bioengineering. Plast Reconstr Surg 135(5):1489–1498. https://doi.org/10.1097/PRS.0000000000001193

    Article  CAS  PubMed  Google Scholar 

  18. Junge K, Binnebosel M, von Trotha KT et al (2012) Mesh biocompatibility: Effects of cellular inflammation and tissue remodelling. Langenbecks Arch Surg 397(2):255–270. https://doi.org/10.1007/s00423-011-0780-0

    Article  PubMed  Google Scholar 

  19. Anderson JM, Rodriguez A, Chang DT (2008) Foreign body reaction to biomaterials. Semin Immunol 20(2):86–100

    Article  CAS  PubMed  Google Scholar 

  20. Novitsky YW, Cristiano JA, Harrell AG et al (2008) Immunohistochemical analysis of host reaction to heavyweight-, reduced-weight-, and expanded polytetrafluoroethylene (ePTFE)-based meshes after short- and long-term intraabdominal implantations. Surg Endosc 22(4):1070–1076. https://doi.org/10.1007/s00464-007-9737-3

    Article  CAS  PubMed  Google Scholar 

  21. Beyer-Berjot L, Moszkowicz D, Bridoux V et al (2020) Mesh repair in crohn’s disease: A case-matched multicenter study in 234 patients. World J Surg. https://doi.org/10.1007/s00268-020-05436-y

    Article  PubMed  Google Scholar 

  22. Binnebosel M, Klink CD, Otto J et al (2010) Impact of mesh positioning on foreign body reaction and collagenous ingrowth in a rabbit model of open incisional hernia repair. Hernia 14(1):71–77. https://doi.org/10.1007/s10029-009-0580-4

    Article  CAS  PubMed  Google Scholar 

  23. Rosen MJ, Denoto G, Itani KM et al (2013) Evaluation of surgical outcomes of retro-rectus versus intraperitoneal reinforcement with bio-prosthetic mesh in the repair of contaminated ventral hernias. Hernia 17(1):31–35. https://doi.org/10.1007/s10029-012-0909-2

    Article  CAS  PubMed  Google Scholar 

  24. Kasperk R, Klinge U, Schumpelick V (2000) The repair of large parastomal hernias using a midline approach and a prosthetic mesh in the sublay position. Am J Surg 179(3):186–188

    Article  CAS  PubMed  Google Scholar 

  25. Halm JA, de Wall LL, Steyerberg EW, Jeekel J, Lange JF (2007) Intraperitoneal polypropylene mesh hernia repair complicates subsequent abdominal surgery. World J Surg. 31(2):423–9. https://doi.org/10.1007/s00268-006-0317-9

    Article  CAS  PubMed  Google Scholar 

  26. Holihan JL, Nguyen DH, Nguyen MT, Mo J, Kao LS, Liang MK (2016) Mesh location in open ventral hernia repair: a systematic review and network meta-analysis. World J Surg 40(1):89–99. https://doi.org/10.1007/s00268-015-3252-9

    Article  PubMed  Google Scholar 

  27. El-Gazzaz GH, Farag SH, El-Sayd MA, Mohamed HH (2012) The use of synthetic mesh in patients undergoing ventral hernia repair during colorectal resection: risk of infection and recurrence. Asian J Surg 35(4):149–153. https://doi.org/10.1016/j.asjsur.2012.06.003

    Article  PubMed  Google Scholar 

Download references

Funding

Not applicable.

Author information

Authors and Affiliations

  1. Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA

    B. C. Perlmutter, H. Alkhatib, A. Fafaj, S. J. Zolin, C. C. Petro, D. M. Krpata, A. S. Prabhu & M. J. Rosen

  2. Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA

    A. L. Lightner & S. D. Holubar

  3. Department of General Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA

    M. J. Rosen

Authors
  1. B. C. Perlmutter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Alkhatib
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. L. Lightner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Fafaj
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. J. Zolin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. C. Petro
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. D. M. Krpata
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. S. Prabhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. S. D. Holubar
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. M. J. Rosen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization:, HA, ALL, AF, SJZ, DMK, ASP, SDH, MJR. Methodology: BCP, HA, AF, SJZ, ALL, ASP, SDH, MJR. Formal analysis and investigation: BCP, HA. Writing—Original draft preparation: BCP. Writing—Review and editing: CCP, ASP, ALL, SDH, DMK, MJR. Supervision: MJR.

Corresponding author

Correspondence to M. J. Rosen.

Ethics declarations

Conflict of interest

Stefan Holubar has had a financial relationship with the following companies: Takeda Pharmaceutical Company, Shionogi Inc.

Twitter handles: @BPerlmutter MD, @AlkhatibHemasat, @AmyLightnerMD, @samzolin, @ClaytonCharles, @DKrpataMD, @ajitaprabhumd, @HolubarStefan, @MikeRosenMD.

Ethical approval

The Institutional Review Board (IRB) of Cleveland Clinic Foundation approved all protocols and research related to this study. Due to the retrospective and low-risk nature of this study, the IRB waived the requirement to obtain informed consent from patients included in this study.

Availability of data and material:

Data will not be shared.

Code Availability: Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Perlmutter, B.C., Alkhatib, H., Lightner, A.L. et al. Short-term outcomes and healthcare resource utilization following incisional hernia repair with synthetic mesh in patients with Crohn’s disease. Hernia 25, 1557–1564 (2021). https://doi.org/10.1007/s10029-021-02476-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-021-02476-8

Keywords

Search

Navigation