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Negative-Pressure Wound Therapy in the Management of High-Grade Ventral Hernia Repairs

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

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Abstract

Background

Despite improved operative techniques, open ventral hernia repair (VHR) surgery in high-risk, potentially contaminated patients remains challenging. As previously reported by our group, the use of a modified negative-pressure wound therapy system (hybrid-VAC or HVAC) in patients with grade 2 hernias is associated with lower surgical site occurrence (SSO) and surgical site infection (SSI) rates. Accordingly, the authors aim to evaluate whether the HVAC would similarly improve surgical site outcomes following VHR in patients with grade 3 hernias.

Methods

A 4-year retrospective review (2011–2014) was conducted of all consecutive, modified ventral hernia working group (VHWG) grade 3 hernia repairs with HVAC closure performed by a single surgeon (FEE) at a single institution. Operative data and 90-day outcomes were evaluated. Overall outcomes (e.g., recurrence, reoperation, mortality) were reviewed for the study group.

Results

A total of 117 patients with an average age of 56.7 ± 11.9 years were classified as grade 3 hernias and underwent open VHR with subsequent HVAC closure. Fifty patients were male (42.7 %), the mean BMI was 35.2 (±9.5), and 60.7 % had a history of prior hernia repair. The average fascial defect size was 201.5 (±167.3) cm2 and the mean length of stay was 14.2 (±9.3) days. Ninety-day outcomes showed an SSO rate of 20.7 % and an SSI rate of 5.2 %. The overall hernia recurrence rate was 4.2 % (n=6) with a mean follow-up of 11 ± 7.3 months.

Conclusion

Modified VHWG grade 3 ventral hernias are associated with significant morbidity. In our series utilizing the HVAC system after VHR, the observed rate of SSO and SSI compared favorably to reported series. Further prospective cost-effective studies are warranted to validate these findings.

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Notes

  1. Surgimend; TEI Biosciences, Boston, MA, USA.

  2. Prolene; Ethicon LLC, USA.

References

  1. Pans, A., P. Elen, W. Dewe, and C. Desaive, Long-term results of polyglactin mesh for the prevention of incisional hernias in obese patients. World J Surg, 1998. 22(5): p. 479–82; discussion 482–3.

    Article  CAS  PubMed  Google Scholar 

  2. Kurmann, A., E. Visth, D. Candinas, and G. Beldi, Long-term follow-up of open and laparoscopic repair of large incisional hernias. World J Surg, 2011. 35(2): p. 297–301.

    Article  PubMed  Google Scholar 

  3. Sugerman, H.J., J.M. Kellum Jr, H.D. Reines, E.J. DeMaria, H.H. Newsome, and J.W. Lowry, Greater risk of incisional hernia with morbidly obese than steroid-dependent patients and low recurrence with prefascial polypropylene mesh. The American Journal of Surgery, 1996. 171(1): p. 80–84.

    Article  CAS  PubMed  Google Scholar 

  4. Itani, K.M., M. Rosen, D. Vargo, S.S. Awad, G. Denoto, 3rd, and C.E. Butler, Prospective study of single-stage repair of contaminated hernias using a biologic porcine tissue matrix: the RICH Study. Surgery, 2012. 152(3): p. 498–505.

    Article  PubMed  Google Scholar 

  5. Poulose, B.K., J. Shelton, S. Phillips, D. Moore, W. Nealon, D. Penson, W. Beck, and M.D. Holzman, Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia, 2012. 16(2): p. 179–83.

    Article  CAS  PubMed  Google Scholar 

  6. Carbonell, A.M., C.N. Criss, W.S. Cobb, Y.W. Novitsky, and M.J. Rosen, Outcomes of synthetic mesh in contaminated ventral hernia repairs. J Am Coll Surg, 2013. 217(6): p. 991–8.

    Article  PubMed  Google Scholar 

  7. Krpata, D.M., J.A. Blatnik, Y.W. Novitsky, and M.J. Rosen, Evaluation of high-risk, comorbid patients undergoing open ventral hernia repair with synthetic mesh. Surgery, 2013. 153(1): p. 120–5.

    Article  PubMed  Google Scholar 

  8. Pauli, E.M., D.M. Krpata, Y.W. Novitsky, and M.J. Rosen, Negative pressure therapy for high-risk abdominal wall reconstruction incisions. Surg Infect (Larchmt), 2013. 14(3): p. 270–4.

    Article  Google Scholar 

  9. Liang, M.K., R.L. Berger, L.T. Li, J.A. Davila, S.C. Hicks, and L.S. Kao, Outcomes of laparoscopic vs open repair of primary ventral hernias. JAMA Surgery, 2013. 148(11): p. 1043–1048.

    Article  PubMed  Google Scholar 

  10. Nguyen, M.T., R.L. Berger, S.C. Hicks, J.A. Davila, L.T. Li, L.S. Kao, and M.K. Liang, Comparison of outcomes of synthetic mesh vs suture repair of elective primary ventral herniorrhaphy: a systematic review and meta-analysis. JAMA Surg, 2014. 149(5): p. 415–21.

    Article  PubMed  Google Scholar 

  11. Diaz, J.J., Jr, A.M. Conquest, S.J. Ferzoco, et al., Multi-institutional experience using human acellular dermal matrix for ventral hernia repair in a compromised surgical field. Archives of Surgery, 2009. 144(3): p. 209–215.

    Article  PubMed  Google Scholar 

  12. Arroyo, A., P. Garcia, F. Perez, J. Andreu, F. Candela, and R. Calpena, Randomized clinical trial comparing suture and mesh repair of umbilical hernia in adults. Br J Surg, 2001. 88(10): p. 1321–3.

    Article  CAS  PubMed  Google Scholar 

  13. Polat, C., A. Dervisoglu, G. Senyurek, M. Bilgin, K. Erzurumlu, and K. Ozkan, Umbilical hernia repair with the prolene hernia system. Am J Surg, 2005. 190(1): p. 61–4.

    Article  PubMed  Google Scholar 

  14. Berger, R.L., L.T. Li, S.C. Hicks, and M.K. Liang, Suture versus preperitoneal polypropylene mesh for elective umbilical hernia repairs. J Surg Res, 2014. 192(2): p. 426–31.

    Article  PubMed  Google Scholar 

  15. Asolati, M., S. Huerta, G. Sarosi, R. Harmon, C. Bell, and T. Anthony, Predictors of recurrence in veteran patients with umbilical hernia: single center experience. Am J Surg, 2006. 192(5): p. 627–30.

    Article  PubMed  Google Scholar 

  16. Stoppa, R., X. Henry, P. Verhaeghe, B. Fwamba, and K. Odimba, [Trends in the surgical treatment of chronic dehiscences of the abdominal walls]. Bull Acad Natl Med, 1981. 165(4): p. 493–501.

    CAS  PubMed  Google Scholar 

  17. Breuing, K., C.E. Butler, S. Ferzoco, M. Franz, C.S. Hultman, J.F. Kilbridge, M. Rosen, R.P. Silverman, and D. Vargo, Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery, 2010. 148(3): p. 544–58.

    Article  PubMed  Google Scholar 

  18. Kanters, A.E., D.M. Krpata, J.A. Blatnik, Y.M. Novitsky, and M.J. Rosen, Modified hernia grading scale to stratify surgical site occurrence after open ventral hernia repairs. J Am Coll Surg, 2012. 215(6): p. 787–93.

    Article  PubMed  Google Scholar 

  19. Skipworth, J.R., S. Vyas, L. Uppal, D. Floyd, and A. Shankar, Improved outcomes in the management of high-risk incisional hernias utilizing biological mesh and soft-tissue reconstruction: a single center experience. World J Surg, 2014. 38(5): p. 1026–34.

    Article  CAS  PubMed  Google Scholar 

  20. Sbitany, H., E. Kwon, H. Chern, E. Finlayson, M.G. Varma, and S.L. Hansen, Outcomes Analysis of Biologic Mesh Use for Abdominal Wall Reconstruction in Clean-Contaminated and Contaminated Ventral Hernia Repair. Ann Plast Surg, 2013.

  21. Köhler, G.M.D., M.M.D. Weitzendorfer, V.M.D. Kalcher, and K.M.D. Emmanuel, Synthetic Mesh Repair for Incisional Hernia Treatment in High-risk Patients for Surgical Site Occurrences. The American Surgeon, 2015. 81(4): p. 387–394.

    PubMed  Google Scholar 

  22. Conde-Green, A., T.L. Chung, L.H. Holton, 3rd, H.G. Hui-Chou, Y. Zhu, H. Wang, H. Zahiri, and D.P. Singh, Incisional negative-pressure wound therapy versus conventional dressings following abdominal wall reconstruction: a comparative study. Ann Plast Surg, 2013. 71(4): p. 394–7.

    Article  CAS  PubMed  Google Scholar 

  23. Soares, K.C., P.A. Baltodano, C.W. Hicks, C.M. Cooney, I.O. Olorundare, P. Cornell, K. Burce, and F.E. Eckhauser, Novel wound management system reduces surgical site morbidity after ventral hernia repairs: a critical analysis. Am J Surg, 2014.

  24. Dindo, D., N. Demartines, and P.A. Clavien, Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg, 2004. 240(2): p. 205–13.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Horan, T.C., R.P. Gaynes, W.J. Martone, W.R. Jarvis, and T.G. Emori, CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control, 1992. 20(5): p. 271–4.

    Article  CAS  PubMed  Google Scholar 

  26. Vandenbroucke, J.P., E. von Elm, D.G. Altman, P.C. Gotzsche, C.D. Mulrow, S.J. Pocock, C. Poole, J.J. Schlesselman, and M. Egger, Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med, 2007. 4(10): e297.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Sanders, D.L. and A.N. Kingsnorth, The modern management of incisional hernias. Vol. 344. 2012.

  28. Harris, P.A., R. Taylor, R. Thielke, J. Payne, N. Gonzalez, and J.G. Conde, Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform, 2009. 42(2): p. 377–81.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Nasajpour, H., K.A. LeBlanc, and M.H. Steele, Complex hernia repair using component separation technique paired with intraperitoneal acellular porcine dermis and synthetic mesh overlay. Ann Plast Surg, 2011. 66(3): p. 280–4.

    Article  CAS  PubMed  Google Scholar 

  30. Hawn, M.T., C.W. Snyder, L.A. Graham, S.H. Gray, K.R. Finan, and C.C. Vick, Long-term follow-up of technical outcomes for incisional hernia repair. J Am Coll Surg, 2010. 210(5): p. 648–55, 655–7.

    Article  PubMed  Google Scholar 

  31. Andersen, L.P.H., M. Klein, I. Gögenur, and J. Rosenberg, Long-term recurrence and complication rates after incisional hernia repair with the open onlay technique. BMC Surgery, 2009. 9: p. 6–6.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Chavarriaga, L.F., E. Lin, A. Losken, M.W. Cook, L.O. Jeansonne, B.C. White, J.F. Sweeney, J.R. Galloway, and S.S. Davis, Jr., Management of complex abdominal wall defects using acellular porcine dermal collagen. Am Surg, 2010. 76(1): p. 96–100.

    PubMed  Google Scholar 

  33. Schuster, R., J. Singh, B.Y. Safadi, and S.M. Wren, The use of acellular dermal matrix for contaminated abdominal wall defects: wound status predicts success. Am J Surg, 2006. 192(5): p. 594–7.

    Article  CAS  PubMed  Google Scholar 

  34. Rosen, M.J., D.M. Krpata, B. Ermlich, and J.A. Blatnik, A 5-year clinical experience with single-staged repairs of infected and contaminated abdominal wall defects utilizing biologic mesh. Ann Surg, 2013. 257(6): p. 991–6.

    Article  PubMed  Google Scholar 

  35. Vidovic, D., D. Jurisic, B.D. Franjic, E. Glavan, M. Ledinsky, and M. Bekavac-Beslin, Factors affecting recurrence after incisional hernia repair. Hernia, 2006. 10(4): p. 322–5.

    Article  CAS  PubMed  Google Scholar 

  36. Kim, H., K. Bruen, and D. Vargo, Acellular dermal matrix in the management of high-risk abdominal wall defects. The American Journal of Surgery, 2006. 192(6): p. 705–709.

    Article  PubMed  Google Scholar 

  37. Morris, L.M. and K.A. Leblanc, Components separation technique utilizing an intraperitoneal biologic and an onlay lightweight polypropylene mesh: “a sandwich technique”. Hernia, 2013. 17(1): p. 45–51.

    Article  CAS  PubMed  Google Scholar 

  38. Sailes, F.C., J. Walls, D. Guelig, M. Mirzabeigi, W.D. Long, A. Crawford, J.H. Moore, Jr., S.E. Copit, G.A. Tuma, and J. Fox, Ventral hernia repairs: 10-year single-institution review at Thomas Jefferson University Hospital. J Am Coll Surg, 2011. 212(1): p. 119–23.

    Article  PubMed  Google Scholar 

  39. Finan, K.R., C.C. Vick, C.I. Kiefe, L. Neumayer, and M.T. Hawn, Predictors of wound infection in ventral hernia repair. Am J Surg, 2005. 190(5): p. 676–81.

    Article  PubMed  Google Scholar 

  40. Dunne, J.R., D.L. Malone, J.K. Tracy, and L.M. Napolitano, Abdominal wall hernias: risk factors for infection and resource utilization. J Surg Res, 2003. 111(1): p. 78–84.

    Article  PubMed  Google Scholar 

  41. Vargo, D., Negative pressure wound therapy in the prevention of wound infection in high risk abdominal wound closures. Am J Surg, 2012. 204(6): p. 1021–3; discussion 1023–4.

    Article  PubMed  Google Scholar 

  42. Iqbal, C.W., T.H. Pham, A. Joseph, J. Mai, G.B. Thompson, and M.G. Sarr, Long-term outcome of 254 complex incisional hernia repairs using the modified Rives-Stoppa technique. World J Surg, 2007. 31(12): p. 2398–404.

    Article  PubMed  Google Scholar 

  43. Raigani, S., G.S. De Silva, C.N. Criss, Y.W. Novitsky, and M.J. Rosen, The impact of developing a comprehensive hernia center on the referral patterns and complexity of hernia care. Hernia, 2014. 18(5): p. 625–30.

    Article  CAS  PubMed  Google Scholar 

  44. Dowsett, C., L. Davis, V. Henderson, and R. Searle, The economic benefits of negative pressure wound therapy in community-based wound care in the NHS. Int Wound J, 2012. 9(5): p. 544–52.

    Article  PubMed  Google Scholar 

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Financial Disclosures

This study was made possible in part through an investigator initiated trial grant from KCI®.

Ethical Approval

The Johns Hopkins Medicine Institutional Review Board (IRB) approved this retrospective study of Johns Hopkins Hospital patients. This study conforms to the Declaration of Helsinki ethical principles for biomedical research.

Authors’Contributions

Nelson Rodriguez-Unda has substantial contributions to the (1) conception and design, acquisition of data, analysis, and interpretation of the data; (2) drafting the article and revising the article critically for important intellectual content; and (3) final approval of the version to be published.

Kevin C. Soares, Saïd C. Azoury, Pablo A. Baltodano, Caitlin W. Hicks, Peter Cornell, Carisa M. Cooney, and Frederic E. Eckhauser have substantial contributions to the (1) conception and design; (2) revising the article critically for important intellectual content; and (3) final approval of the version to be published.

Karen K. Burce has substantial contributions to the (1) conception, design, collection, and interpretation of the data; (2) revising the article critically for important intellectual content; and (3) final approval of the version to be published.

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Authors and Affiliations

  1. Department of Surgery, Johns Hopkins University School of Medicine, Blalock 618, 600 N. Wolfe Street, Baltimore, MD, 21287, USA

    Nelson Rodriguez-Unda, Kevin C. Soares, Saïd C. Azoury, Pablo A. Baltodano, Caitlin W. Hicks, Karen K. Burce, Peter Cornell, Carisa M. Cooney & Frederic E. Eckhauser

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  1. Nelson Rodriguez-Unda
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Correspondence to Frederic E. Eckhauser.

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Rodriguez-Unda, N., Soares, K.C., Azoury, S.C. et al. Negative-Pressure Wound Therapy in the Management of High-Grade Ventral Hernia Repairs. J Gastrointest Surg 19, 2054–2061 (2015). https://doi.org/10.1007/s11605-015-2894-0

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