Faculty Collaboration Database

Safety and Efficacy of Synthetic Mesh for Ventral Hernia Repair in a Contaminated Field. J Am Coll Surg 2020 Apr;230(4):405-413

Date

01/20/2020

Pubmed ID

31954819

DOI

10.1016/j.jamcollsurg.2019.12.008

Scopus ID

2-s2.0-85079546716 (requires institutional sign-in at Scopus site)   61 Citations

Abstract

BACKGROUND: Controversy remains about appropriate mesh selection during ventral hernia repair (VHR) in a contaminated field. Fear of mesh infection has led to increased use of biologic and absorbable synthetic meshes rather than permanent synthetic mesh in these cases. We report the safety and efficacy of permanent synthetic mesh during contaminated VHR.

STUDY DESIGN: Retrospective review of our database identified all cases of contaminated VHR from July 2007 to May 2019. Student's t-test and Wilcoxon rank sum were used to analyze continuous variables, and discrete variables with Fisher's or Kruskal-Wallis test.

RESULTS: There were 541 contaminated cases: 245 clean-contaminated, 214 contaminated, and 82 dirty cases. Suture repair was performed in 46 patients, biologic mesh was used in 38, absorbable synthetic mesh in 55, and permanent synthetic mesh in 402. Mesh was extraperitoneal in 97% of cases. Incidence of surgical site infection in each group was 17.4%, 36.8%, 32.7%, and 14.2%, respectively (p < 0.001). Multivariate analysis showed no effect of mesh selection on risk of surgical site infection. Mesh was removed in 7 patients; 5 were permanent synthetic (1.2%), 1 was absorbable synthetic (1.8%), and 1 was biologic (2.6%). In 4 patients there was mesh-specific complication and the remaining meshes were removed during exploration for indications unrelated to the mesh. At a median follow-up of 30.2 months, recurrence occurred in 15.2% of patients and was significantly lower with permanent synthetic mesh.

CONCLUSIONS: Permanent synthetic mesh placed in an extraperitoneal position is not only safe for VHR in a contaminated field, but it confers a significantly lower rate of surgical site infection and recurrence compared with biologic or bioabsorbable meshes.

Author List

Warren J, Desai SS, Boswell ND, Hancock BH, Abbad H, Ewing JA, Carbonell AM, Cobb WS

Author

Nicole Boswell MD Postdoctoral Fellow in the Dermatology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Bacterial Infections
Female
Hernia, Ventral
Herniorrhaphy
Humans
Male
Middle Aged
Retrospective Studies
Surgical Mesh
Surgical Wound Infection
Treatment Outcome