Faculty Collaboration Database

A dual-stage approach to contaminated, high-risk ventral hernia repairs. J Surg Res 2016 Jul;204(1):200-4

Date

07/28/2016

Pubmed ID

27451887

DOI

10.1016/j.jss.2016.04.065

Scopus ID

2-s2.0-84979643034 (requires institutional sign-in at Scopus site)   10 Citations

Abstract

BACKGROUND: The Modified Hernia Grading System (MHGS) was developed to risk stratify complex ventral hernia repairs (VHRs). MHGS grade 3 patients have mesh infections, dirty or contaminated fields, and/or violation of the alimentary tract. Reported surgical site infection (SSI) rates are over 40% after single-stage VHR in contaminated fields. In an attempt to decrease the SSI rate in MHGS grade 3 patients, we developed a dual-stage VHR (DSVHR) approach.

METHODS: We reviewed adult general surgery patients undergoing DSVHR between January 2010 and June 2014. All patients were MHGS grade 3. Primary end point was 30-d superficial and deep SSI. Secondary end points included other surgical site occurrences, 6-mo recurrence, and mesh excision rates.

RESULTS: Fifteen patients underwent DSVHR. Mean age was 56 y, and median body mass index was 38.3 kg/m(2). Operative indication included enterocutaneous fistulas (ECF; n = 6), ECF with infected mesh (n = 2), infected mesh (n = 2), and VHR requiring bowel resection (n = 5). Thirty-one operative procedures were performed with median of 2.5 d between procedures. Fascial closure was re-established in 12 patients; five patients had underlay biologic mesh placement; seven underwent component separation with retrorectus mesh placement (synthetic [n = 2], biologic [n = 5]). The remaining patients underwent bridging repair with biologic mesh. One patient developed a recurrence after 6 mo, whereas a single patient had a recurrence of their ECF. Four (27%) patients developed a SSI, with an additional four (27%) experiencing a surgical site occurrence. There were no postoperative mesh infections.

CONCLUSIONS: DSVHR in MHGS grade 3 patients is associated with a lower SSI rate than previously reported for those undergoing single-stage repairs.

Author List

Kugler NW, Bobbs M, Webb T, Carver TW, Milia D, Paul JS

Authors

Thomas W. Carver MD Associate Professor in the Surgery department at Medical College of Wisconsin
Nathan W. Kugler MD Assistant Professor in the Surgery department at Medical College of Wisconsin
David J. Milia MD Professor in the Surgery department at Medical College of Wisconsin

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

Adult
Aged
Female
Follow-Up Studies
Hernia, Ventral
Herniorrhaphy
Humans
Male
Middle Aged
Retrospective Studies
Risk Factors
Surgical Mesh
Surgical Wound Infection
Treatment Outcome