Faculty Collaboration Database

Retro-rectus placement of bio-absorbable mesh improves patient outcomes. Surg Endosc 2019 Aug;33(8):2629-2634

Date

10/27/2018

Pubmed ID

30361969

DOI

10.1007/s00464-018-6560-y

Scopus ID

2-s2.0-85055677831 (requires institutional sign-in at Scopus site)   12 Citations

Abstract

BACKGROUND: There is little consensus on the ideal anatomical placement of bio-absorbable mesh. We hypothesized that retro-rectus placement of bio-absorbable mesh would significantly reduce recurrence rates when compared to intraperitoneal mesh placement.

METHODS: A retrospective review was conducted of patients who underwent open complex ventral hernia repair using bio-absorbable mesh (Bio-A, Gore, Flagstaff, AZ). Patient demographics and Centers for Disease Control wound type were collected.

RESULTS: A total of 81 patients were included. Seventy-four (91.4%) of these hernia repairs had mesh in the retro-rectus position, while 7 (8.6%) had intraperitoneal mesh placement. Patient demographics, including preoperative comorbidities, did not differ between groups. The retro-rectus group trended to have larger hernia defects (156.2 cm²) compared to the intraperitoneal group (63.9 cm²) (p = 0.058). Overall complications (e.g., dehiscence, wound drainage, cellulitis, sepsis) were also similar in both groups of patients. Recurrence rates in the retro-rectus and intraperitoneal group were 8.1% and 42.9%, respectively (p = 0.005). When evaluating only patients with CDC class 1 wounds, the recurrence rate in the retro-rectus group was 8.2% and the intraperitoneal group was 50% (p = 0.02). Overall, the average patient follow-up was 22 months and did not differ between groups. Both the retro-rectus and intraperitoneal groups indicated a significant (p < 0.05) improvement in quality of life from baseline. No long-term (> 7 days) antibiotics were used and no mesh implants were removed during the study.

CONCLUSION: Patients who underwent open complex ventral hernia repairs with bio-absorbable mesh in the retro-rectus position experienced lower overall complication rates than those with intraperitoneal mesh placement. Despite a larger hernia defect in the retro-rectus group, recurrence rates were significantly reduced with retro-rectus placement of mesh compared to intraperitoneal placement. In addition, recurrence rates using bio-absorbable mesh in clean wounds are comparable to previously published recurrence rates with permanent mesh.

Author List

Cho JE, Helm MC, Helm JH, Mier N, Kastenmeier AS, Gould JC, Goldblatt MI

Authors

Matthew I. Goldblatt MD Professor in the Surgery department at Medical College of Wisconsin
Jon Gould MD Chief, Professor in the Surgery department at Medical College of Wisconsin
Andrew Sean Kastenmeier MD Associate Professor in the Surgery department at Medical College of Wisconsin

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

Absorbable Implants
Adult
Aged
Female
Hernia, Ventral
Herniorrhaphy
Humans
Male
Middle Aged
Postoperative Complications
Quality of Life
Recurrence
Retrospective Studies
Secondary Prevention
Surgical Mesh