B Lasses Martínez1, M J Peña Soria2, J J Cabeza Gómez2, D Jiménez Valladolid2, M Flores Gamarra2, C Fernández Pérez3, A Torres García2, I Delgado Lillo2. 1. Surgery Department, Hospital Clinico San Carlos, Universidad Complutense de Madrid, Calle Profesor Martin Lagos s/n, 28040, Madrid, Spain. bibianalasses@gmail.com. 2. Surgery Department, Hospital Clinico San Carlos, Universidad Complutense de Madrid, Calle Profesor Martin Lagos s/n, 28040, Madrid, Spain. 3. Preventive Medicine Department, Hospital Clinico San Carlos, Universidad Complutense de Madrid, Calle Profesor Martin Lagos s/n, 28040, Madrid, Spain.
Abstract
PURPOSE: Patients with large incisional hernias have significant morbidity and their management is a challenge for the surgical team because of the large abdominal wall involvement. The choice of surgical technique is still controversial. The purpose of this study is to analyze the predictive factors for recurrence after intraperitoneal mesh repair in patients with large incisional hernias. METHODS: A retrospective cohort observational study with a prospectively collected database was performed in the Hospital Clinico San Carlos (Madrid, Spain). All consecutive patients operated on from January 2009 to December 2014 with incisional hernia of 10 or more centimeters in its transverse diameter were included. An intraperitoneal repair with a composite mesh fixed with discontinuous absorbable suture and fibrin sealant was performed. Demographic data, comorbidities, and early and long term outcomes were analyzed. The primary outcome was the presence of recurrence. RESULTS: One hundred and twenty patients were included. Mean age was 63.3 years (SD 12.9) and sex ratio was 1.4:1. Seventy-two patients (60%) were ASA III-IV. Forty-five patients (37.5%) had recurrent ventral hernias. Mean defect size was 14.7 cm (SD 3.21) of width. Overall postoperative morbidity rate was 25%. Median hospital stay was 6 days (IQR 4-8). Recurrence rate was 8.3%, after a median follow-up of 16 months (IQR 10-25). Multivariate analysis showed significant association between ASA III-IV, use of Composix Kugel™ mesh, superficial surgical site infection, and the presence of recurrence. CONCLUSIONS: The recurrence rate after intraperitoneal mesh repair in patients with large incisional hernias might be associated with ASA III-IV, use of Composix Kugel™ mesh, and superficial surgical site infection.
PURPOSE:Patients with large incisional hernias have significant morbidity and their management is a challenge for the surgical team because of the large abdominal wall involvement. The choice of surgical technique is still controversial. The purpose of this study is to analyze the predictive factors for recurrence after intraperitoneal mesh repair in patients with large incisional hernias. METHODS: A retrospective cohort observational study with a prospectively collected database was performed in the Hospital Clinico San Carlos (Madrid, Spain). All consecutive patients operated on from January 2009 to December 2014 with incisional hernia of 10 or more centimeters in its transverse diameter were included. An intraperitoneal repair with a composite mesh fixed with discontinuous absorbable suture and fibrin sealant was performed. Demographic data, comorbidities, and early and long term outcomes were analyzed. The primary outcome was the presence of recurrence. RESULTS: One hundred and twenty patients were included. Mean age was 63.3 years (SD 12.9) and sex ratio was 1.4:1. Seventy-two patients (60%) were ASA III-IV. Forty-five patients (37.5%) had recurrent ventral hernias. Mean defect size was 14.7 cm (SD 3.21) of width. Overall postoperative morbidity rate was 25%. Median hospital stay was 6 days (IQR 4-8). Recurrence rate was 8.3%, after a median follow-up of 16 months (IQR 10-25). Multivariate analysis showed significant association between ASA III-IV, use of Composix Kugel™ mesh, superficial surgical site infection, and the presence of recurrence. CONCLUSIONS: The recurrence rate after intraperitoneal mesh repair in patients with large incisional hernias might be associated with ASA III-IV, use of Composix Kugel™ mesh, and superficial surgical site infection.
Entities:
Keywords:
Composite mesh; Intraperitoneal mesh repair; Large incisional hernia; Large ventral hernia
Authors: Lucas Timmermans; Barry de Goede; Sven M van Dijk; Gert-Jan Kleinrensink; Johannes Jeekel; Johan F Lange Journal: Am J Surg Date: 2013-10-26 Impact factor: 2.565
Authors: Corey W Iqbal; Tuan H Pham; Anthony Joseph; Jane Mai; Geoffrey B Thompson; Michael G Sarr Journal: World J Surg Date: 2007-12 Impact factor: 3.352
Authors: U A Dietz; M S Winkler; R W Härtel; A Fleischhacker; A Wiegering; C Isbert; Ch Jurowich; P Heuschmann; C-T Germer Journal: Hernia Date: 2012-10-16 Impact factor: 4.739