Laura Beyer-Berjot1, David Moszkowicz2, Valérie Bridoux3, Lucil Schneider4, Luca Theuil5, Yves François6, Solafah Abdalla7, Eddy Cotte6, Léon Maggiori8, Antoine Brouquet7, François-Régis Souche5, Philippe Zerbib4, Jean-Jacques Tuech3, Yves Panis8, Stéphane Berdah9. 1. Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Univ, Chemin des Bourrely, 13015, Marseille, France. laura.beyer@ap-hm.fr. 2. Department of Digestive, Oncologic and Metabolic Surgery, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, UVSQ/Université Paris Saclay, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France. 3. Department of Digestive Surgery, Hôpital Charles-Nicolle, CHU de Rouen, 1 rue de Germont, 76000, Rouen, France. 4. Department of Digestive Surgery, Hôpital Claude Huriez, CHRU de Lille, rue Michel Polonowski, 59037, Lille, France. 5. Department of Digestive Surgery, Hôpital Saint Eloi, CHU de Montpellier, 80 Avenue Augustin Fliche, 34000, Montpellier, France. 6. Department of Gastrointestinal Surgery, Hospices Civils de Lyon, Université de Lyon, Centre Hospitalier Lyon-Sud, 165 chemin du grand Revoyet, 69495, Pierre Bénite, France. 7. Department of Digestive and Oncologic Surgery, Hôpital Bicêtre, APHP, Université Paris Sud, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France. 8. Department of Colorectal Surgery, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université Paris VII Diderot, 100 Boulevard du Général Leclerc, 92110, Clichy, France. 9. Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Univ, Chemin des Bourrely, 13015, Marseille, France.
Abstract
BACKGROUND: There are no specific guidelines for ventral hernia management in Crohn's disease (CD) patients. We aimed to assess the risk of septic morbidity after mesh repair in CD. METHODS: This was a retrospective multicentre study comparing CD and non-CD patients undergoing mesh repair for ventral hernia (primary or incisional hernia). Controls were matched 1:1 for the presence of a stoma, history of surgical sepsis, hernia size and Ventral Hernia Working Group (VHWG) score. All demographic, pre-, intra- and postoperative data were retrieved, including long-term data. RESULTS: We included 234 patients, with 114 CD patients. Both groups had comparable VHWG scores (p = 0.12), hernia sizes (p = 0.11), ASA scores ≥ 3 (p = 0.70), body mass index values (p = 0.14), presence of stoma (CD 21.9% vs. controls 15%, p = 0.16), history of sepsis (14% vs. 6.7%, p = 0.23), rates of malnutrition (4.4% vs. 1.7%, p = 0.46), rates of incisional hernia (93% vs. 95%, p = 0.68) and concomitant procedures (18.4% vs. 11.7%, p = 0.12). CD patients carried a higher risk of postoperative septic morbidity (18.4% vs. 5%, p = 0.001), entero-prosthetic fistula (7% vs. 0, p < 0.01) and mesh withdrawals (5.3% vs. 0, p = 0.011). Ventral hernia recurrence rates were similar (14% vs. 8.3%, p = 0.15). In the univariate analysis, the risk factors for septic morbidity were CD (p = 0.001), malnutrition (p = 0.004), use of biological mesh (p < 0.0001) and concomitant procedure (p = 0.004). The mesh position, the means used for mesh fixation as well as the presence of a stoma were not identified as risk factors. CONCLUSIONS: CD seems to be a risk factor for septic morbidity after mesh repair.
BACKGROUND: There are no specific guidelines for ventral hernia management in Crohn's disease (CD) patients. We aimed to assess the risk of septic morbidity after mesh repair in CD. METHODS: This was a retrospective multicentre study comparing CD and non-CDpatients undergoing mesh repair for ventral hernia (primary or incisional hernia). Controls were matched 1:1 for the presence of a stoma, history of surgical sepsis, hernia size and Ventral Hernia Working Group (VHWG) score. All demographic, pre-, intra- and postoperative data were retrieved, including long-term data. RESULTS: We included 234 patients, with 114 CDpatients. Both groups had comparable VHWG scores (p = 0.12), hernia sizes (p = 0.11), ASA scores ≥ 3 (p = 0.70), body mass index values (p = 0.14), presence of stoma (CD 21.9% vs. controls 15%, p = 0.16), history of sepsis (14% vs. 6.7%, p = 0.23), rates of malnutrition (4.4% vs. 1.7%, p = 0.46), rates of incisional hernia (93% vs. 95%, p = 0.68) and concomitant procedures (18.4% vs. 11.7%, p = 0.12). CDpatients carried a higher risk of postoperative septic morbidity (18.4% vs. 5%, p = 0.001), entero-prosthetic fistula (7% vs. 0, p < 0.01) and mesh withdrawals (5.3% vs. 0, p = 0.011). Ventral hernia recurrence rates were similar (14% vs. 8.3%, p = 0.15). In the univariate analysis, the risk factors for septic morbidity were CD (p = 0.001), malnutrition (p = 0.004), use of biological mesh (p < 0.0001) and concomitant procedure (p = 0.004). The mesh position, the means used for mesh fixation as well as the presence of a stoma were not identified as risk factors. CONCLUSIONS:CD seems to be a risk factor for septic morbidity after mesh repair.
Authors: B C Perlmutter; H Alkhatib; A L Lightner; A Fafaj; S J Zolin; C C Petro; D M Krpata; A S Prabhu; S D Holubar; M J Rosen Journal: Hernia Date: 2021-08-03 Impact factor: 4.739