D Charleux-Muller1, R Hurel2, T Fabacher3, C Brigand4, S Rohr4, S Manfredelli5, G Passot6,7, P Ortega-Deballon8, V Dubuisson9, Y Renard2, B Romain4. 1. Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 avenue Molière, 67200, Strasbourg, France. diane.charleuxmuller@gmail.com. 2. Department of General and Digestive Surgery, Robert Debre University Hospital, University of Reims Champagne Ardenne, Reims, France. 3. Department of Public Health, Biostatistic Laboratory, Strasbourg University Hospital, 1 place de l'Hôpital BP426, 67091, Strasbourg, France. 4. Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 avenue Molière, 67200, Strasbourg, France. 5. Department of Digestive and Oncologic Surgery, Liver Transplantation Unit, University Hospital of Besançon, Besançon, France. 6. Department of General, Digestive and Endocrine Surgery, Hospital Lyon Sud, Hospices Civils de Lyon, 165, Chemin du Grand Revoyet, 69495, Pierre Bénite, France. 7. EMR 3738, University Hospital, Claude Bernard Lyon 1, Lyon, France. 8. Department of General and Digestive Surgery, University Hospital of Dijon, Dijon, France. 9. Department of Vascular and General Surgery, Bordeaux University Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France.
Abstract
PURPOSE: To analyze the postoperative morbidity and 1-year recurrence rate of incisional hernia repair using a biosynthetic long-term absorbable mesh in patients at higher risk of surgical infection in a contaminated surgical field. METHODS: All patients undergoing incisional hernia repair in a contaminated surgical field with the use of a biosynthetic long-term absorbable mesh (Phasix®) between May 2016 and September 2018 at six participating university centers were included in this retrospective cohort and were followed-up until September 2019. Regarding the risk of surgical infection, patients were classified according to the modified Ventral Hernia Working Group classification. Preoperative, operative and postoperative data were collected. All patients' surgical site infections (SSIs) and occurrences (SSOs) and recurrence rates were the endpoints of the study. RESULTS: Two hundred and fifteen patients were included: 170 with mVHWG grade 3 (79%) and 45 with mVHWG grade 2 (21%). The SSI and SSO rates at 12 months were 22.3% and 39.5%, respectively. According to the Dindo-Clavien classification, 43 patients (20.0%) had at least one minor complication, and 57 patients (26.5%) had at least one major complication. Among the 121 patients (56.3%) having at least 1 year of follow-up, the clinical recurrence rate was 12.4%. Multivariate analysis showed that a concomitant gastrointestinal procedure was an independent risk factor for surgical infection (OR = 2.61), and an emergency setting was an independent risk factor for major complications (OR = 11.9). CONCLUSION: The use of a biosynthetic absorbable mesh (Phasix®) is safe in a contaminated surgical field, with satisfying immediate postoperative and 1-year results. TRIAL REGISTRATION: The study is registered on Clinical Trial ID: NCT04132986.
PURPOSE: To analyze the postoperative morbidity and 1-year recurrence rate of incisional hernia repair using a biosynthetic long-term absorbable mesh in patients at higher risk of surgical infection in a contaminated surgical field. METHODS: All patients undergoing incisional hernia repair in a contaminated surgical field with the use of a biosynthetic long-term absorbable mesh (Phasix®) between May 2016 and September 2018 at six participating university centers were included in this retrospective cohort and were followed-up until September 2019. Regarding the risk of surgical infection, patients were classified according to the modified Ventral Hernia Working Group classification. Preoperative, operative and postoperative data were collected. All patients' surgical site infections (SSIs) and occurrences (SSOs) and recurrence rates were the endpoints of the study. RESULTS: Two hundred and fifteen patients were included: 170 with mVHWG grade 3 (79%) and 45 with mVHWG grade 2 (21%). The SSI and SSO rates at 12 months were 22.3% and 39.5%, respectively. According to the Dindo-Clavien classification, 43 patients (20.0%) had at least one minor complication, and 57 patients (26.5%) had at least one major complication. Among the 121 patients (56.3%) having at least 1 year of follow-up, the clinical recurrence rate was 12.4%. Multivariate analysis showed that a concomitant gastrointestinal procedure was an independent risk factor for surgical infection (OR = 2.61), and an emergency setting was an independent risk factor for major complications (OR = 11.9). CONCLUSION: The use of a biosynthetic absorbable mesh (Phasix®) is safe in a contaminated surgical field, with satisfying immediate postoperative and 1-year results. TRIAL REGISTRATION: The study is registered on Clinical Trial ID: NCT04132986.
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