Surgical Treatment of Large Incisional Hernias with Intraperitoneal Composite Mesh: a Cohort Study

Overview

Journal Hernia

Publisher Springer

Date 2016 Dec 24

PMID 28008551

Citations 4

Authors

B Lasses Martinez

M J Pena Soria

J J Cabeza Gomez

D Jimenez Valladolid

M Flores Gamarra

C Fernandez Perez

A Torres Garcia

I Delgado Lillo

Affiliations

Soon will be listed here.

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.

Citing Articles

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Open intraperitoneal onlay mesh repair with anterior component separation as a bail-out procedure in the management of complex hernias.

Vierstraete M, Molnar A, Berrevoet F Hernia. 2024; 28(3):887-893.

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Complex giant incisional hernia repair with intraperitoneal mesh: A case report.

Palacios Huatuco R, Pinsak A, Palencia R Ann Med Surg (Lond). 2021; 65:102340.

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Effectiveness of Prophylactic Intraperitoneal Mesh Implantation for Prevention of Incisional Hernia in Patients Undergoing Open Abdominal Surgery: A Randomized Clinical Trial.

Kohler A, Lavanchy J, Lenoir U, Kurmann A, Candinas D, Beldi G JAMA Surg. 2018; 154(2):109-115.

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