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Messer N, Ellis RC, Maskal SM, Chang JH, Prabhu AS, Miller BT, Beffa LR, Petro CC, Mazzola Poli de Figueiredo S, Fafaj A, Essani V, Rosen MJ. Sequential surgeries following transversus abdominis release for abdominal wall reconstruction: Insights from a single-center analysis. Am J Surg 2024; 234:99-104. [PMID: 38580567 DOI: 10.1016/j.amjsurg.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/28/2024] [Accepted: 03/13/2024] [Indexed: 04/07/2024]
Abstract
INTRODUCTION Abdominal surgery following transversus abdominis release (TAR) procedure commonly involves incisions through the previously implanted mesh, potentially creating vulnerabilities for hernia recurrence. Despite the popularity of the TAR procedure, current literature regarding post-AWR surgeries is limited. This study aims to reveal the incidence and outcomes of post-TAR non-hernia-related abdominal surgeries of any kind. METHODS Adult patients who underwent non-hernia-related abdominal surgery following ventral hernia repair with concurrent TAR procedure and permanent synthetic mesh in the Cleveland Clinic Center for Abdominal Core Health between January 2014 and January 2022 were queried from a prospectively collected database in the Abdominal Core Health Quality Collaborative. We evaluated 30-day wound morbidity, perioperative complications, and long-term hernia recurrence. RESULTS A total of 1137 patients who underwent TAR procedure were identified, with 53 patients (4.7%) undergoing subsequent non-hernia-related abdominal surgery post-TAR. Small bowel obstruction was the primary indication for reoperation (22.6%), and bowel resection was the most frequent procedure (24.5%). 49.1% of the patients required urgent or emergent surgery, with the majority (70%) having open procedures. Fascia closure was achieved by absorbable sutures in 50.9%, and of the open cases, fascia closure was achieved by running sutures technique in 35.8%. 20.8% experienced SSO, the SSOPI rate was 11.3%, and 26.4% required more than a single reoperation. A total of 88.7% were available for extended follow-up, spanning 17-30 months, resulting in a 36.1% recurrent hernia diagnosis rate. CONCLUSIONS Abdominal surgery following TAR surgery is associated with significant comorbidities and significantly impacts hernia recurrence rates. Our study findings underscore the significance of making all efforts to minimize reoperations after TAR procedure and offers suggestions on managing the abdominal wall of these complex cases.
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Affiliation(s)
- Nir Messer
- Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA; Department of Surgery, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel -Aviv University, Tel Aviv, Israel.
| | - Ryan C Ellis
- Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Sara M Maskal
- Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jenny H Chang
- Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Ajita S Prabhu
- Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Benjamin T Miller
- Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Lucas Ra Beffa
- Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Clayton C Petro
- Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Aldo Fafaj
- Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Varisha Essani
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Michael J Rosen
- Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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Baker JJ, Rosenberg J. Coatings for Permanent Meshes Used to Enhance Healing in Abdominal Hernia Repair: A Scoping Review. Surg Innov 2024:15533506241255258. [PMID: 38803124 DOI: 10.1177/15533506241255258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
INTRODUCTION Hernia meshes are used to reduce recurrence and pain rates, but the rates are still high. This could be improved with coatings of the mesh. This scoping review aimed to provide an overview of mesh coatings used to promote healing in abdominal hernia repair and to report beneficial and unbeneficial effects. METHODS We included human and animal studies with abdominal hernias that were repaired with non-commercially coated meshes. We searched Pubmed, Embase, Cochrane Central, LILACS, and CNKI without language constraints. RESULTS Of 2933 identified studies, 58 were included: six studies had a total of 408 humans and 52 studies had 2679 animals. The median follow-up was 12 months (range 1-156), and 95% of the hernias were incisional. There were 44 different coatings which included platelet-rich plasma, mesenchymal stem cells, growth factors, vitamin E, collagen-derived products, various polysaccharides, silk proteins, chitosan, gentamycin, doxycycline, nitrofurantoin, titanium, and diamond-like carbon. Mesenchymal stem cells and platelet-rich plasma were the most researched. Mesenchymal stem cells notably reduced inflammation and foreign body reactions but did not impact other healing metrics. In contrast, platelet-rich plasma positively influenced tissue ingrowth, collagen deposition, and neovascularization and had varying effects on inflammation and foreign body reactions. CONCLUSION We identified 44 different mesh coatings and they showed varying results. Mesenchymal stem cells and platelet-rich plasma were the most studied, with the latter showing considerable promise in improving biomechanical properties in hernia repair. Further investigations are needed to ascertain their definitive use in humans.
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Affiliation(s)
- Jason Joe Baker
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Jacob Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
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Lemdani MS, Niu EF, Amro C, Gala Z, Ewing JN, Honig SE, Broach RB, Fischer JP. Outcomes and Quality of Life After Resorbable Synthetic Ventral Hernia Repair in Contaminated Fields. Ann Plast Surg 2024; 92:S156-S160. [PMID: 38556666 DOI: 10.1097/sap.0000000000003860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
INTRODUCTION The ideal mesh type for hernia repair in a contaminated field remains controversial. Data regarding outcomes beyond 1 year and the impact on quality of life (QoL) are unknown. This study aims to evaluate the long-term surgical outcomes and patient-reported outcomes (PROs) after contaminated repair with poly-4-hydroxybutyrate (P4HB) mesh. MATERIALS METHODS Patients undergoing a contaminated hernia repair with P4HB between 2015 and 2020 were identified. Surgical site occurrences and hernia recurrences were recorded. Long-term PROs as defined by the Abdominal Hernia-Q and Hernia-Related Quality-of-Life Survey were assessed. RESULTS Fifty-five patients were included with a mean age of 54.5 years, a body mass index of 34 kg/m2, and a defect size of 356.9 ± 227.7 cm2. Median follow-up time was 49 months with a reoperation rate of 14.5% and a hernia recurrence rate of 7.3%. Of the 55 patients, 37 completed preoperative and postoperative PRO questionnaires. When comparing preoperative with postoperative Abdominal Hernia-Q, there was significant improvement in overall PROs (2.1 vs 3.5, P < 0.001). This improvement was maintained with no significant changes between postoperative scores over the course of 5 years. Patients with complications saw the same improvement in postoperative PRO scores as those without complications. CONCLUSIONS Our study found a low hernia recurrence and acceptable long-term reoperation rates in patients undergoing hernia repair with P4HB mesh in a contaminated setting. We demonstrate a sustained significant improvement in QoL scores after hernia repair. These data yield insight into the long-term outcomes and QoL improvement, providing physicians further knowledge to better counsel their patients.
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Affiliation(s)
- Mehdi S Lemdani
- From the Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
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Rodriguez-Quintero JH, Romero-Velez G, Mandujano C, Huang LC, Sreeramoju P, Malcher F. Slowly absorbable mesh in sublay ventral hernia repair in contaminated fields. Surg Endosc 2023; 37:8080-8090. [PMID: 37670192 DOI: 10.1007/s00464-023-10362-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/30/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND In the past years, there has been increasing evidence that supports the use of permanent mesh in contaminated wounds. Given this increased evidence, the indications to opt for slowly absorbable "biosynthetic" prostheses have been questioned. To address this, we compared the outcomes of slowly absorbable mesh in contaminated cases in a well-matched multicentric cohort. METHODS The Abdominal Core Health Quality Collaborative (ACHQC) database was queried for patients undergoing elective ventral hernia repair in Centers for Disease Control (CDC)-III operations (2013-2022). We compared demographics, hernia characteristics, and postoperative outcomes among types of mesh. We used propensity score matching to adjust for sex, diabetes, body mass index, smoking status, and operative time between mesh groups. Patients within other CDC classes and those with mesh positioned elsewhere than retro-rectus/preperitoneal space were excluded. RESULTS A total of 760 patients were included in the analysis. Slowly absorbable synthetic mesh (SA) was utilized in only 7% of the cases, while permanent (P) and biologic (B) mesh in 77% and 16%, respectively. After matching, 255 patients were studied. There was no difference in surgical site occurrence (8% SA, 16% P, 10% B, p = 0.27), surgical site infection (20% SA, 17% P, 12% B p = 0.54), surgical site occurrence requiring intervention (18% SA, 13% P, 14% B p = 0.72), readmission (12% SA, 14% P, 12% B, p = 0.90), or reoperation (8% SA, 2% P, 4% B, p = 0.14) at 30 days. In patients with 1-year follow-up, there was no difference in recurrence among groups (20% SA, 26% P, 24% B p = 0.90). CONCLUSION Based on our findings, SA has comparable outcomes to other types of mesh, particularly when an optimal retro-rectus repair is performed.
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Affiliation(s)
| | | | - Camilo Mandujano
- Department of Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Li-Ching Huang
- Center of Quantitative Sciences, Vanderbilt University, Nashville, TN, USA
| | | | - Flavio Malcher
- Department of Surgery, New York University, 530 1st Ave, New York, NY, USA.
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Mazzola Poli de Figueiredo S, Tastaldi L, Mao RMD, Lima DL, Huang LC, Lu R. Biologic versus synthetic mesh in open ventral hernia repair: A systematic review and meta-analysis of randomized controlled trials. Surgery 2023; 173:1001-1007. [PMID: 36623959 DOI: 10.1016/j.surg.2022.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/28/2022] [Accepted: 12/11/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Ventral hernia repair is one of the most common operations performed worldwide, and using mesh is standard of care to decrease recurrence. Biologic meshes are increasingly used to minimize complications associated with synthetic mesh, but with significantly higher cost and unclear efficacy. Until recently, most of the evidence supporting the use of biologic meshes was from retrospective cohorts with high heterogeneity and risk of bias. We aimed to report a meta-analysis of randomized controlled trials comparing the outcomes of synthetic and biologic mesh in elective open ventral hernia repair. METHODS A literature search of PubMed, Embase, and Cochrane Library databases was performed to identify randomized controlled trials comparing biologic and synthetic mesh in elective open ventral hernia repairs. The postoperative outcomes were assessed by means of pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. Heterogeneity was assessed with I2 statistics. RESULTS A total of 1,090 studies were screened, and 22 were fully reviewed. Four randomized controlled trials and 632 patients were included in the meta-analysis. Fifty-eight percent of patients had contaminated wounds (Wound Classification II-IV). Hernia recurrence (odds ratio 2.75; 95% confidence interval 1.76-4.31; P < .00001; I2 = 0%) and surgical site infections (odds ratio 1.53; 95% confidence interval 1.02-2.29; P = .04; I2 = 0%) were significantly more common in patients with biologic mesh. The rates of seroma, hematoma, and mesh removal were similar in both groups. CONCLUSION As compared to synthetic mesh, biologic meshes resulted in increased hernia recurrences and surgical site infections. Current evidence supports macroporous, uncoated synthetic mesh as the implant of choice for elective open ventral hernia repair, and its use should be considered even in contaminated cases.
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Affiliation(s)
| | - Luciano Tastaldi
- Department of Surgery, University of Texas Medical Branch, Galveston, TX. https://twitter.com/LTastaldiMD
| | - Rui-Min Diana Mao
- Department of Surgery, University of Texas Medical Branch, Galveston, TX. https://twitter.com/DianaMaoMD
| | - Diego Laurentino Lima
- Department of Surgery, Montefiore Medical Center, Bronx, NY. https://twitter.com/DiLaurentino
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Richard Lu
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
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