Outcomes of synthetic mesh in contaminated ventral hernia repairs

Alfredo M Carbonell, Cory N Criss, William S Cobb, Yuri W Novitsky, Michael J Rosen
Journal of the American College of Surgeons 2013, 217 (6): 991-8

BACKGROUND: Given the questionable long-term durability of biologic meshes, additional prosthetic options for ventral hernia repairs (VHR) in contaminated fields are necessary. Recent evidence suggests improved bacterial resistance of reduced-weight, large-pore synthetics, giving a potential mesh alternative for repair of contaminated hernias. We aimed to evaluate the clinical outcomes of 2 institutions' experience implanting lightweight polypropylene synthetic mesh in clean-contaminated and contaminated fields.

STUDY DESIGN: Open VHRs performed with polypropylene mesh in the retro-rectus position in clean-contaminated and contaminated fields were evaluated. Primary outcomes parameters included surgical site infection, surgical site occurrence, mesh removal, and hernia recurrence.

RESULTS: One hundred patients (50 male, 50 female) with a mean age of 60 ± 13 years and a mean body mass index (calculated as kg/m(2)) of 32 ± 9.3 met inclusion criteria. There were 42 clean-contaminated and 58 contaminated cases. The incidence of surgical site occurrence was 26.2% in clean-contaminated cases and 34% in contaminated cases. The 30-day surgical site infection rate was 7.1% for clean-contaminated cases and 19.0% for contaminated cases. There were a total of 7 recurrences with a mean follow-up of 10.8 ± 9.9 months (range 1 to 63 months). Mesh removal was required in 4 patients: 2 due to early anastomotic leaks, 1 due to stomal disruption and retraction in a morbidly obese patient, and 1 from a long-term enterocutaneous fistula.

CONCLUSIONS: Although perhaps not yet considered standard of care in the United States, we have demonstrated favorable infection, recurrence, and mesh removal rates associated with the use of synthetic mesh in contaminated VHR.

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