Omar Toubat, BA, Evan T Alicuben, MD, Kamran Samakar, MD, Namir Katkhouda, MD, Caitlin C Houghton, MD, John C Lipham, MD, Kulmeet Sandhu, MD, Adrian Dobrowolsky, MD, Nikolai A Bildzukewicz, MD. Department of Surgery, Keck School of Medicine of USC
Introduction – Abdominal wall reconstruction (AWR) with mesh placement is commonly performed in patients with complex ventral hernias. Recently, bio-absorbable mesh has emerged as an alternative to synthetic and biologic mesh types, however few studies have evaluated its efficacy in AWR. The aim of this study was to describe our institutional experience with bio-absorbable mesh in a high-risk patient cohort.
Methods and Procedures – Patients who underwent incisional hernia repair with component separation and bio-absorbable mesh placement (Gore Bio-A or Bard Phasix) between 2013 and 2018 were identified. Demographic and surgical characteristics and relevant outcome data were retrospectively collected from patient records.
Results – In total, 50 patients (32 males, 64.0%) were included, with a mean age of 58.7 years and mean BMI of 30.7 (range 21.0-44.9). 9 (18.0%) patients had a modified Charlson-Deyo (CD) comorbidity score of 1 and 33 (66.0%) patients had a CD score of greater than 2. 9 (18.0%) patients had a history of wound infection. Operative characteristics are summarized in Table 1. The median LOS following surgery was 4 days (range 1-20). The mean follow-up period after discharge was 8.9 months (range 0.4-39.4). Postoperatively, 11 (22.0%) patients experienced at least one seroma, 14 (28.0%) had a surgical site infection, and 5 (10.0%) experienced surgical site bleeding/hematoma formation. Of the six patients that required surgical reintervention, 3 underwent surgical debridement, 2 underwent surgical repair for hernia recurrence, and 1 underwent both debridement and repair for recurrence. Overall, 7 (14.0%) patients experienced a recurrence, with a mean time to recurrence of 1.3 years.
Conclusion – Bio-absorbable mesh is an emerging alternative to synthetic and biologic mesh in incisional hernia repair. The use of bio-absorbable mesh in conjunction with component separation is a durable approach for complex AWR.
| Characteristic | Number |
|---|---|
| Surgical Status | |
| Elective | 48 |
| Emergent | 2 |
| Repair Type | |
| Initial | 27 |
| Recurrent | 23 |
| Mesh Placement | |
| Onlay | 19 |
| Underlay/Retrorectus | 24 |
| Onlay and Underlay/Retrorectus | 7 |
| Component Separation | |
| Bilateral Posterior | 18 |
| Bilateral Anterior | 17 |
| TAR | 11 |
| Bilateral Posterior and Anterior | 4 |
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95531
Program Number: P530
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster