Jenny M Shao, MD1, Yewande Alimi, MD, MS1, Dylan Conroy, BS2, Parag Bhanot, MD1. 1Medstar Georgetown University Hospital, 2Georgetown University School of Medicine
Background: Complex incisional hernia repairs using component separation techniques can have associated wound complications as high as 57%. Major and minor flap and wound complications can lead to mesh infections, hernia recurrence, reoperations, hospital readmissions and increasing health care costs. Usage of intraoperative indocyanine green (ICG) to assess skin flaps prior to abdominal wall closure has been shown to decrease skin flap necrosis and post-operative complications by identifying patients at risk and allowing concurrent intraoperative modifications to the flap. Primary outcome will be to assess the utility of ICG in changing intraoperative decision making. Secondary outcomes analyzed are the incidence of post-operative wound operative complications, hernia recurrence rates, major 30-day complications, and cost benefit analysis of using ICG.
Methods: An IRB- approved retrospective study within MedStar Georgetown University Hospital database was conducted, incorporating all consecutive patients undergoing complex incisional hernia repair with perforator sparing component separation technique (PSCST) from 2014 to 2018. In this group of 99 patients, a total of 69 patients had both PSCST and concurrent administration of 4 mg IV ICG intraoperatively with fluorescent assessment of their skin flaps. They were then analyzed based on patient characteristics, Ventral Hernia Working Group (VHWG) grade, comorbidities, operative factors, complications, and post-operative recovery. Wound complications were defined as post-operative need for antibiotics, need for incision and drainage, or unplanned take backs to the operating room.
Results: 69 patients underwent perforator sparing component separation for complex ventral hernia repairs with intraoperative usage of indocyanine green. In 31(44.9%) patients, intraoperative use of ICG led to further debridement of skin flaps and change in intraoperative management. The overall incidence of wound infection was 8.6% (n=6), with 2 superficial site infections (SSI), and 4 deeper surgical site infections (DSI). Of these 6 patients, 4 patients (5.8%) required reoperations for wound infections. Total recurrence rate was 1.4% (n=1). Other complications post-operatively included 1 (1.4%) hematoma, 5 (7.2%) seromas (none of which required intervention), no organ space infections, no mesh explants, and no mortalities. Total cost of intraoperative ICG per patient was $3,806. The cost of readmission for infection can cost upwards of $124,069 per patient.
Conclusions: Intraoperative ICG can help decrease overall costs associated with complex ventral hernia repairs by decreasing wound complication rates. Preventing abdominal wall infections in just 3 out of every 100 patients would help offset the cost of using intraoperative ICG in complex abdominal wall reconstruction.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93538
Program Number: S029
Presentation Session: Complex Abdominal Wall Hernia
Presentation Type: Podium