Sean R Maloney, Kathryn A Schlosser, Tanushree Prasad, Kent W Kercher, Paul D Colavita, Vedra A Augenstein, B. Todd Heniford. Carolinas Medical Center
Background: CST is a complex operation that can be very helpful in AWR for large defects. Consensus exists that CST should be reserved for a definitive repair, as CST may not be repeatable. There are no large studies evaluating CST in contaminated cases.
Methods: A prospective, single institution study examined all patients undergoing CST during contaminated cases (CDC wound class 2, 3, 4). Univariate analysis and multivariate logistic regression were performed.
Results: 286 of 775 CSTs were in contaminated cases. 102 (35.7%) included an external oblique release (EOR). Patient characteristics include: age 58.6±11.2yr, BMI 34.6±7.5kg/m2, 28.4% diabetic, and 56.3% female. Mean defect size was very large (279.1±235.0cm2), 66.1% were recurrent, and 47.5% were incarcerated. Mesh, used in 95.1%, had a mean area of 755.4±355.3cm2. Most meshes (62.6%) were biologic. With resection of infected mesh (N=49), biologic mesh was always used. Wound complication rate was 39.5%, with 20 recurrences (7.0%). When comparing biologic to synthetic mesh (only used in class 2 wounds), there were no differences in recurrence (7.5%vs3.7%,p0.204) or wound complications (41.6%vs33.6%,p0.176). When comparing EOR to posterior (P)CST, defects were larger (396.6±330.0vs215.1±121.4cm2,p<0.001), OR time was longer (278.3±104.8vs223.7±64.2min,p<0.001), mesh infections were more common (5.4%vs0.6%,p=0.017), and rate of recurrence was higher (12.8%vs3.8%,p=0.005). There was no difference in wound complications (45.1%vs36.4%,p0.150). Synthetic mesh was used more often (39.6% vs19.4%,p0.028) in cases with successful fascial closure (89.2% of cases). Multivariate analysis was performed to control for potentially confounding factors (defect size, diabetes, sex, BMI, OR time, panniculectomy, tobacco, and prior hernia repair); there were no differences in wound complication or recurrence between EOR vs PCST, mesh type, or fascial closure.
Conclusions: CST, rarely used without mesh, appears successful in contaminated AWR, despite a high wound complication rate. When controlling for confounding factors, there was no difference between CST approaches in the face of contamination.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94136
Program Number: S028
Presentation Session: Complex Abdominal Wall Hernia
Presentation Type: Podium