Sean R Maloney, Kathryn A Schlosser, Tanushree Prasad, Paul D Colavita, Kent W Kercher, Vedra A Augenstein, B. Todd Heniford. Carolinas Medical Center
Introduction: CST allows mobilization of the abdominal wall to allow in an attempt to close the midline fascia. This technique has been associated with increased wound complications. The aim of this study is to compare operative outcomes and quality of life (QOL) after CST versus No-CST in large, preperitoneal ventral hernia repairs (PPVHR).
Methods: A prospective, single institution hernia study examined all patients undergoing PPVHR with synthetic mesh. Emergency and contaminated operations were excluded. A case control cohort with similar BMI, sex, and defect size was identified using propensity score matching technique from cases with No-CST. QOL was assessed using the Carolinas Comfort Scale (CCS).
Results: There were 340 cases with CST included for case control. The algorithm was able to match 113 CST cases to 113 No-CST cases. The groups (CST vs No-CST) were similar regarding age (59.8±12.3 vs 58.6±12.4years, p0.5), BMI (32.4±5.8 vs 32.9±6.7kg/m2, p0.901), diabetes (22.3 vs 31.0, p0.142), smoking (13.3 vs 13.3, p1.0), defect size (196.1±118.3 vs 198.1±122.6cm2, p0.9), mesh size (956.9±237.0 vs 966.5±219.6cm2, p0.7), and follow up time (21.3±22.2 vs 20.7±23.2 months, p0.6). In univariate analysis, there was no difference in recurrence between the CST and no-CST groups (0.9% vs 0.9%, p1.000) or mesh infection (0.9% vs 0.0%, p0.5). CST did have more wound complications (29.2% vs 16.1%, p0.02). Controlling for panniculectomy and diabetes with multivariate logistic regression, CST had an increased risk for wound complications (OR 2.27, CI 1.16-4.47).
QOL was routinely assessed. The groups were similar pre-operatively with 76.3% of CST patients and 77.8% of No-CST patients having pain (p0.890). At 1, 6, 12, 24 and 36 months post-operatively, the groups had equal QOL as measured by pain and movement limitations.
Conclusions: In large ventral hernias, CST can be helpful in allowing successful fascial closure. While CST with mesh results in an increased rate of wound complications, CST should be performed when necessary to achieve fascial closure, as the recurrence rates are equal to similarly sized hernias that have successful fascial closure without CST. Additionally, in the largest QOL comparative study to date, CST does not negatively impact patient QOL in the repair of large ventral hernias short or long term.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95028
Program Number: S025
Presentation Session: Complex Abdominal Wall Hernia
Presentation Type: Podium