Paravasthu Ramanujam, MD FACS, Hadi Najafian, DO FACS FASCRS, Pedram Motamedi, Sushil Pandey. West Valley Colon & Rectal Surgery Center
The purpose of our study is to compare the incidence of wound complication when ostomy is closed primarily or use of using GORE® BIO-A® Tissue Reinforcement, an absorbable tissue scaffold .
In this retrospective study, 14 patients with ostomies underwent elective closure with reinforcement using GORE® BIO-A® Tissue Reinforcement, an absorbable tissue scaffold. This group was compared with 14 other patients who had elective ostomy closures with no reinforcement. All bowel anastomosis were completed with GIA and TA stapler creating a functional end-to-end anastomosis. GORE® BIO-A® Tissue Reinforcement (W. L. Gore & Associates, Flagstaff, AZ) is an absorbable mesh composed of a 3 dimensional tissue scaffold which is replaced by tissue in about 6 months. In the group where mesh was used, the mesh was placed in the retrorectus space above the posterior fascia and anchored with absorbable sutures to the fascia. The rest of the fascial and skin closures were similar in both groups. Both groups were comparable in terms of age, sex, BMI, nature of ostomy. Mean follow up duration was 24 months.
The outcomes parameters were surgical site infection and the incidence of wound hernias.
Of the 14 patients who had absorbable mesh reinforcement, 6 had loop ileostomies and 8 had loop colostomies. This is similar to the group of 14 patients where no reinforcement was used.
The wound infection rates in both groups were similar, with 2 patients in each group developing wound infection. All patients with wound infection were managed by opening the wound and daily dressing. In all 4 patients, wounds healed satisfactorily. However, in the group with no mesh reinforcement, three patients developed ventral hernia within 6 months. In the group where mesh was used, no patients developed ventral hernia and the mesh was not removed.
Even though the number of patients in both groups is small, the use of GORE® BIO-A® Tissue Reinforcement seems to reduce the incidence of ostomy closure site hernias (ventral hernia). Also when there is a wound infection in this potentially contaminated wound, this mesh seems to resist the infection and help to prevent future hernias. However, prospective studies with a larger number of patients and longer follow-up is needed to establish our preliminary findings
Session Number: Poster – Poster Presentations
Program Number: P066