• Skip to primary navigation
  • Skip to main content
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • SAGES Store
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
    • “Unofficial” Logo Products
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2024 Scientific Session Call For Abstracts
      • 2024 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Fellows Career Development Course
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • OWLS
  • Log In

Underlay Versus Retrorectus Mesh Placement in Complex Ventral Hernia Repair Utilizing Endoscopic Component Separation

M Gustafson, MD, R Kimball, MD, B Pellini, MD, I Daoud, MD, FACS. Department of Minimally Invasive Surgery, St. Francis Hospital and Medical Center; Hartford, CT.

Introduction: Abdominal wall reconstruction for complex abdominal wall defects remains a challenge. Although open component separation with medialization of the rectus muscles restores integrity and function of the abdominal wall, it is fraught with wound complications. Multiple studies demonstrate a decreased incidence of wound complications with endoscopic component separation as perforating vessels remain intact. The ideal mesh and its placement, however, remain elusive. We aim to investigate outcomes after endoscopic component separation with open ventral hernia repair and underlay versus retrorectus mesh placement.

Results: Forty-eight patients underwent bilateral endoscopic component separation with open ventral hernia repair and either underlay or retrorectus mesh placement by a single surgeon at our institution between February 2010 and July 2013. Mesh was placed as an underlay in 27 patients and retrorectus in 21. The demographics of the underlay and retrorectus groups were similar in that there was no significant difference in ASA p = 0.53, ethnicity p = 0.50, mean age (59.8 vs 55.1 yrs, p = 0.18), BMI (32.2 vs 35.8 p = 0.48), size of fascial defect (10.8 vs 10.7cm, p = 0.88) and hernia grade p = 0.66. There were more female patients in the retrorectus group, however this was not statistically significant (67% vs 41%, p = 0.067). There were no significant differences in overall incidence of complications (29.6% vs 42.9%, p = 0.15), hospital length of stay (6.8 vs 6.6 days, p = 0.78), surgical site infections (15% vs 14%, p = 0.64), and recurrence (11% vs 0%, p = 0.17). There were more patients with seromas requiring drainage in the retrorectus group (15% vs 0%, p = 0.031).

Discussion: With the exception of increased rates of seroma requiring drainage, retrorectus placement of mesh in our open ventral hernia repairs with endoscopic component separation yields outcomes comparable to underlay mesh placement. The incidence of both procedure-related and nonprocedure-related complications, recurrence and hospital length of stay are equivalent. The majority of seromas requiring drainage have been lateral, in the field of the component separation, thus it is difficult to attribute this to retrorectus mesh placement. Our drain placement has not been consistent throughout this period and this should be investigated for potential association with seroma development. One limitation of this study is a shorter average follow up in the retrorectus group (8.7, range 2-15 months) compared to the underlay group (31.6, range 19-43 months) owing to a later date of service. Although retrorectus mesh placement has not increased perioperative morbidity, at least two years of follow up is sought to better assess recurrence rates. Placing mesh outside of the peritoneal cavity has the potential benefit of utilizing a synthetic mesh above the posterior rectus sheath, thus avoiding the complications feared with intraperitoneal placement of synthetic meshes and significant cost of biologic prostheses.

View Poster

5,110

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064
1-310-437-0544
[email protected]
Monday - Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons