Sushil Pandey, MD, Hadi Najafian, DO, Paravasthu Ramanujam, MD, Krishna Ramanujam, MS
West Valley Colon and Rectal Surgery Center
Introduction
The incidence of wound (ventral) hernia and infection is high after Ostomy (Colostomy/Ileostomy) closure. The primary purpose of this study is to evaluate the incidence of ventral hernia when ostomy is closed using GORE® BIO-A® Tissue Reinforcement, an absorbable tissue scaffold. The secondary purpose is to evaluate the complication after ostomy closure using mesh.
Material and Methods
In this prospective study, 50 patients with ostomies underwent elective closure with reinforcement using GORE® BIO-A® Tissue Reinforcement from June 1, 2011 to May 30, 2012. 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. The mesh was placed either in retro-rectus space or over fascia as an onlay.
Results:
50 patients had absorbable mesh reinforcement during ostomy closure. The demographics of the patient is as below:
| Age in years: mean(range) | 67(29-88) |
| Sex: Male:Female | 28:22 |
| ASA: mean(range) | 3(2-4) |
| BMI: mean(range) | 28(17.3-43) |
| Ostomy: Ileostomy:colostomy | 35:15 |
| Technique:Overlay:retro-rectus | 38:12 |
| Hospital stay in days: mean(range) | 4(1-10) |
| Follow up in months: mean(range) | 6.4(3.5-13) |
Post-operative Operative complication is as below:
| Wound Infection | 3 |
| Wound Hematoma | 2 |
| Enterocutaneous Fistula | 1 |
| Ileus | 1 |
| Wound Hernia | 0 |
All complication was managed conservatively. Removal of mesh was not needed for any of the complications. There was no incidence of wound hernia during above mentioned follow up.
Conclusions
Use of GORE® BIO-A® Tissue Reinforcement seems to prevent the incidence of ostomy closure site hernias (ventral hernia). Biologic mesh in infected wound can be managed conservatively without removing it. However, randomized controlled studies with a larger number of patients and longer follow-up is needed to establish our preliminary findings.
Session: Poster Presentation
Program Number: P092
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