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The worst-case scenario: Bridging repair with a biologic mesh in high-risk patients with very large abdominal wall hernias-a prospective multicenter study.
- Source :
-
Surgery [Surgery] 2021 Feb; Vol. 169 (2), pp. 318-324. Date of Electronic Publication: 2020 Oct 14. - Publication Year :
- 2021
-
Abstract
- Background: While modern techniques allow midline fascial closure for most abdominal hernias, a bridge repair with mesh may be the only alternative in very large defects. When the risk of infection is high, the use of prosthetic mesh is controversial. We aim to examine outcomes after bridge repair of very large abdominal hernias at high risk for postoperative infection with a second-generation biologic mesh.<br />Methods: Prospective, multicenter, single-arm study of patients with very large abdominal hernias who received bridge repair with a neonatal bovine dermis mesh. Primary outcome was hernia recurrence, as identified on computed tomography 1 year after the operation. Secondary outcomes included mesh laxity, surgical site occurrences, and any other mesh-related complications. Independent risk factors of the outcomes were determined by univariate and multivariable analyses.<br />Results: A total of 117 bridge repair patients were enrolled with a mean defect size of 442.5 ± 254.2 cm <superscript>2</superscript> . The patients were predominantly obese (mean body mass index 36.5 ± 10.5) and with multiple comorbidities (Charlson comorbidity index 3 ± 2.5). Hernia recurrence was identified in 24 (20.5%) patients. An infected mesh at the index operation was an independent predictor of hernia recurrence, whereas obesity was an independent predictor of the pooled endpoint of recurrence and mesh laxity. Surgical site occurrences were recorded in 36.8% of the patients, and no independent risk factors were identified.<br />Conclusion: In patients with very large abdominal hernias and at high risk for postoperative infection, who cannot undergo midline fascial closure, a bridge repair with neonatal bovine dermis mesh offers an acceptable profile in terms of hernia recurrence and wound occurrences.<br /> (Copyright © 2020. Published by Elsevier Inc.)
- Subjects :
- Abdominal Wall diagnostic imaging
Abdominal Wall surgery
Adult
Aged
Animals
Cattle
Female
Follow-Up Studies
Hernia, Ventral diagnosis
Herniorrhaphy instrumentation
Humans
Male
Middle Aged
Prospective Studies
Recurrence
Risk Factors
Surgical Wound Infection etiology
Tomography, X-Ray Computed
Treatment Outcome
Biocompatible Materials adverse effects
Hernia, Ventral surgery
Herniorrhaphy adverse effects
Surgical Mesh adverse effects
Surgical Wound Infection epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1532-7361
- Volume :
- 169
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 33066982
- Full Text :
- https://doi.org/10.1016/j.surg.2020.08.036