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Published on: February 27, 2017
Impact of pericardium bovine patch (Tutomesh(®)) on incisional hernia treatment in contaminated or potentially
A Gurrado1, I F Franco, G Lissidini
1Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School,"Aldo Moro" of Bari, Policlinico, P.zza G. Cesare,11, 70124, Bari, Italy, angelagurrado@libero.it.
Purpose:
This retrospective comparative study analyzes the outcome of patients affected by incisional hernia in potentially contaminated or contaminated field, treated by three operative techniques.
Methods:
152 patients (62 M:90 F; mean age 65 ± 14 years) underwent incisional hernia repair (January 2002-January 2012) in complicated settings. Criteria of inclusion in the study were represented by the following causes of admission: mesh rejection/infection, obstruction without gangrene but with possible peritoneal bacterial translocation, obstruction with gangrene, enterocutaneous fistula or simultaneous presence of ileo- or colostomy. The patients were divided into three groups: A (n = 76), treated with primary closure technique; B and C (n = 38 each), with reinforcement by synthetic or pericardium bovine mesh (Tutomesh(®)), respectively. The prosthetic groups were divided into Onlay and Sublay subgroups.
Results:
Significant decreases in C vs A were observed for wound infection (3 vs 37%) and recurrence (0 vs 14%), and in C vs B for wound infection (3 vs 53%), seroma (0 vs 34%) and recurrence (0 vs 16%). Patients with concomitant bowel resection (BR) (43%) showed (all P < 0.05) an increase of overall morbidity (55 vs 33%) and wound infection rate (42 vs 24%) compared to cases without BR. Morbidity presented no significant differences in C-Onlay or Sublay subgroups. B-Sublay subgroup has (all P < 0.05) lower overall morbidity (20 vs 75%), wound infection (10 vs 68%) and seroma (0 vs 46%) than B-Onlay.
Conclusions:
The pericardium bovine patch seems to be safe and effective to successfully repair ventral hernia in potentially contaminated operative fields, especially in association with bowel resection.
Insights
Bovine pericardium mesh is a safe and effective option for incisional hernia repair in contaminated surgical fields, particularly when bowel resection is necessary. This method significantly reduces wound infection and recurrence rates compared to primary closure or synthetic mesh.
Area of Science:
- Surgical Innovation
- Hernia Repair Techniques
- Biomaterials in Surgery
Background:
- Incisional hernias in contaminated fields pose significant challenges due to high risks of infection and recurrence.
- Traditional repair methods often have limited success in these complex cases.
- Evaluating alternative biomaterials for hernia repair is crucial for improving patient outcomes.
Purpose of the Study:
- To compare the outcomes of incisional hernia repair using primary closure versus synthetic or bovine pericardium mesh in contaminated surgical settings.
- To analyze the impact of concomitant bowel resection on morbidity and infection rates.
- To assess the safety and efficacy of bovine pericardium mesh (Tutomesh®) in complex hernia repairs.
Main Methods:
- A retrospective comparative study of 152 patients undergoing incisional hernia repair in contaminated fields between January 2002 and January 2012.
- Patients were divided into three groups: primary closure (Group A), synthetic mesh (Group B), and bovine pericardium mesh (Group C).
- Prosthetic groups were further analyzed by Onlay and Sublay techniques, with a focus on complications like infection, seroma, and recurrence.
Main Results:
- Bovine pericardium mesh (Group C) showed significantly lower wound infection (3% vs 37%) and recurrence (0% vs 14%) rates compared to primary closure (Group A).
- Group C also demonstrated lower wound infection (3% vs 53%), seroma (0% vs 34%), and recurrence (0% vs 16%) than synthetic mesh (Group B).
- Concomitant bowel resection increased overall morbidity and wound infection rates, but the bovine pericardium patch remained effective, especially in the Sublay configuration.
Conclusions:
- Bovine pericardium mesh is a safe and effective biomaterial for repairing ventral hernias in potentially contaminated operative fields.
- This mesh is particularly advantageous when associated with bowel resection, offering reduced complication rates.
- The Sublay technique with synthetic mesh showed better outcomes than the Onlay technique regarding morbidity and infection.
