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Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair
Published on: December 23, 2022
A dual-stage approach to contaminated, high-risk ventral hernia repairs
Nathan W Kugler1, Melanie Bobbs1, Travis Webb1
1Division of Trauma and Critical Care, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
Background:
The Modified Hernia Grading System (MHGS) was developed to risk stratify complex ventral hernia repairs (VHRs). MHGS grade 3 patients have mesh infections, dirty or contaminated fields, and/or violation of the alimentary tract. Reported surgical site infection (SSI) rates are over 40% after single-stage VHR in contaminated fields. In an attempt to decrease the SSI rate in MHGS grade 3 patients, we developed a dual-stage VHR (DSVHR) approach.
Methods:
We reviewed adult general surgery patients undergoing DSVHR between January 2010 and June 2014. All patients were MHGS grade 3. Primary end point was 30-d superficial and deep SSI. Secondary end points included other surgical site occurrences, 6-mo recurrence, and mesh excision rates.
Results:
Fifteen patients underwent DSVHR. Mean age was 56 y, and median body mass index was 38.3 kg/m(2). Operative indication included enterocutaneous fistulas (ECF; n = 6), ECF with infected mesh (n = 2), infected mesh (n = 2), and VHR requiring bowel resection (n = 5). Thirty-one operative procedures were performed with median of 2.5 d between procedures. Fascial closure was re-established in 12 patients; five patients had underlay biologic mesh placement; seven underwent component separation with retrorectus mesh placement (synthetic [n = 2], biologic [n = 5]). The remaining patients underwent bridging repair with biologic mesh. One patient developed a recurrence after 6 mo, whereas a single patient had a recurrence of their ECF. Four (27%) patients developed a SSI, with an additional four (27%) experiencing a surgical site occurrence. There were no postoperative mesh infections.
Conclusions:
DSVHR in MHGS grade 3 patients is associated with a lower SSI rate than previously reported for those undergoing single-stage repairs.
Insights
Dual-stage ventral hernia repair (DSVHR) in complex cases (MHGS grade 3) shows lower surgical site infection (SSI) rates compared to single-stage repairs. This innovative approach offers improved outcomes for high-risk patients undergoing ventral hernia repair (VHR).
Area of Science:
- Surgical Innovation
- Hernia Repair Techniques
- Wound Complication Management
Background:
- The Modified Hernia Grading System (MHGS) stratifies complex ventral hernia repairs (VHRs).
- MHGS grade 3 patients present high risks: mesh infections, contaminated fields, or alimentary tract violations.
- Single-stage VHR in contaminated fields report over 40% surgical site infection (SSI) rates.
Purpose of the Study:
- To evaluate the efficacy of a dual-stage ventral hernia repair (DSVHR) approach.
- To decrease the surgical site infection (SSI) rate in MHGS grade 3 patients.
- To assess secondary outcomes including surgical site occurrences, recurrence, and mesh excision rates.
Main Methods:
- Retrospective review of adult general surgery patients undergoing DSVHR between January 2010 and June 2014.
- All patients were classified as MHGS grade 3.
- Primary endpoint: 30-day superficial and deep SSI. Secondary endpoints: surgical site occurrences, 6-month recurrence, and mesh excision.
Main Results:
- Fifteen patients underwent DSVHR, with a median of 2.5 days between procedures.
- Four patients (27%) developed SSI, and four (27%) experienced other surgical site occurrences. No postoperative mesh infections occurred.
- One recurrence (7%) was noted at 6 months; one patient had ECF recurrence. Various mesh types and repair techniques were employed.
Conclusions:
- Dual-stage VHR (DSVHR) in MHGS grade 3 patients is associated with a lower SSI rate.
- This approach appears to be a viable strategy for reducing complications in complex ventral hernia repairs.
- Further research is warranted to confirm these findings in larger cohorts.
