Comparison of Outcomes After Partial Versus Complete Mesh Excision

Area of Science:

• Surgical outcomes research
• Hernia repair techniques
• Biomaterial explantation

Background:

• Ventral hernia repair (VHR) commonly utilizes mesh prosthetics.
• Management strategies for explanted mesh during reoperation are not well-defined.
• Limited evidence exists for partial mesh excision (PME) as an alternative to complete mesh excision (CME).

Purpose of the Study:

• To compare patient outcomes following mesh explantation via PME versus CME.
• To identify specific patient groups or conditions where PME may lead to different outcomes.

Main Methods:

• Analysis of the Abdominal Hernia Surgeon Quality Collaborative (AHSQC) registry data.
• Inclusion of ventral hernia repair patients who underwent mesh excision.
• Propensity score matching to control for confounding variables.

Main Results:

• Propensity-matched analysis of 1904 patients revealed significantly higher overall complications (35% vs. 29%, P=0.01) after PME.
• PME was associated with increased surgical site infection/sequelae (SSI/SSO), surgical site occurrence of infection (SSOPI), and reoperation rates.
• In clean-contaminated wounds, PME showed higher SSOPI rates (24% vs. 9%, P=0.02).
• In cases of mesh infection/fistulas, PME resulted in higher SSOPI (46% vs. 24%, P=0.04) and reoperation (21% vs. 6%, P=0.03).
• Odds-ratio analysis indicated PME increased the likelihood of SSOPI (OR 1.5) and reoperation (OR 2.2).

Conclusions:

• Guidelines for mesh management during VHR reexploration are necessary due to increasing mesh use.
• This multicenter study indicates PME is associated with significantly increased postoperative complications in patients with clean-contaminated wounds and mesh infections/fistulas.
• Outcomes were similar between PME and CME in patients with clean wounds.