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Absorbable mesh in a contaminated field: hernia repair outcomes
Victoria Wagner1, Brittany E Levy2, Jennifer T Castle1
1Department of Surgery, University of Kentucky College of Medicine, 780 Rose Street, Lexington, KY, 40536, USA.
Updates in Surgery
|December 2, 2022
Summary
Biosynthetic mesh is effective for hernia repair across various wound classes. While higher wound classes show increased complications and readmissions, hernia recurrence rates remain similar compared to clean wounds.
Area of Science:
- Surgical Innovation
- Biomaterials in Medicine
- Hernia Surgery Outcomes
Background:
- Hernia repair mesh enhances incisional hernia repair stability and reduces reoperations.
- Surgeons debate the optimal mesh type (synthetics, biologics, biosynthetics) for specific patients.
- Biosynthetic mesh offers an absorbable alternative for hernia repair.
Purpose of the Study:
- To evaluate patient outcomes using biosynthetic mesh based on CDC wound classification.
- To compare surgical outcomes between different wound classes (I-IV) using biosynthetic mesh.
- To identify factors correlating with higher wound classes in ventral hernia repair.
Main Methods:
- Retrospective case review of open ventral hernia repairs with absorbable mesh implants (Jan 2013-Dec 2017).
- Utilized local National Surgery Quality Improvement (NSQIP) databases.
- Analyzed patient demographics, operative details, and clinical outcomes based on CDC wound classification.
Main Results:
- 112 cases identified; 32% were wound classes II-IV.
- Higher wound classes correlated with diabetes, prior hernia repair, parastomal hernia, emergent presentations, bowel resection, larger mesh size, increased infections, and wound disruption.
- Higher wound classes showed longer hospital stays and greater readmission rates (38.9% vs. 11.8%).
Conclusions:
- Biosynthetic mesh repair in contaminated wounds (CDC class II-IV) led to more emergent presentations, bowel resections, larger mesh use, and readmissions compared to clean wounds (class I).
- Despite increased peri-operative issues in higher wound classes, hernia recurrence rates were similar across all CDC wound classes for biosynthetic mesh repairs.
- Biosynthetic mesh demonstrates comparable hernia recurrence rates regardless of wound contamination level.
