Outcomes of abdominal wall closure with fascial bridging using a polyglactin 910 (Vicryl) Mesh following non-trauma
Nir Messer1,2, Alex Bertke3, Benjamin T Miller4
1Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, OH, USA. masrinir@gmail.com.
Introduction:
Complete primary fascial closure following midline laparotomy is occasionally unachievable, necessitating abdominal wall closure via fascial bridging with polyglactin 910 (Vicryl) mesh. Despite its frequent use, literature on the outcomes of Vicryl mesh for fascial bridging remains sparse and controversial, with some studies indicating potential associations with enterocutaneous fistulas and bowel obstruction. This study evaluates the outcomes of fascial bridging utilizing Vicryl mesh for non-trauma laparotomies.
Methods:
We conducted a retrospective analysis of adult patients who underwent abdominal wall closure using Vicryl mesh at Cleveland Clinic centers from January 2018 to April 2023. Data were extracted from the Epic System, focusing on outcomes including fistula formation, the need for interventions for small bowel obstruction, and overall wound and postoperative morbidity, with a minimum follow-up of six months.
Results:
Among the 124,536 patients who underwent non-trauma laparotomies, 202 (0.17%) met the inclusion criteria, with a median follow-up of 47 months (SD ± 18.9 months). Postoperative outcomes following abdominal wall closure with Vicryl mesh included a 48.5% rate of surgical site infections, a 27.2% incidence of skin dehiscence, a 9.9% occurrence of soft tissue necrosis, and 2% experienced bowel evisceration secondary to mesh detachment. Enterocutaneous fistulas developed in 8.4% of patients, with no interventions for small bowel obstruction required within the first six months postoperatively. These complication rates are comparable to other abdominal closure techniques in similarly complex cases.
Conclusions:
Fascial bridging with Vicryl mesh is a safe method for abdominal wall closure, with enterocutaneous fistula and small bowel obstruction rates comparable to those seen with other techniques. Nevertheless, primary closure of the linea alba should be prioritized, with mesh implantation minimized whenever feasible.
