Biologic mesh for repair of ventral hernias in contaminated fields: long-term clinical and patient-reported outcomes View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2016-06-22

AUTHORS

Amin Madani, Petru Niculiseanu, Wanda Marini, Pepa A. Kaneva, Benjamin Mappin-Kasirer, Melina C. Vassiliou, Kosar Khwaja, Paola Fata, Gerald M. Fried, Liane S. Feldman

ABSTRACT

BackgroundGuidelines recommend biologic prosthetics for ventral hernia repair (VHR) in contaminated fields, yet long-term and patient-reported data are limited. We aimed to determine the long-term rate of hernia recurrence, and other clinical and patient-reported outcomes following the use of porcine small intestine submucosa (PSIS) for VHR in a contaminated field.MethodsConsecutive patients undergoing open VHR with PSIS mesh in a contaminated field from 2004 to 2014 were prospectively evaluated for hernia recurrence and other post-operative complications. Multivariate logistic and Cox regression analyses identified predictors of hernia recurrence and surgical site infection. Patient-reported outcomes were evaluated using SF-36, Hernia-Related Quality-of-Life Survey (HerQLes) and Body Image Questionnaire instruments.ResultsForty-six hernias were repaired in clean-contaminated [16 (35 %)], contaminated [11 (24 %)] and dirty [19 (41 %)] fields. Median follow-up was 47 months [interquartile range: 31–79] and all patients had greater than 12-month follow-up. Sixteen patients (35 %) were not re-examined. Incidence of surgical site events and surgical site infection were 43 % (n = 20) and 56 % (n = 25), respectively. American Society of Anesthesiologists score 3 or greater was an independent predictor of surgical site infection (odds ratio 5.34 [95 % confidence interval 1.01–41.80], p = 0.04). Hernia recurrence occurred in 61 % (n = 28) with a median time to diagnosis of 16 months [interquartile range 8–26]. After bridged repair, 16 of 18 patients (89 %) recurred, compared to 12 of 28 (43 %) when fascia was approximated (p < 0.01). Bridged repair was an independent predictor of recurrence (odds ratio 10.67 [95 % confidence interval 2.42–76.08], p < 0.01). Patients with recurrences had significantly worse scores on the SF-36 mental health component and self-perceived body image, whereas HerQLes scores were similar.ConclusionsHernia recurrences and wound infections are high with the use of biologic PSIS mesh in contaminated surgical fields. Careful consideration is warranted using this approach. More... »

PAGES

861-871

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00464-016-5044-1

DOI

http://dx.doi.org/10.1007/s00464-016-5044-1

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1023815744

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/27334966


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37 schema:description BackgroundGuidelines recommend biologic prosthetics for ventral hernia repair (VHR) in contaminated fields, yet long-term and patient-reported data are limited. We aimed to determine the long-term rate of hernia recurrence, and other clinical and patient-reported outcomes following the use of porcine small intestine submucosa (PSIS) for VHR in a contaminated field.MethodsConsecutive patients undergoing open VHR with PSIS mesh in a contaminated field from 2004 to 2014 were prospectively evaluated for hernia recurrence and other post-operative complications. Multivariate logistic and Cox regression analyses identified predictors of hernia recurrence and surgical site infection. Patient-reported outcomes were evaluated using SF-36, Hernia-Related Quality-of-Life Survey (HerQLes) and Body Image Questionnaire instruments.ResultsForty-six hernias were repaired in clean-contaminated [16 (35 %)], contaminated [11 (24 %)] and dirty [19 (41 %)] fields. Median follow-up was 47 months [interquartile range: 31–79] and all patients had greater than 12-month follow-up. Sixteen patients (35 %) were not re-examined. Incidence of surgical site events and surgical site infection were 43 % (n = 20) and 56 % (n = 25), respectively. American Society of Anesthesiologists score 3 or greater was an independent predictor of surgical site infection (odds ratio 5.34 [95 % confidence interval 1.01–41.80], p = 0.04). Hernia recurrence occurred in 61 % (n = 28) with a median time to diagnosis of 16 months [interquartile range 8–26]. After bridged repair, 16 of 18 patients (89 %) recurred, compared to 12 of 28 (43 %) when fascia was approximated (p < 0.01). Bridged repair was an independent predictor of recurrence (odds ratio 10.67 [95 % confidence interval 2.42–76.08], p < 0.01). Patients with recurrences had significantly worse scores on the SF-36 mental health component and self-perceived body image, whereas HerQLes scores were similar.ConclusionsHernia recurrences and wound infections are high with the use of biologic PSIS mesh in contaminated surgical fields. Careful consideration is warranted using this approach.
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46 Body Image Questionnaire
47 Bridged repairs
48 Cox regression analysis
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51 Life Survey
52 MethodsConsecutive patients
53 SF-36
54 SF-36 mental health component
55 analysis
56 anesthesiologists
57 approach
58 biologic prosthetics
59 biologics
60 body image
61 careful consideration
62 complications
63 components
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65 contaminated field
66 data
67 diagnosis
68 dirty field
69 events
70 fascia
71 field
72 health component
73 hernia
74 hernia recurrence
75 hernia repair
76 images
77 incidence
78 independent predictors
79 infection
80 logistics
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82 median time
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85 months
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96 quality
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98 rate
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100 regression analysis
101 repair
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103 self-perceived body image
104 site events
105 site infection
106 small intestine submucosa
107 society
108 submucosa
109 surgical field
110 surgical site events
111 surgical site infection
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113 time
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