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01-01-2019 | Original Scientific Report with Video

Abdominal Wall Reconstruction Utilizing the Combination of Absorbable and Permanent Mesh in a Retromuscular Position: A Multicenter Prospective Study

Authors: Miguel Ángel García-Ureña, Javier López-Monclús, Diego Cuccurullo, Luis Alberto Blázquez Hernando, Providencia García-Pastor, Stefano Reggio, Elena Jiménez Cubedo, Carlos San Miguel Méndez, Arturo Cruz Cidoncha, Alvaro Robin Valle de Lersundi

Published in: World Journal of Surgery | Issue 1/2019

Abstract

Background

Optimal mesh reinforcement for abdominal wall reconstruction (AWR) in complex hernias remains questionable. Use of biologic, absorbable and synthetic meshes has been described. The idea of using an absorbable mesh (AM) under a permanent mesh (PM) in a retromuscular position may help in these challenging situations.

Methods

Between 2011 and 2016, consecutive patients undergoing open AWR utilizing an AM as posterior layer reinforcement and configuration of a large PM were identified in a multicenter prospectively maintained database in four hospitals. Main outcomes included demographics, ventral hernia classifications, perioperative data, complications and recurrences.

Results

A total of 169 complex incisional hernias were analyzed. Mean age was 60.9, with mean body mass index 30.7 (range: 20–46). Location of incisional hernias (IH) was: 80 midline, 59 lateral and 30 midline and lateral. 78% were grade I and II in Ventral Hernia Working Group classification. 52% of patients were discharged with no complication. There were 19% seromas, 13% hematomas, 12% surgical-site infection and 10% skin dehiscence. Only partial mesh removal was necessary in one patient. After a mean follow-up of 26 months (range 15–59), there were five (3.2%) recurrences. Reoperations on patients showed a band of fibrosis separating the peritoneum from the PM.

Conclusion

The combination of AM with very large PM in the same retromuscular position in AWR seems to be safe. The efficacy with recurrence rates below 4% in complex midline and lateral IH may be explained by the use of larger PMs that are extended and configured with the support of AMs. Reoperations on patients have confirmed the previous experimental reports on the use of the AM.

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Title: Abdominal Wall Reconstruction Utilizing the Combination of Absorbable and Permanent Mesh in a Retromuscular Position: A Multicenter Prospective Study
Authors: Miguel Ángel García-Ureña
Javier López-Monclús
Diego Cuccurullo
Luis Alberto Blázquez Hernando
Providencia García-Pastor
Stefano Reggio
Elena Jiménez Cubedo
Carlos San Miguel Méndez
Arturo Cruz Cidoncha
Alvaro Robin Valle de Lersundi
Publication date: 01-01-2019
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 1/2019
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-018-4765-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abdominal Wall Reconstruction Utilizing the Combination of Absorbable and Permanent Mesh in a Retromuscular Position: A Multicenter Prospective Study

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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