Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Hernia
Published in: Hernia 3/2020

Open Access 01-06-2020 | Hernia Surgery | Original Article

Long-term outcomes after contaminated complex abdominal wall reconstruction

Authors: F. E. E. de Vries, J. D. Hodgkinson, J. J. M. Claessen, O. van Ruler, C. A. Leo, Y. Maeda, O. Lapid, M. C. Obdeijn, P. J. Tanis, W. A. Bemelman, J. Constantinides, G. B. Hanna, J. Warusavitarne, C. Vaizey, M. A. Boermeester

Published in: Hernia | Issue 3/2020

Login to get access

Abstract

Purpose

Complex abdominal wall repair (CAWR) in a contaminated operative field is a challenge. Available literature regarding long-term outcomes of CAWR comprises studies that often have small numbers and heterogeneous patient populations. This study aims to assess long-term outcomes of modified-ventral hernia working group (VHWG) grade 3 repairs. Because the relevance of hernia recurrence (HR) as the primary outcome for this patient group is contentious, the need for further hernia surgery (FHS) was also assessed in relation to long-term survival.

Methods

A retrospective cohort study with a single prospective follow-up time-point nested in a consecutive series of patients undergoing CAWR in two European national intestinal failure centers.

Results

In long-term analysis, 266 modified VHWG grade 3 procedures were included. The overall HR rate was 32.3%. The HR rates for non-crosslinked biologic meshes and synthetic meshes when fascial closure was achieved were 20.3% and 30.6%, respectively. The rates of FHS were 7.2% and 16.7%, and occurred only within the first 3 years. Bridged repairs showed poorer results (fascial closure 22.9% hernia recurrence vs bridged 57.1% recurrence). Overall survival was relatively good with 80% en 70% of the patients still alive after 5 and 10 years, respectively. In total 86.6% of the patients remained free of FHS.

Conclusions

In this study of contaminated CAWR, non-crosslinked biologic mesh shows better results than synthetic mesh. Bridging repairs with no posterior and/or anterior fascial closure have a higher recurrence rate. The overall survival was good and the majority of patients remained free of additional hernia surgery.
Appendix
Available only for authorised users
Literature
1.
Ventral Hernia Working Group, Breuing K, Butler CE et al (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148(3):544–558CrossRef
2.
Kanters AE, Krpata DM, Blatnik JA et al (2012) Modified hernia grading scale to stratify surgical site occurrence after open ventral hernia repairs. J Am Coll Surg 215(6):787–793CrossRef
3.
Engledow A, Chan S, Forbes A et al (2010) The management of enterocutaneous fistula in a regional unit in the United kingdom: a prospective study. Dis Colon Rectum 53(2):192–199CrossRef
4.
Ravindran P, Ansari N, Young CJ et al (2014) Definitive surgical closure of enterocutaneous fistula: outcome and factors predictive of increased postoperative morbidity. Colorectal Dis 16(3):209–218CrossRef
5.
Owen RM, Love TP, Perez SD et al (2013) Definitive surgical treatment of enterocutaneous fistula. JAMA Surg 148(2):118CrossRef
6.
Atema JJ, Mirck B, Van Arum I et al (2016) Outcome of acute intestinal failure. Br J Surg 103(6):701–708CrossRef
7.
Hodgkinson JD, Maeda Y, Leo CA et al (2017) Complex abdominal wall reconstruction in the setting of active infection and contamination: a systematic review of hernia and fistula recurrence rates. Colorectal Dis 19:319–330CrossRef
8.
Atema JJ, de Vries FEE, Boermeester MA (2016) Systematic review and meta-analysis of the repair of potentially contaminated and contaminated abdominal wall defects. Am J Surg 212(5):982–995.e1CrossRef
9.
Connolly PT, Teubner A, Lees NP et al (2008) Outcome of reconstructive surgery for intestinal fistula in the open abdomen. Ann Surg 247(3):440–444CrossRef
10.
Shah B, Tiwari M, Goede M et al (2011) Not all biologics are equal! Hernia 15:165–171CrossRef
11.
Krpata D, Stein S, Eston M et al (2013) Outcomes of simultaneous large complex abdominal wall reconstruction and enterocutaneous fistula takedown. Am J Surg 205:354–359CrossRef
12.
Sbitany H, Kwon E, Chern H et al (2015) Outcomes analysis of biologic mesh use for abdominal wall reconstruction in clean-contaminated and contaminated ventral hernia repair. Ann Plast Surg 75:201–204CrossRef
13.
Vaizey CJ, Maeda Y, Barbosa E et al (2016) European Society of Coloproctology consensus on the surgical management of intestinal failure in adults. Colorectal Dis 18(6):535–548CrossRef
14.
Parker M, Goldberg RF, Dinkins MM et al (2011) Pilot study on objective measurement of abdominal wall strength in patients with ventral incisional hernia. Surg Endosc Other Interv Tech 25(11):3503–3508CrossRef
15.
Atema J, de Vries F, Boermeester MA (2016) Systematic review and meta-analysis of the repair of potentially contaminated and contaminated abdominal wall defects. Am J Surg 212:982–995CrossRef
16.
Itani KMF, Rosen M, Vargo D et al (2012) Prospective study of single-stage repair of contaminated hernias using a biologic porcine tissue matrix: the RICH study. Surgery (United States) 152(3):498–505
17.
Slater N, Bokkerink W, Konijn V et al (2015) Safety and durability of one-stage repair of abdominal wall defects with enteric fistulas. Ann Surg 261:553–557CrossRef
18.
Richmond B, Ubert A, Judhan R et al (2014) Component separation with porcine acellular dermal reinforcement is superior to traditional bridged mesh repairs in the open repair of significant midline ventral hernia defects. Am Surg. 80(8):725–731PubMedPubMedCentral
19.
Holihan JL, Askenasy EP, Greenberg JA et al (2016) Component separation vs. bridged repair for large ventral hernias: a multi-institutional risk-adjusted comparison, systematic review, and meta-analysis. Surg Infect (Larchmt) 17(1):17–26CrossRef
20.
Giordano S, Garvey PB, Baumann DP et al (2017) Primary fascial closure with biologic mesh reinforcement results in lesser complication and recurrence rates than bridged biologic mesh repair for abdominal wall reconstruction: a propensity score analysis. Surgery 161(2):499–508CrossRef
21.
Köckerling F, Alam NN, Antoniou SA et al (2018) What is the evidence for the use of biologic or biosynthetic meshes in abdominal wall reconstruction? Hernia 22(2):249–269CrossRef
22.
Iacco A, Adeyemo A, Riggs T et al (2014) Single institutional experience using biological mesh for abdominal wall reconstruction. Am J Surg 208(3):480–484CrossRef
23.
Basta MN, Fischer JP, Kovach SJ (2015) Assessing complications and cost-utilization in ventral hernia repair utilizing biologic mesh in a bridged underlay technique. Am J Surg 209(4):695–702CrossRef
24.
Sneiders D, Jairam AP, de Smet GHJ et al (2020) Incisional hernia cannot be diagnosed by a patient-reported diagnostic questionnaire. J Surg Res. 245:656–662CrossRef
Metadata
Title
Long-term outcomes after contaminated complex abdominal wall reconstruction
Authors
F. E. E. de Vries
J. D. Hodgkinson
J. J. M. Claessen
O. van Ruler
C. A. Leo
Y. Maeda
O. Lapid
M. C. Obdeijn
P. J. Tanis
W. A. Bemelman
J. Constantinides
G. B. Hanna
J. Warusavitarne
C. Vaizey
M. A. Boermeester
Publication date
01-06-2020
Publisher
Springer Paris
Keyword
Hernia Surgery
Published in
Hernia / Issue 3/2020
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-020-02124-7

Other articles of this Issue 3/2020

Hernia 3/2020 Go to the issue

Original Article

Goni Moreno progressive preoperative pneumoperitoneum for giant hernias: a monocentric retrospective study of 162 patients

Original Article

Abdominal wall hernia surgery in The Netherlands: a national survey

Original Article

Evaluation of a workshop to teach a new surgical technique in abdominal wall reconstruction

Original Article

Comparison of a 3D head-mounted display (HMS-3000MT) and 3D passive polarizing display with 2D technique for first laparoscopic inguinal hernia repair by novice surgeons

Original Article

Learning curve in open inguinal hernia repair: a quality improvement multicentre study about Lichtenstein technique

Original Article

Is round ligament varicosity in pregnancy a common precursor for the later development of inguinal hernias? The prospective analysis of 28 patients over 9 years