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01-06-2021 | Seroma | Original Article

Non-coated versus coated mesh for retrorectus ventral hernia repair: a propensity score-matched analysis of the Americas Hernia Society Quality Collaborative (AHSQC)

Authors: J. D. Thomas, A. Fafaj, S. J. Zolin, C. M. Horne, L.-C. Huang, S. Phillips, S. Rosenblatt, C. C. Petro, D. M. Krpata, M. J. Rosen, A. S. Prabhu

Published in: Hernia | Issue 3/2021

Abstract

Purpose

The outcomes of utilizing anti-adhesive barrier-coated mesh in the retrorectus position during open ventral hernia repair are unknown. We compared the wound-related outcomes between non-coated (NCM) and coated mesh (CM) placed in the retrorectus space.

Methods

Patients undergoing elective, open, clean ventral hernia repair with retrorectus mesh were retrospectively identified in the Americas Hernia Society Quality Collaborative. Propensity score matching was performed based on clinically relevant demographic and operative covariates. The primary outcome was wound morbidity, defined as surgical site infection (SSI), surgical site occurrence (SSO), and SSO requiring procedural intervention (SSOPI).

Results

3609 patients were included (3281 NCM, 328 CM). Following 2:1 propensity score matching, rates of myofascial release remained the only statistically different matching parameter; external oblique releases were performed more frequently in the CM group (8% vs. 15%; p = 0.03). Rates of SSI (3% vs. 4%; p = 0.16) were similar between groups. Increased rates of SSO (13% vs. 18%; p = 0.045) and SSOPI (4% vs. 8%; p = 0.038) were observed in the CM group. The CM group had a higher rate of postoperative seroma (3% vs. 7%; p = 0.027) compared to the NCM group.

Conclusion

Barrier-coated mesh in the retrorectus position was associated with increased wound morbidity requiring procedural intervention. Due to a lack of clinical benefit, the use of more costly barrier-coated mesh in the retrorectus position is not justified for routine, open ventral hernia repairs at this time.

Burger JWA, Luijendijk RW, Hop WCJ et al (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240:578–583. https://doi.org/10.1097/01.sla.0000141193.08524.e7(discussion 583-585)CrossRefPubMedPubMedCentral

Nguyen MT, Berger RL, Hicks SC et al (2014) Comparison of outcomes of synthetic mesh vs suture repair of elective primary ventral herniorrhaphy: a systematic review and meta-analysis. JAMA Surg 149:415–421. https://doi.org/10.1001/jamasurg.2013.5014CrossRefPubMed

Mathes T, Walgenbach M, Siegel R (2016) Suture versus mesh repair in primary and incisional ventral hernias: a systematic review and meta-analysis. World J Surg 40:826–835. https://doi.org/10.1007/s00268-015-3311-2CrossRefPubMed

Fafaj A, Petro CC, Tastaldi L et al (2020) Intraperitoneal versus retromuscular mesh placement for open incisional hernias: an analysis of the Americas Hernia Society Quality Collaborative. Br J Surg. https://doi.org/10.1002/bjs.11560CrossRefPubMed

Sosin M, Nahabedian MY, Bhanot P (2018) The perfect plane: a systematic review of mesh location and outcomes, update 2018. Plast Reconstr Surg 142:107S–116S. https://doi.org/10.1097/PRS.0000000000004864CrossRefPubMed

Holihan JL, Nguyen DH, Nguyen MT et al (2016) Mesh location in open ventral hernia repair: a systematic review and network meta-analysis. World J Surg 40:89–99. https://doi.org/10.1007/s00268-015-3252-9CrossRefPubMed

Liang MK, Holihan JL, Itani K et al (2017) Ventral hernia management: expert consensus guided by systematic review. Ann Surg 265:80–89. https://doi.org/10.1097/SLA.0000000000001701CrossRef

van’t Riet M, de Vos van Steenwijk PJ, Bonthuis F et al (2003) Prevention of adhesion to prosthetic mesh: comparison of different barriers using an incisional hernia model. Ann Surg 237:123–128. https://doi.org/10.1097/00000658-200301000-00017CrossRef

Pauli EM, Rosen MJ (2013) Open ventral hernia repair with component separation. Surg Clin North Am 93:1111–1133. https://doi.org/10.1016/j.suc.2013.06.010CrossRefPubMed

10.

Kalaba S, Gerhard E, Winder JS et al (2016) Design strategies and applications of biomaterials and devices for hernia repair. Bioact Mater 1:2–17. https://doi.org/10.1016/j.bioactmat.2016.05.002CrossRefPubMedPubMedCentral

11.

Zolin SJ, Fafaj A, Krpata DM (2020) Transversus abdominis release (TAR): what are the real indications and where is the limit? Hernia 24:333–340. https://doi.org/10.1007/s10029-020-02150-5CrossRefPubMed

12.

Poulose BK, Roll S, Murphy JW et al (2016) Design and implementation of the Americas Hernia Society Quality Collaborative (AHSQC): improving value in hernia care. Hernia 20:177–189. https://doi.org/10.1007/s10029-016-1477-7CrossRefPubMed

13.

Haskins IN, Horne CM, Krpata DM et al (2018) A call for standardization of wound events reporting following ventral hernia repair. Hernia 22:729–736. https://doi.org/10.1007/s10029-018-1748-6CrossRef

14.

Surgical Site Infection (SSI) Event. Centers for disease control and prevention. https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf.

15.

Baucom RB, Ousley J, Feurer ID et al (2016) Patient reported outcomes after incisional hernia repair-establishing the ventral hernia recurrence inventory. Am J Surg 212:81–88. https://doi.org/10.1016/j.amjsurg.2015.06.007CrossRefPubMed

16.

Krpata DM, Schmotzer BJ, Flocke S et al (2012) Design and initial implementation of HerQLes: a hernia-related quality-of-life survey to assess abdominal wall function. J Am Coll Surg 215:635–642. https://doi.org/10.1016/j.jamcollsurg.2012.06.412CrossRefPubMed

17.

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 215:787–793. https://doi.org/10.1016/j.jamcollsurg.2012.08.012CrossRef

18.

Wegdam JA, Thoolen JMM, Nienhuijs SW et al (2019) Systematic review of transversus abdominis release in complex abdominal wall reconstruction. Hernia 23:5–15. https://doi.org/10.1007/s10029-018-1870-5CrossRefPubMed

19.

Albino FP, Patel KM, Nahabedian MY et al (2013) Does mesh location matter in abdominal wall reconstruction? A systematic review of the literature and a summary of recommendations. Plast Reconstr Surg 132:1295–1304. https://doi.org/10.1097/PRS.0b013e3182a4c393CrossRefPubMed

20.

Lehr SC, Schuricht AL (2001) A minimally invasive approach for treating postoperative seromas after incisional hernia repair. JSLS 5:267–271PubMedPubMedCentral

21.

Hafezi F, Nouhi AH (2002) Abdominoplasty and seroma. Ann Plast Surg 48:109–110. https://doi.org/10.1097/00000637-200201000-00022CrossRefPubMed

22.

Plymale MA, Harris JW, Davenport DL et al (2016) Abdominal wall reconstruction: the uncertainty of the impact of drain duration upon outcomes. Am Surg 82:207–211CrossRef

23.

Nockolds CL, Hodde JP, Rooney PS (2014) Abdominal wall reconstruction with components separation and mesh reinforcement in complex hernia repair. BMC Surg 14:25. https://doi.org/10.1186/1471-2482-14-25CrossRefPubMedPubMedCentral

24.

Aho JM, Nickerson TP, Thiels CA et al (2016) Prevention of postoperative seromas with dead space obliteration. Int J Surg Lond Engl 29:70–73. https://doi.org/10.1016/j.ijsu.2016.03.004CrossRef

25.

Baroudi R, Ferreira CAA (1998) Seroma: how to avoid it and how to treat it. Aesthet Surg J 18:439–441. https://doi.org/10.1016/S1090-820X(98)70073-1CrossRefPubMed

26.

Brown CN, Finch JG (2010) Which mesh for hernia repair? Ann R Coll Surg Engl 92:272–278. https://doi.org/10.1308/003588410X12664192076296CrossRefPubMedPubMedCentral

27.

Salgaonkar H, Lomanto D (2018) Mesh technology—an update. Ann Laparos Endos Surg. https://doi.org/10.21037/ales.2018.09.10CrossRef

28.

Heller L, McNichols CH, Ramirez OM (2012) Component separations. Semin Plast Surg 26:25–28. https://doi.org/10.1055/s-0032-1302462CrossRefPubMedPubMedCentral

29.

de Vries Reilingh TS, van Goor H, Rosman C et al (2003) “Components separation technique” for the repair of large abdominal wall hernias. J Am Coll Surg 196:32–37. https://doi.org/10.1016/s1072-7515(02)01478-3CrossRefPubMed

30.

Krpata DM, Blatnik JA, Novitsky YW, Rosen MJ (2012) Posterior and open anterior components separations: a comparative analysis. Am J Surg 203:318–322. https://doi.org/10.1016/j.amjsurg.2011.10.009(discussion 322)CrossRefPubMed

31.

Lowe JB, Lowe JB, Baty JD, Garza JR (2003) Risks associated with “components separation” for closure of complex abdominal wall defects. Plast Reconstr Surg 111:1276–1283. https://doi.org/10.1097/01.PRS.0000047021.36879.FD(quiz 1284-1285; discussion 1286-1288)CrossRefPubMed

32.

Singhal V, Szeto P, VanderMeer TJ, Cagir B (2012) Ventral hernia repair: outcomes change with long-term follow-up. JSLS 16:373–379. https://doi.org/10.4293/108680812X13427982377067CrossRefPubMedPubMedCentral

33.

Guzman MJ, Gitelis ME, Linn JG et al (2015) A model of cost reduction and standardization: improved cost savings while maintaining the quality of care. Dis Colon Rectum 58:1104–1107. https://doi.org/10.1097/DCR.0000000000000463CrossRefPubMed

34.

Krpata DM, Haskins IN, Rosenblatt S et al (2018) Development of a disease-based hernia program and the impact on cost for a hospital system. Ann Surg 267:370–374. https://doi.org/10.1097/SLA.0000000000002093CrossRefPubMed

Title: Non-coated versus coated mesh for retrorectus ventral hernia repair: a propensity score-matched analysis of the Americas Hernia Society Quality Collaborative (AHSQC)
Authors: J. D. Thomas
A. Fafaj
S. J. Zolin
C. M. Horne
L.-C. Huang
S. Phillips
S. Rosenblatt
C. C. Petro
D. M. Krpata
M. J. Rosen
A. S. Prabhu
Publication date: 01-06-2021
Publisher: Springer Paris
Keyword: Seroma
Published in: Hernia / Issue 3/2021
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-020-02229-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Non-coated versus coated mesh for retrorectus ventral hernia repair: a propensity score-matched analysis of the Americas Hernia Society Quality Collaborative (AHSQC)

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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