Short-term outcomes of heavyweight versus mediumweight synthetic mesh in a retrospective cohort of clean-contaminated and contaminated retromuscular ventral hernia repairs.
Contamination
Heavyweight
Hernia
Permanent mesh
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
11 Jun 2024
11 Jun 2024
Historique:
received:
11
03
2024
accepted:
19
05
2024
medline:
12
6
2024
pubmed:
12
6
2024
entrez:
11
6
2024
Statut:
aheadofprint
Résumé
Mediumweight (40-60 g/m The Abdominal Core Health Quality Collaborative database was retrospectively queried for a cohort of patients who underwent open RMVHR with MWPP or HWPP mesh placed in CDC class II/III wounds from 2012 to 2023. Mesh types were compared using a 3:1 propensity score-matched analysis. Covariates for matching included CDC classification, BMI, diabetes, smoking within 1 year, hernia, and mesh width. Primary outcome of interest included wound complications. Secondary outcomes included reoperations and readmissions at 30 days. A total of 1496 patients received MWPP or HWPP (1378 vs. 118, respectively) in contaminated RMVHR. After propensity score matching, 351 patients remained in the mediumweight and 117 in the heavyweight mesh group. There were no significant differences in surgical site infection (SSI) rates (13.4% vs. 14.5%, p = 0.877), including deep SSIs (0.3% vs. 0%, p = 1), surgical site occurrence rates (17.9% vs. 22.2%, p = 0.377), surgical site occurrence requiring procedural intervention (16% vs. 17.9%, p = 0.719), mesh removal (0.3% vs. 0%, p = 1), reoperations (4.6% vs. 2.6%, p = 0.428), or readmissions (12.3% vs. 9.4%, p = 0.504) at 30 days. HWPP mesh was not associated with increased wound morbidity, mesh excisions, reoperations, or readmissions in the early postoperative period compared with MWPP mesh in open RMVHR for CDC II/III cases. Longer follow-up will be necessary to determine if HWPP mesh may be a suitable alternative to MWPP mesh in contaminated scenarios.
Sections du résumé
BACKGROUND
BACKGROUND
Mediumweight (40-60 g/m
METHODS
METHODS
The Abdominal Core Health Quality Collaborative database was retrospectively queried for a cohort of patients who underwent open RMVHR with MWPP or HWPP mesh placed in CDC class II/III wounds from 2012 to 2023. Mesh types were compared using a 3:1 propensity score-matched analysis. Covariates for matching included CDC classification, BMI, diabetes, smoking within 1 year, hernia, and mesh width. Primary outcome of interest included wound complications. Secondary outcomes included reoperations and readmissions at 30 days.
RESULTS
RESULTS
A total of 1496 patients received MWPP or HWPP (1378 vs. 118, respectively) in contaminated RMVHR. After propensity score matching, 351 patients remained in the mediumweight and 117 in the heavyweight mesh group. There were no significant differences in surgical site infection (SSI) rates (13.4% vs. 14.5%, p = 0.877), including deep SSIs (0.3% vs. 0%, p = 1), surgical site occurrence rates (17.9% vs. 22.2%, p = 0.377), surgical site occurrence requiring procedural intervention (16% vs. 17.9%, p = 0.719), mesh removal (0.3% vs. 0%, p = 1), reoperations (4.6% vs. 2.6%, p = 0.428), or readmissions (12.3% vs. 9.4%, p = 0.504) at 30 days.
CONCLUSION
CONCLUSIONS
HWPP mesh was not associated with increased wound morbidity, mesh excisions, reoperations, or readmissions in the early postoperative period compared with MWPP mesh in open RMVHR for CDC II/III cases. Longer follow-up will be necessary to determine if HWPP mesh may be a suitable alternative to MWPP mesh in contaminated scenarios.
Identifiants
pubmed: 38862822
doi: 10.1007/s00464-024-10946-0
pii: 10.1007/s00464-024-10946-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Morris MP et al (2021) Ventral hernia repair with synthetic mesh in a contaminated field: a systematic review and meta-analysis. Hernia J Hernias Abdom Wall Surg 25:1035–1050
doi: 10.1007/s10029-020-02358-5
Morales-Conde S, Hernández-Granados P, Tallón-Aguilar L, Verdaguer-Tremolosa M, López-Cano M (2022) Ventral hernia repair in high-risk patients and contaminated fields using a single mesh: proportional meta-analysis. Hernia J Hernias Abdom Wall Surg 26:1459–1471
doi: 10.1007/s10029-022-02668-w
Carbonell AM, Cobb WS (2013) Safety of prosthetic mesh hernia repair in contaminated fields. Surg Clin North Am 93:1227–1239
doi: 10.1016/j.suc.2013.06.012
pubmed: 24035085
Warren J et al (2020) Safety and efficacy of synthetic mesh for ventral hernia repair in a contaminated field. J Am Coll Surg 230:405–413
doi: 10.1016/j.jamcollsurg.2019.12.008
pubmed: 31954819
Polcz ME et al (2023) Outcomes of light and midweight synthetic mesh use in clean-contaminated and contaminated ventral incisional hernia repair: an ACHQC comparative analysis. Surg Endosc 37:5583–5590
doi: 10.1007/s00464-022-09739-0
pubmed: 36319897
Rosen MJ et al (2022) Biologic vs synthetic mesh for single-stage repair of contaminated ventral hernias: a randomized clinical trial. JAMA Surg 157:293–301
doi: 10.1001/jamasurg.2021.6902
pubmed: 35044431
pmcid: 8771431
Maskal S et al (2023) Mediumweight polypropylene mesh fractures after open retromuscular ventral hernia repair: incidence and associated risk factors. Surg Endosc 37:5438–5443
doi: 10.1007/s00464-023-10039-4
pubmed: 37038022
Krpata DM et al (2021) Effect of hernia mesh weights on postoperative patient-related and clinical outcomes after open ventral hernia repair: a randomized clinical trial. JAMA Surg 156:1085–1092
doi: 10.1001/jamasurg.2021.4309
pubmed: 34524395
Poulose BK et al (2016) Design and implementation of the Americas Hernia Society Quality Collaborative (AHSQC): improving value in hernia care. Hernia J Hernias Abdom Wall Surg 20:177–189
doi: 10.1007/s10029-016-1477-7
Carbonell AM, Criss CN, Cobb WS, Novitsky YW, Rosen MJ (2013) Outcomes of synthetic mesh in contaminated ventral hernia repairs. J Am Coll Surg 217:991–998
doi: 10.1016/j.jamcollsurg.2013.07.382
pubmed: 24045140
Krpata DM, Blatnik JA, Novitsky YW, Rosen MJ (2012) Posterior and open anterior components separations: a comparative analysis. Am J Surg 203:318–322
doi: 10.1016/j.amjsurg.2011.10.009
pubmed: 22244073
Ellis R, Miller BT (2023) Mesh selection in abdominal wall reconstruction: an update on biomaterials. Surg Clin North Am 103:1019–1028
doi: 10.1016/j.suc.2023.04.010
pubmed: 37709387
Petro CC et al (2015) Central failures of lightweight monofilament polyester mesh causing hernia recurrence: a cautionary note. Hernia 19:155–159
doi: 10.1007/s10029-014-1237-5
pubmed: 24659227
Vernon Jones R, Boeke PJ (1956) Properties of marlex 50 ethylene polymer. Ind Eng Chem 48:1155–1156
doi: 10.1021/ie50559a022
Blatnik JA et al (2012) In vivo analysis of the morphologic characteristics of synthetic mesh to resist MRSA adherence. J Gastrointest Surg Off J Soc Surg Aliment Tract 16:2139–2144
doi: 10.1007/s11605-012-1992-5
Pérez-Köhler B, García-Moreno F, Bayon Y, Pascual G, Bellón JM (2015) Inhibition of staphylococcus aureus adhesion to the surface of a reticular heavyweight polypropylene mesh soaked in a combination of chlorhexidine and allicin: an in vitro study. PLoS ONE 10:e0126711
doi: 10.1371/journal.pone.0126711
pubmed: 25962163
pmcid: 4427482
Usher FC, Gannon JP (1959) Marlex mesh, a new plastic mesh for replacing tissue defects: I experimental studies. AMA Arch Surg 78:131–137
doi: 10.1001/archsurg.1959.04320010133022
pubmed: 13605404
Usher FC, Wallace SA (1958) Tissue reaction to plastics: a comparison of Nylon, Orlon, Dacron, Teflon, and Marlex. AMA Arch Surg 76:997–999
doi: 10.1001/archsurg.1958.01280240155026
pubmed: 13532148
Schmitt HJ, Grinnan GL (1967) Use of Marlex mesh in infected abdominal war wound. Am J Surg 113:825–828
doi: 10.1016/0002-9610(67)90355-8
pubmed: 5337255
Voyles CR et al (1981) Emergency abdominal wall reconstruction with polypropylene mesh: short-term benefits versus long-term complications. Ann Surg 194:219–223
doi: 10.1097/00000658-198108000-00017
pubmed: 6455099
pmcid: 1345243
Stone HH, Fabian TC, Turkleson ML, Jurkiewicz MJ (1981) Management of acute full-thickness losses of the abdominal wall. Ann Surg 193:612–618
doi: 10.1097/00000658-198105000-00011
pubmed: 6263197
pmcid: 1345130
Alkhatib H et al (2020) Outcomes of transversus abdominis release (TAR) with permanent synthetic retromuscular reinforcement for bridged repairs in massive ventral hernias: a retrospective review. Hernia J Hernias Abdom Wall Surg 24:341–352
doi: 10.1007/s10029-019-02046-z