Advertisement

Hernia

, Volume 23, Issue 5, pp 1003–1008 | Cite as

Abdominal wall reconstruction with large polypropylene mesh: is bigger better?

  • M. Nisiewicz
  • T. Hughes
  • M. A. Plymale
  • D. L. Davenport
  • J. S. RothEmail author
Original Article
  • 93 Downloads

Abstract

Purpose

Hernia repair for large and complex hernias presents challenges related to the availability of larger mesh sizes. When sizes beyond those manufactured are required, multiple meshes (MM) may be sutured to create a larger graft. With the availability of large polypropylene mesh up to 50 × 50 cm (LM), abdominal wall reconstruction (AWR) may be accomplished with a single mesh. This study evaluates clinical and economic outcomes following AWR with component separation utilizing MM and LM.

Methods

A retrospective study was performed with review of health records and cost accounting data. Patients that underwent AWR with LM were case matched 1:1 with patients undergoing MM repair based upon comorbidities, defect size and wound class.

Results

Twenty-four patients underwent AWR with LM. Twenty patients (10F, 10 M) who underwent AWR with LM were matched with 20 MM AWR (11F, 9 M). Age, BMI, ASA 3 + , never smoker, diabetes, and hernia characteristics were similar between LM and MM. Operative cost ($4295 vs $3669, p = 0.127), operative time (259 min vs 243 min, p = 0.817), length of stay (5.5 vs 6.2, p = 0.484), wound complication (30% vs 20%, p = 0.716), infected seroma (5% vs 5%, p = 1), and readmission (5% vs 15%, p = 0.605) were similar between LM and MM, respectively.

Conclusions

This is the first report of patients undergoing AWR with a large 50 × 50 cm prolene mesh. In this small cohort, clinical outcomes were similar between those undergoing repair with multiple sutured mesh sheets and a single large mesh.

Keywords

Abdominal wall reconstruction Loss of domain Prolene mesh Hospital costs Multiple mesh pieces 

Notes

Compliance with ethical standards

Conflict of interest

Authors MN, TH, MP, DP report no conflict of interest related to this study. JR has received grant funding from Becton Dickinson/CR Bard, is a consultant for Becton Dickinson/CR Bard, Allergan, and Johnson and Johnson and is a shareholder with Miromatrix.

Ethical approval

This study was approved by the University of Kentucky Institutional Review Board and meets all human rights and ethical standards.

Human and animal rights

This article does not contain any studies directly involving human participants as it is a review of previously collected data.

Informed Consent

lndividual patient consent was not required.

References

  1. 1.
    Mcadory RS, Cobb WS, Alfredo Carbonell M (2009) Progressive preoperative pneumoperitoneum for hernias with loss of domain. Am Surg 75:504–508PubMedGoogle Scholar
  2. 2.
    Christensen K, Doblhammer G, Rau R, Vaupel JW (2009) Ageing populations: the challenges ahead. Lancet 374:1196–1208.  https://doi.org/10.1016/S0140-6736(09)61460-4 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Hruby A, Hu FB (2015) The epidemiology of obesity: a big picture. Pharmacoeconomics 33:673–689.  https://doi.org/10.1007/s40273-014-0243-x CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ (2012) Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg 204(5):709–716.  https://doi.org/10.1016/j.amjsurg.2012.02.008(Epub 2012 May 16) CrossRefPubMedGoogle Scholar
  5. 5.
    Holihan JL, Askenasy EP, Greenberg JA, Keith JN, Martindale RG, Roth JS, Mo J, Ko TC, Kao LS, Liang MK, Ventral Hernia Outcome Collaboration Writing Group (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):17–26.  https://doi.org/10.1089/sur.2015.124 CrossRefGoogle Scholar
  6. 6.
    Warren JA, McGrath SP, Hale AL, Ewing JA, Carbonell AM, Cobb WS (2017) Patterns of recurrence and mechanisms of failure after open ventral hernia repair with mesh. Am Surg 83:1275–1282PubMedGoogle Scholar
  7. 7.
    Renard Y, Lardière-Deguelte S, de Mestier L, Appere F, Colosio A, Kianmanesh R, Palot JP (2016) Management of large incisional hernias with loss of domain: a prospective series of patients prepared by progressive preoperative pneumoperitoneum. Surgery 160:426–435.  https://doi.org/10.1016/j.surg.2016.03.033(Epub 2016) CrossRefPubMedGoogle Scholar
  8. 8.
    Moreno IG (1947) Chronic eventrations and large hernias; preoperative treatment by progressive pneumoperitomeum; original procedure. Surgery 22:945–953PubMedGoogle Scholar
  9. 9.
    Oliver-Allen HS, Hunter C, Lee GK (2015) Abdominal compartment syndrome as a rare complication following component separation repair: case report and review of the literature. Hernia 19:293–299.  https://doi.org/10.1007/s10029-015-1362-9 CrossRefPubMedGoogle Scholar
  10. 10.
    Mavrodin CI, Pariza G, Ion D, Antoniac VI (2013) Abdominal compartment syndrome—a major complication of large incisional hernia surgery. Chirurgia (Bucur) 108:414–417Google Scholar
  11. 11.
    Eriksson A, Rosenberg J, Bisgaard T (2014) Surgical treatment for giant incisional hernia: a qualitative systematic review. Hernia 18:31–38.  https://doi.org/10.1007/s10029-013-1066-y CrossRefPubMedGoogle Scholar
  12. 12.
    Carbonell AM, Cobb WS, Chen SM (2008) Posterior components separation during retromuscular hernia repair. Hernia 12:359–362.  https://doi.org/10.1007/s10029-008-0356-2 CrossRefPubMedGoogle Scholar
  13. 13.
    Raynor RW, Del Guercio LR (1989) The place for pneumoperitoneum in the repair of massive hernia. World J Surg 13:581–585CrossRefGoogle Scholar
  14. 14.
    Bueno-Lledó J, Torregrosa A, Ballester N, Carreño O, Carbonell F, Pastor PG, Pamies J, Cortés V, Bonafé S, Iserte J (2017) Preoperative progressive pneumoperitoneum and botulinum toxin type A in patients with large incisional hernia. Hernia 2:233–243.  https://doi.org/10.1007/s10029-017-1582-2 CrossRefGoogle Scholar
  15. 15.
    Cakmak M, Caglayan F, Somuncu S, Leventoglu A, Ulusoy S, Akman H, Kaya M (2006) Effect of paralysis of the abdominal wall muscles by botulinum A toxin to intraabdominal pressure: an experimental study. J Pediatr Surg 41:821–825CrossRefGoogle Scholar
  16. 16.
    Ibarra-Hurtado TR, Nuño-Guzmán CM, Miranda-Díaz AG, Troyo-Sanromán R, Navarro-Ibarra R, Bravo-Cuéllar L (2014) Effect of botulinum toxin type A in lateral abdominal wall muscles thickness and length of patients with midline incisional hernia secondary to open abdomen management. Hernia 18:647–652.  https://doi.org/10.1007/s10029-014-1280-2 CrossRefPubMedGoogle Scholar
  17. 17.
    Elstner KE, Read JW, Rodriguez-Acevedo O, Cosman PH, Dardano AN, Jacombs AS, Edye M, Zea A, Boesel T, Mikami DJ, Ibrahim N (2017) Preoperative chemical component relaxation using Botulinum toxin A: enabling laparoscopic repair of complex ventral hernia. Surg Endosc 31:761–768.  https://doi.org/10.1007/s00464-016-5030-7 CrossRefPubMedGoogle Scholar
  18. 18.
    Zielinski MD, Goussous N, Schiller HJ, Jenkins D (2013) Chemical components separation with botulinum toxin A: a novel technique to improve primary fascial closure rates of the open abdomen. Hernia 17:101–107.  https://doi.org/10.1007/s10029-012-0995-1 CrossRefPubMedGoogle Scholar
  19. 19.
    Farooque F, Jacombs AS, Roussos E, Read JW, Dardano AN, Edye M, Ibrahim N (2016) Preoperative abdominal muscle elongation with botulinum toxin A for complex incisional ventral hernia repair. ANZ J Surg 86:79–83.  https://doi.org/10.1111/ans.13258 CrossRefPubMedGoogle Scholar
  20. 20.
    Rodriguez-Acevedo O, Elstner KE, Jacombs ASW, Read JW, Martins RT, Arduini F, Wehrhahm M, Craft C, Cosman PH, Dardano AN, Ibrahim N (2018) Preoperative botulinum toxin A enabling defect closure and laparoscopic repair of complex ventral hernia. Surg Endosc 32:831–839.  https://doi.org/10.1007/s00464-017-5750-3 CrossRefPubMedGoogle Scholar
  21. 21.
    Zendejas B, Khasawneh MA, Srvantstyan B, Jenkins DH, Schiller HJ, Zielinski MD (2013) Outcomes of chemical component paralysis using botulinum toxin for incisional hernia repairs. World J Surg 37:2830–2837.  https://doi.org/10.1007/s00268-013-2211-6 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  • M. Nisiewicz
    • 1
  • T. Hughes
    • 2
  • M. A. Plymale
    • 2
  • D. L. Davenport
    • 3
  • J. S. Roth
    • 2
    Email author
  1. 1.University of Kentucky College of MedicineLexingtonUSA
  2. 2.Division of General Surgery, Department of Surgery, C 222, Chandler Medical CenterUniversity of KentuckyLexingtonUSA
  3. 3.Department of SurgeryUniversity of KentuckyLexingtonUSA

Personalised recommendations