Ventral Hernia Repair With a Hybrid Absorbable-permanent Preperitoneal Mesh.

Background: The concept of preoperative prehabilitation has garnered attention as a means to manage the comorbidities of patients undergoing ventral hernia repair (VHR). In this regard, some comorbidities have been studied as potential risk factors for postoperative complications following VHR, such as diabetes, immunosuppression, and smoking. However, evidence regarding the impact of sarcopenia, defined by reduced muscle mass and highly associated with frailty syndrome, remains a gap. We aimed to perform a systematic review and meta-analysis analyzing the impact of sarcopenia on VHR outcomes. Methods: Cochrane Central, Embase, PubMed, MEDLINE, and Web of Science were searched for studies analyzing the impact of sarcopenia on VHR from inception until April 2024. Outcomes assessed were recurrence, surgical site occurrences (SSO), surgical site infection (SSI), and hospital length of stay (LOS). Data analysis was done using RStudio 4.1.2 Software. Results: The initial search yielded 263 results, of which 172 were screened after the exclusion of the duplicates. The full-text review was done for eight studies, of which three were included after applying the eligibility criteria. Our sample comprised 275 patients, of which 79 (28,7%) presented with sarcopenia. All included studies used radiological muscle findings to define sarcopenia. Our analysis showed no differences in recurrence rates between patients with sarcopenia and controls (risk ratios [RR]: 1.24; 95% confidence interval [CI]: 0.79-1.94; P = .35). Furthermore, no differences were found in SSI (RR: 0.7; 95% CI: 0.39-1.25.; P = .23). Interestingly, a higher SSO rate was noted for patients without sarcopenia (95% CI: 0.35-0.96; P = .04). No differences were found in LOS (mean difference 4.7 hours; 95% CI: -0.67 to 10.1; P = .4). Conclusion: Our analysis showed no differences were found in recurrence, SSI, and LOS following VHR in patients with sarcopenia. Furthermore, there was a reduced SSO for patients with sarcopenia.

Introduction: Mesh has become the preferred method due to its ability to integrate with the host’s tissue, reducing recurrence rates compared to primary suture repairs. While synthetic mesh reduces recurrence rates, it may lead to inflammation and infection. To evaluate its performance, this study aims to assess the short-term outcome following ventral hernia repair with biosynthetic mesh. Background: In Ventral Hernia Working Group Grade 3 hernias, which are often contaminated due to factors like prior wound infections, the presence of a stoma, or gastrointestinal tract violations, the heightened risk of infection poses significant challenges. In such cases, the success of mesh repair is jeopardized by potential contamination, complicating the surgical process; prompting consideration of resorbable or biological meshes despite higher costs. A recent advancement is biosynthetic mesh, notably poly-4-hydroxybutyrate, which offers strength comparable to polypropylene mesh and undergoes resorption. However, it retains only 70% strength after 12 weeks, potentially contributing to recurrence. Its efficacy in contaminated sites requires further exploration. Methods: We conducted a retrospective cohort study to thoroughly assess the potential complications following ventral hernia repair. This study will include all patients whose ages are >16 and underwent either open or laparoscopic ventral hernia repair with a biosynthetic mesh at King Abdulaziz Medical City, Saudi Arabia, Riyadh National Guard Health Affairs. The study period extends from January 2020 to December 2023. The study data were extracted from patients’ medical records through the BestCare system. Results: The mean age of our cohort was 58.65 with body mass index 39.6 when looking at comorbidities diabetes mellitus and HTN were the most common comorbidities with 32% affected with diabetes, and 39% affected with hypertension. The most common hernia type observed in our study was incision hernia accounting for 36% of all hernia types followed by inguinal hernia 24.6%. Complications were assessed at 4 time intervals of 1, 3, and 6 months and 1 year. The majority of the patients with complications presented at the 1st month with seroma accounting for 2.2% followed by surgical site infection (SSI) 1.8% and only three patients had 1-year postoperative recurrence. Discussion: The long-term effects of using a permanent synthetic mesh have not been fully understood. However, examining the outcomes associated with absorbable mesh can provide a useful framework for discussing potential risks with patients. Reported outcomes include rates of hernia recurrence and various surgical site occurrences requiring intervention, such as SSI, seroma, wound dehiscence, skin necrosis, hematoma, and fistula. It is important to note that this study is a retrospective cohort study with long-term follow-up, rather than a randomized controlled trial. In addition, other peer-reviewed studies have assessed alternative resorbable synthetic or biologic hernia repair materials, including TIGR® Matrix, Gore® Bio-A®, and Strattice™. Conclusion: In short, our results are comparable to the published reports. No statistically significant improvement in quality of life or reduction of pain was observed. Few patients report the lasting presence of mesh sensation. Results of the biosynthetic mesh after longer periods of follow-up on recurrences and remodeling will provide further valuable information to make clear recommendations.

Postoperative outcomes of ventral hernia repair in veterans

BackgroundThe enhanced view totally extraperitoneal (eTEP) approach is becoming increasingly more widely accepted as a promising technique in the treatment of ventral hernia. However, evidence is still lacking regarding the perioperative, postoperative and long-term outcomes of this technique. The aim of this meta-analysis is to summarize the current available evidence regarding the perioperative and short-term outcomes of ventral hernia repair using eTEP.Study designA systematic search was performed of PubMed, EMBASE, Cochrane Library and Web of Science electronic databases to identify studies on the laparoscopic or robotic-enhanced view totally extraperitoneal (eTEP) approach for the treatment of ventral hernia. A pooled meta-analysis was performed. The primary end point was focused on short-term outcomes regarding perioperative characteristics and postoperative parameters.ResultsA total of 13 studies were identified involving 918 patients. Minimally invasive eTEP resulted in a rate of surgical site infection of 0% [95% CI 0.0–1.0%], a rate of seroma of 5% [95% CI 2.0–8.0%] and a rate of major complications (Clavien–Dindo III–IV) of 1% [95% CI 0.0–3.0%]. The rate of intraoperative complications was 2% [95% CI 0.0–4.0%] with a conversion rate of 1.0% [95% CI 0.0–3.0%]. Mean hospital length of stay was 1.77 days [95% CI 1.21–2.24]. After a median follow-up of 6.6 months (1–24), the rate of recurrence was 1% [95% CI 0.0–1.0%].ConclusionMinimally invasive eTEP is a safe and effective approach for ventral hernia repair, with low reported intraoperative complications and good outcomes.

Closed suction drains (CSD) are commonly used in ventral hernia repair (VHR), with or without prolonged postoperative prophylactic antibiotics (PPA) for the duration of their use. We examine the evidence that PPA with CSD reduce surgical site infection (SSI) in patients undergoing VHR. We also examine the evidence assessing the association between SSI and CSD in VHR. A systematic review of PubMed, CIHNL, and Cochrane databases was performed to identify studies analyzing rates of SSI with CSD in patients undergoing abdominal VHR and related procedures with or without the concomitant use of PPA. The primary outcome was the rate of SSI. Five studies totaling 772 patients were identified, 525 patients were confirmed to have CSD, and 434 patients received prolonged antibiotics while drains were in place. PPA had no significant effect on SSI in two studies and were associated with decreased SSI in one study (Odds ratio 0.235, 95% confidence interval 0.090-0.617, P = 0.003). Two studies documented a higher rate of SSI in patients with CSD (79% vs 49% and 19% vs 10%) on univariate analysis. One study demonstrated a very low risk of SSI despite CSD (4.2%) and another demonstrated no increased risk with or without CSD. The use of drains is not clearly associated with an increased risk of SSI in VHR, and there is limited evidence to support antibiotic use while the drains are in place to decrease the potential risk. Prospective randomized studies are needed to more clearly assess these associations.

Drain Placement Does Not Increase Infectious Complications After Retromuscular Ventral Hernia Repair with Synthetic Mesh: an AHSQC Analysis

Surgical site occurrences, not body mass index, increase the long-term risk of ventral hernia recurrence

Very few studies have documented perioperative outcomes of ventral hernia repair in octogenarians. The aim of this study is to report the perioperative and the long-term outcomes of robotic ventral hernia repair (RVHR) in aged 80-89years patients. From a prospectively maintained database, aged 80-89years patients who underwent robotic procedures between 2013 and 2018 were analyzed retrospectively including perioperative outcomes and long-term follow-up. Complications were assessed with validated grading systems and index. 21 octogenarians with average age 83.48 were included. Intraperitoneal onlay mesh repair, transabdominal preperitoneal repair, retromuscular repair with or without transversus abdominis release technique were performed without conversion. The average operating time was 150min. The mean hospital length of stay of all cohorts was 1.24day. There was a strong correlation between operating time and hospital length of stay. The median follow-up was 23.5months. According to Clavien-Dindo classification, grade-I and grade-II complications were observed in 23.8% and 28.6% patients, respectively; major complications (grade-III and IV) were not observed. The maximum Comprehensive Complication Index® score was 29.6. None of the patients experienced hernia recurrence or chronic pain. To our best knowledge this study is the first to present perioperative as well as long-term outcomes of octogenarian patients who underwent RVHR. The results indicate the safety and efficacy of RVHR in octogenarians.

Preoperative Chlorhexidine Gluconate Use Can Increase Risk for Surgical Site Infections after Ventral Hernia Repair

Aim The application of component separation techniques for the repair of large and other complex ventral hernias, has been a landmark in their successful management. The aim of this study is to present our experience with the posterior component separation with transversus abdominis release (TAR) in patients with these very demanding ventral hernias. Material & Methods A retrospective analysis of prospectively collected data of all patients who underwent elective ventral hernia repair with TAR technique between January 2016 and May 2021 was performed. Selection of the type of inserted mesh was based on the risk of developing surgical site infection (SSI) and other surgical site occurrences (SSOs). Preoperative, intraoperative, and postoperative data were analyzed. Results A total of 167 patients with large and other complex ventral hernias were included in the final analysis. More than 80% of patients had one or more comorbidities. Of all patients, 156 (93.4%) had a history of previous abdominal surgery, 42 (25.1%) had a history of SSI and 11 (6.6%) had active fistulas, of which nine involved previous implanted meshes. Postoperatively, SSOs were presented in 12 patients (7.2%), including three cases of SSI. Neither mesh infection occurred, nor mesh excision required. With a mean follow-up of 3 years, only one recurrence has been observed. Conclusions With a wound complication rate of less than 8% and a recurrence rate of less than 1%, our results show that TAR is a reliable, safe and effective technique for the repair of large and other complex ventral hernias.

Tailoring surgical approach for elective ventral hernia repair based on obesity and National Surgical Quality Improvement Program outcomes

Impact of sex on ventral hernia repair outcomes: A systematic review and meta-analysis

Evaluation of high-risk, comorbid patients undergoing open ventral hernia repair with synthetic mesh

Negative pressure wound therapy on closed incisions (iNPWT) is a wound dressing system developed to promote wound healing and avoid complications after surgical procedures. The effect of iNPWT is well established in various surgical fields, however, the effect on postoperative wound complications after ventral hernia repair remains unknown. The aim of this systematic review and meta-analysis was to investigate the effect of iNPWT on patients undergoing open ventral hernia repair (VHR) compared with conventional wound dressing. This systematic review and meta-analysis followed the PRISMA guidelines. The databases PubMed, Embase, Cochrane Library, Web of science and Cinahl were searched for original studies comparing iNPWT to conventional wound dressing in patients undergoing VHR. The primary outcome was surgical site occurrence (SSO), secondary outcomes included surgical site infection (SSI) and hernia recurrence. The literature search identified 373 studies of which 10 were included in the meta-analysis including a total of 1087 patients. Eight studies were retrospective cohort studies, one was a cross-sectional pilot study, and one was a randomized controlled trial. The meta-analysis demonstrated that iNPWT was associated with a decreased risk of SSO (OR 0.27 [0.19, 0.38]; P < 0.001) and SSI (OR 0.32 [0.17, 0.55]; P < 0.001). There was no statistically significant association with the risk of hernia recurrence (OR 0.62 [0.27, 1.43]; P = 0.26). Based on the findings of this systematic review and meta-analysis iNPWT following VHR was found to significantly reduce the incidence of SSO and SSI, compared with standard wound dressing. INPWT should be considered for patients undergoing VHR.

Introduction: In publications on ventral incisional hernia repair, the Chevrel technique and the onlay operation are often equated. This present review now aims to present the difference between these surgical techniques and analyze the findings available on the Chevrel technique.Materials and Methods: A systematic search of the available literature was performed in January 2019 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library, as well as a search of relevant journals, books, and reference lists. Thirty-four publications were identified as relevant for this review. For assessment of the Chevrel-technique with other surgical procedures there are no randomized controlled trials, prospective or retrospective comparative studies available but only case series. In the majority of case series the follow-up procedure is not reported.Results: In the onlay technique the defect is closed with direct suture or it is omitted altogether. Whereas, in the Chevrel technique this is done with sliding myofascial flaps harvested from the rectus sheaths. In the few case series available this appears to result in a lower recurrence rate for the Chevrel technique compared with the onlay technique. However, the rates of postoperative complications, surgical site occurrences (SSOs), surgical site infections (SSIs), seroma, and skin necrosis are as high as in the onlay technique. The reason for this is that both techniques require subcutaneous undermining with severance of perforator vessels.Conclusion: If mesh placement in onlay position has been chosen for specific reasons, preference can be given to the Chevrel technique over the standard onlay technique, although the study quality is limited.