Complex Incisional Hernia Repair Utilizing Biological Mesh and Soft-Tissue Reconstruction: A Single Centre Experience

J. Skipworth, I. Younis, D. Floyd, A. Shankar

Moderator(s): Rogier Simmermacher (Utrecht, The Netherlands) & Jaap Bonjer (Amsterdam, The Netherlands)

12:15 - 12:30h at Jurriaanse Zaal

Categories: Session 6. Complex/contaminated hernia

Parallel session: Session 6. Complex / Contaminated Hernia

Background:
Incisional hernia repair (IHR) may be complex in the presence of obesity, co-morbidities (e.g. diabetes and malignancy), infected mesh, fistulae and loss of domain. Historical techniques for repair of such hernias are associated with significant morbidity and led to the development of a novel technique within our unit.

Methods:
A retrospective review of IHRs performed as a single-stage procedure, by a general and plastic surgeon, was undertaken (Feb 2009-Sep 2013). Repair involved extensive resection of soft-tissue (including hernia sac) and mesh placement in the intra-peritoneal space (Bard[TRADEMARK] composite for VHWG grades 1 or 2; Strattice[TRADEMARK] for grades 3 or 4 or high-risk grade 2), midline fascial closure, and abdominal wall reconstruction (with soft-tissue flaps where necessary).

Results:
95 (69 biological/26 composite) patients underwent IHR (64% female; median age 59 years; BMI 31.5 kg/m2; length of stay 8 nights; follow-up 24 months). 9 (9%) patients were grade 4, 47 (49%) grade 3, 28 (29%) grade 2 and 11 (12%) grade 1. 27 (28%) were recurrent hernias, 19 (20%) had diabetes and 31 (33%) had malignancy. 25 (26%) patients developed complications including 18 (19%) surgical-site occurrences (SSOs); 3 (3%) returning to theatre; 7 (7%) respiratory and 3 (3%) cardiac complications. Clinical follow-up revealed 4 (4%) hernia recurrences: 1 has undergone further repair and 3 are asymptomatic. None of the patients required mesh-removal.

Conclusions:
This technique is associated with a low incidence of recurrence and SSO, findings that may rely upon radical resection of poorly-vascularised soft-tissue (bioburden reduction) and abdominal wall reconstruction utilising healthy tissue. The low SSO incidence in grade 2 patients repaired with synthetic mesh has led to a change in our unit’s practice, with biological mesh now exclusively reserved for grade 3 and 4 IHRs.

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