Repair of giant abdominal hernias: does the type of prosthesis matter?
Closure of the abdominal wall after trauma or major surgery may be difficult due to visceral edema or fascial weakness; thus, the risk of developing a ventral hernia (VH) is high. Commonly, these hernias are repaired using a prosthetic mesh. Complications following mesh repair can develop. We hypothesize that the type of prosthetic material affects outcome. This is a retrospective chart review of patients admitted from 1996 to 2002 undergoing VH (> or = 20 x 10 cm) repair with prosthetic mesh. Data collected included age, sex, and race. Patients were stratified by prosthetic material as follows: Gore-Tex (GR), Marlex + Gore-Tex (MG), Marlex (MR), and Marlex + Vicryl (MV). For the purpose of clinical analysis, the groups were collapsed into subgroups: Gore-Tex exposure (GT) or non-Gore-Tex exposure (NG). Outcome measures were hernia recurrence (HR), wound infection (WI), and fistula formation (FF). Statistical analysis utilized chi2 test and Fisher's exact test. There were 55 VH repairs in 37 patients. The mean age was 43.9 (+/- 16.3), males out-numbered females 22 (59.5%) to 15 (40.5%). The majority of the patients were Caucasian (29; 78.4%). There were 30 trauma patients (81.1%), and 7 general surgery patients (18.9%). The HR for the study (n = 55) was 20 (36.4%), the WI was 17 (30.9%), and the FF was 3 (5.5%). GR group (6; 66.7%) had a significant higher wound IF rate than MR group (8; 26.7%) (Chi P = 0.02, Fisher P = 0.047). All other group comparisons (HR, WI, and FF) were N.S. The Gore-Tex versus non-Gore-Tex subgroup comparison results were as follows: GT (n = 18) had a WI 8 (44.4%), HR 6 (33.3%), and FF 0 (0%). NG (n = 37) had a WI 9 (24.3%), HR 14 (37.8%), and a FF 3 (8.1%). There was a trend toward a higher wound infection in the GT versus NG, but it did not reach statistical significance. We conclude that 1) the wound infection rate was higher in the Gore-Tex versus the Marlex group (Chi P = 0.02, Fisher P = 0.047). Wound infection in the presence of Gore-Tex usually mandates the removal of the mesh resulting in a hernia recurrence. 2) There was a trend toward a higher wound infection in the GT (44.4%) versus NG (24.3%), but it did not reach statistical significance.
Diaz
Jose J
JJ
Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee 37212, USA.
Gray
Brian W
BW
Dobson
Jean M
JM
Grogan
Eric L
EL
May
Addison K
AK
Miller
Richard
R
Guy
Jeffrey
J
O'Neill
Patrick
P
Morris
John A
JA
D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D017577:Cutaneous Fistula / Q000209:etiology; D019544:Equipment Failure Analysis; D005260:Female; D006555:Hernia, Ventral / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011098:Polyglactin 910 / Q000009:adverse effects / Q000627:therapeutic use*; D011126:Polypropylenes / Q000009:adverse effects / Q000627:therapeutic use*; D011138:Polytetrafluoroethylene / Q000009:adverse effects / Q000627:therapeutic use*; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000295:instrumentation*; D016459:Prosthesis-Related Infections / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013526:Surgical Mesh / Q000009:adverse effects / Q000592:standards* / Q000600:supply & distribution; D013530:Surgical Wound Infection / Q000209:etiology; D013714:Tennessee; D016896:Treatment Outcome
D011126:Polypropylenes; D011098:Polyglactin 910; D011138:Polytetrafluoroethylene