title: Evaluation of surgical outcomes of retro-rectus versus intraperitoneal reinforcement with bio-prosthetic mesh in the repair of contaminated ventral hernias.
abstract: BACKGROUND
  Hernia repairs in contaminated fields are often reinforced with a bioprosthetic mesh. When choosing which of the multiple musculofascial abdominal wall planes provides the most durable repair, there is little guidance. We hypothesized that the retro-rectus plane would reduce recurrence rates versus intraperitoneal placement due to greater surface area contact of mesh with well-vascularized tissue.
  
  
  METHODS
  Forty-nine of the 80 patients in an ongoing, prospective, multicenter study of contaminated ventral hernia repairs (RICH study, NCT00617357) achieved fascial closure after musculofascial centralization and reinforcement with non-crosslinked porcine acellular dermal matrix (Strattice™, LifeCell, Branchburg, NJ) and were retrospectively analyzed. The Strattice was placed in the retro-rectus position in 23 patients and in the intraperitoneal position in 26.
  
  
  RESULTS
  Subjects were comparable in age, obesity, prior wound infection, presence of a stoma, and infected mesh removal (p > 0.05). More smokers were present in the intraperitoneal group (p = 0.02). Retro-rectus defects were significantly wider and had larger area than the intraperitoneal repairs. At the 1-year follow-up, 44 (90%) of patients were available for review. There was no difference in wound infections, seromas, or hematomas. Recurrent hernias were identified in 10% of retro-rectus repairs and 30% of intraperitoneal repairs (p = 0.14).
  
  
  CONCLUSIONS
  In this retrospective analysis of a prospective multicenter study of large, contaminated ventral hernias, despite a larger hernia defect in the retro-rectus group, placement of the mesh in the retro-rectus compartment resulted in a similar recurrence rate to intraperitoneal mesh placement. Ongoing evaluation is important to establish longer-term outcomes and the validity of these findings.
authors.affiliation: Division of GI and General Surgery, Case Medical Center, University Hospitals of Cleveland, Cleveland, OH 44106, USA. michael.rosen@uhhospitals.org
authors.forename: M J
authors.initials: MJ
authors.lastname: Rosen
authors.forename: G
authors.initials: G
authors.lastname: Denoto
authors.forename: K M F
authors.initials: KM
authors.lastname: Itani
authors.forename: C
authors.initials: C
authors.lastname: Butler
authors.forename: D
authors.initials: D
authors.lastname: Vargo
authors.forename: J
authors.initials: J
authors.lastname: Smiell
authors.forename: R
authors.initials: R
authors.lastname: Rutan
mesh_terms: D000328:Adult; D000368:Aged; D001705:Bioprosthesis; D003094:Collagen / Q000627:therapeutic use; D005260:Female; D006406:Hematoma / Q000209:etiology; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D049291:Seroma / Q000209:etiology; D013526:Surgical Mesh; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology*
chemical_list: C568444:strattice; D003094:Collagen