title: Biologic mesh for repair of ventral hernias in contaminated fields: long-term clinical and patient-reported outcomes.
abstract: Guidelines recommend biologic prosthetics for ventral hernia repair (VHR) in contaminated fields, yet long-term and patient-reported data are limited. We aimed to determine the long-term rate of hernia recurrence, and other clinical and patient-reported outcomes following the use of porcine small intestine submucosa (PSIS) for VHR in a contaminated field.
  
  
  
  Consecutive patients undergoing open VHR with PSIS mesh in a contaminated field from 2004 to 2014 were prospectively evaluated for hernia recurrence and other post-operative complications. Multivariate logistic and Cox regression analyses identified predictors of hernia recurrence and surgical site infection. Patient-reported outcomes were evaluated using SF-36, Hernia-Related Quality-of-Life Survey (HerQLes) and Body Image Questionnaire instruments.
  
  
  
  Forty-six hernias were repaired in clean-contaminated [16 (35 %)], contaminated [11 (24 %)] and dirty [19 (41 %)] fields. Median follow-up was 47 months [interquartile range: 31-79] and all patients had greater than 12-month follow-up. Sixteen patients (35 %) were not re-examined. Incidence of surgical site events and surgical site infection were 43 % (n = 20) and 56 % (n = 25), respectively. American Society of Anesthesiologists score 3 or greater was an independent predictor of surgical site infection (odds ratio 5.34 [95 % confidence interval 1.01-41.80], p = 0.04). Hernia recurrence occurred in 61 % (n = 28) with a median time to diagnosis of 16 months [interquartile range 8-26]. After bridged repair, 16 of 18 patients (89 %) recurred, compared to 12 of 28 (43 %) when fascia was approximated (p < 0.01). Bridged repair was an independent predictor of recurrence (odds ratio 10.67 [95 % confidence interval 2.42-76.08], p < 0.01). Patients with recurrences had significantly worse scores on the SF-36 mental health component and self-perceived body image, whereas HerQLes scores were similar.
  
  
  
  Hernia recurrences and wound infections are high with the use of biologic PSIS mesh in contaminated surgical fields. Careful consideration is warranted using this approach.
authors.affiliation: Department of Surgery, McGill University Health Centre, 1650 Cedar Avenue, Rm D6-257, Montreal, QC, H3G 1A4, Canada. amin.madani@mail.mcgill.ca.|Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Canada. amin.madani@mail.mcgill.ca.
authors.forename: Amin
authors.initials: A
authors.lastname: Madani
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Canada.
authors.forename: Petru
authors.initials: P
authors.lastname: Niculiseanu
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Canada.
authors.forename: Wanda
authors.initials: W
authors.lastname: Marini
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Canada.
authors.forename: Pepa A
authors.initials: PA
authors.lastname: Kaneva
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Canada.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Mappin-Kasirer
authors.affiliation: Department of Surgery, McGill University Health Centre, 1650 Cedar Avenue, Rm D6-257, Montreal, QC, H3G 1A4, Canada.|Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Canada.
authors.forename: Melina C
authors.initials: MC
authors.lastname: Vassiliou
authors.affiliation: Department of Surgery, McGill University Health Centre, 1650 Cedar Avenue, Rm D6-257, Montreal, QC, H3G 1A4, Canada.|Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Canada.
authors.forename: Kosar
authors.initials: K
authors.lastname: Khwaja
authors.affiliation: Department of Surgery, McGill University Health Centre, 1650 Cedar Avenue, Rm D6-257, Montreal, QC, H3G 1A4, Canada.
authors.forename: Paola
authors.initials: P
authors.lastname: Fata
authors.affiliation: Department of Surgery, McGill University Health Centre, 1650 Cedar Avenue, Rm D6-257, Montreal, QC, H3G 1A4, Canada.|Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Canada.
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Fried
authors.affiliation: Department of Surgery, McGill University Health Centre, 1650 Cedar Avenue, Rm D6-257, Montreal, QC, H3G 1A4, Canada.|Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Canada.
authors.forename: Liane S
authors.initials: LS
authors.lastname: Feldman
mesh_terms: D000368:Aged; D000818:Animals; D001688:Biological Products; D001828:Body Image; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D015994:Incidence; D007413:Intestinal Mucosa / Q000637:transplantation*; D007421:Intestine, Small / Q000637:transplantation; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D015999:Multivariate Analysis; D000071066:Patient Reported Outcome Measures; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000453:epidemiology*; D013552:Swine; D016896:Treatment Outcome
chemical_list: D001688:Biological Products
keywords: Biologics; Hernia; Recurrence; Surgical site infection; Surgisis