title: Surgical treatment of large incisional hernias with intraperitoneal composite mesh: a cohort study.
abstract: Patients with large incisional hernias have significant morbidity and their management is a challenge for the surgical team because of the large abdominal wall involvement. The choice of surgical technique is still controversial. The purpose of this study is to analyze the predictive factors for recurrence after intraperitoneal mesh repair in patients with large incisional hernias.
  
  
  
  A retrospective cohort observational study with a prospectively collected database was performed in the Hospital Clinico San Carlos (Madrid, Spain). All consecutive patients operated on from January 2009 to December 2014 with incisional hernia of 10 or more centimeters in its transverse diameter were included. An intraperitoneal repair with a composite mesh fixed with discontinuous absorbable suture and fibrin sealant was performed. Demographic data, comorbidities, and early and long term outcomes were analyzed. The primary outcome was the presence of recurrence.
  
  
  
  One hundred and twenty patients were included. Mean age was 63.3 years (SD 12.9) and sex ratio was 1.4:1. Seventy-two patients (60%) were ASA III-IV. Forty-five patients (37.5%) had recurrent ventral hernias. Mean defect size was 14.7 cm (SD 3.21) of width. Overall postoperative morbidity rate was 25%. Median hospital stay was 6 days (IQR 4-8). Recurrence rate was 8.3%, after a median follow-up of 16 months (IQR 10-25). Multivariate analysis showed significant association between ASA III-IV, use of Composix Kugel™ mesh, superficial surgical site infection, and the presence of recurrence.
  
  
  
  The recurrence rate after intraperitoneal mesh repair in patients with large incisional hernias might be associated with ASA III-IV, use of Composix Kugel™ mesh, and superficial surgical site infection.
authors.affiliation: Surgery Department, Hospital Clinico San Carlos, Universidad Complutense de Madrid, Calle Profesor Martin Lagos s/n, 28040, Madrid, Spain. bibianalasses@gmail.com.
authors.forename: B
authors.identifier: 0000-0002-3051-5115
authors.initials: B
authors.lastname: Lasses Martínez
authors.affiliation: Surgery Department, Hospital Clinico San Carlos, Universidad Complutense de Madrid, Calle Profesor Martin Lagos s/n, 28040, Madrid, Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: Peña Soria
authors.affiliation: Surgery Department, Hospital Clinico San Carlos, Universidad Complutense de Madrid, Calle Profesor Martin Lagos s/n, 28040, Madrid, Spain.
authors.forename: J J
authors.initials: JJ
authors.lastname: Cabeza Gómez
authors.affiliation: Surgery Department, Hospital Clinico San Carlos, Universidad Complutense de Madrid, Calle Profesor Martin Lagos s/n, 28040, Madrid, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Jiménez Valladolid
authors.affiliation: Surgery Department, Hospital Clinico San Carlos, Universidad Complutense de Madrid, Calle Profesor Martin Lagos s/n, 28040, Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Flores Gamarra
authors.affiliation: Preventive Medicine Department, Hospital Clinico San Carlos, Universidad Complutense de Madrid, Calle Profesor Martin Lagos s/n, 28040, Madrid, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Fernández Pérez
authors.affiliation: Surgery Department, Hospital Clinico San Carlos, Universidad Complutense de Madrid, Calle Profesor Martin Lagos s/n, 28040, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Torres García
authors.affiliation: Surgery Department, Hospital Clinico San Carlos, Universidad Complutense de Madrid, Calle Profesor Martin Lagos s/n, 28040, Madrid, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Delgado Lillo
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000368:Aged; D005260:Female; D015718:Fibrin Tissue Adhesive; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D000069290:Incisional Hernia / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh; D013536:Suture Techniques; D013537:Sutures
chemical_list: D015718:Fibrin Tissue Adhesive
keywords: Composite mesh; Intraperitoneal mesh repair; Large incisional hernia; Large ventral hernia