SYNTHETIC MESH REINFORCEMENT IN COMPONENT SEPARATION (CS) VENTRAL
HERNIA REPAIR (VHR): OUTCOMES IN “AT RISK” PATIENTS
KB Williams, MD; JF Bradley3rd, MD; BA Wormer, MD; CT Williams; AL Walters, MS; KT Dacey,
MHA; VA Augenstein, MD; KW Kercher, MD; BT Heniford, MD—Carolinas Medical Center, NC
Background: Indications for prosthetic versus biologic mesh placement within certain patient
populations is controversial. Outcomes of CS in VHR with synthetic mesh were examined in co-morbid
(G2) patients and potentially contaminated (G3) fields.
Methods: A prospective surgical outcomes study was performed from 2007-2012 for all patients
undergoing CS VHR with synthetic mesh specifically looking at G2 (smoker, obese, diabetic, COPD,
steroid use) or G3 (previous wound infection, stoma, violation of GI tract) groups of patients.
Demographics, operative characteristics, and wound complications were analyzed. Standard statistical
analysis was applied.
Results: A total of 122 CS were performed (66%G2, 34%G3) with a mean follow-up of 8.9±9.7 months.
No difference (all p>0.05) was noted comparing G2 vs G3 age(56.8±11.6 vs. 56.0±12.5 years),
BMI(34.5±7.8 vs. 33.9±7.0 kg/m2), or gender. Comorbidities (asthma, CAD, CHF, COPD, diabetes, liver
disease, obesity, steroid and tobacco use) were similar between groups (all p>0.05) except hypertension
(67.7%G2 vs. 45.7%G3, p=0.03). Bilateral CST was performed in the majority of repairs (85.7%) with
preperitoneal mesh (79.5%) and subcutaneous advancement flaps(72.3%); concomitant panniculectomy
was performed in 41% of cases. Defect(286.3±184.2 vs. 321.8±252.5cm2) and mesh size(1001.1±421.4
vs. 1005.4±393.9cm2) were statistically similar for G2 vs. G3 (p>0.05). The majority of G3 had longer
operative time (208.6±58.6 vs. 244.3±75.3 minutes, p=0.01), more EBL (155.1±98.0 vs. 184.3±96.1cc,
p=0.047) and underwent more concomitant procedures (32.1% vs. 53.7%, p=0.02). Post-operatively, there
was no difference (G2 vs. G3, all p>0.05) in LOS (8.3±7.9 vs. 8.8±5.9 days) or complications, and no
mortalities. No differences were seen in wound complications, recurrence or 30-day readmission (Table).
Conclusion: Outcomes for CS in VHR in co-morbid patients and those with potentially contaminated
fields are equivalent and quite acceptable considering the complexity of the operation. With these results,
the consideration of mesh choice in at risk patients should be closely examined.
Table. Wound Complications G2 & G3 Undergoing CST VHR with
Synthetic Mesh
Overall
G2
G3
P-value
14.08%
23.94%
19.72%
4.23%
1.41%
8.45%
8.33%
41.67%
25.00%
5.56%
2.78%
11.43%
0.536
0.059
0.530
1.000
1.000
0.727
19.72% 19.44%
CST VHR, component seperation ventral hernia repair
0.973
Seroma requiring
intervention
12.15%
Wound breakdown
29.91%
Wound infection
21.50%
Mesh infection
4.67%
Recurrence
1.87%
Readmission <30 day
9.43%
Any major wound complication
(mesh infection, operative
or radiographic drainage)
19.63%