Outcomes of Immediate Multistaged Abdominal Wall Reconstruction of Infected Mesh: Predictors of Surgical Site Complications and Hernia Recurrence.

BACKGROUND: Mesh infection is one of the most devastating complications after ventral hernia repair. To date, no clear consensus exists on the optimal timing of definitive abdominal wall reconstruction (AWR) after excision of infected mesh. We evaluated outcomes of immediate multistaged AWR in patients with mesh infection. METHODS: We performed a retrospective review of patients with mesh infection who underwent immediate, multistaged AWR, which consisted of exploratory laparotomy with debridement and mesh explantation, followed by definitive AWR during the same admission. Primary outcomes included hernia recurrence and surgical site occurrences, defined as wound dehiscence, surgical site infection, hematoma, and seroma. RESULTS: Forty-seven patients with infected mesh were identified. At mean follow-up of 9.5 months, 5 patients (10.6%) experienced hernia recurrence. Higher body mass index (P = 0.006), bridge repair (P = 0.035), and postoperative surgical site infection (P = 0.005) were associated with hernia recurrence. CONCLUSION: Immediate multistaged AWR is an effective surgical approach in patients with infected mesh.

Incisional Hernias After Major Abdominal Operations: Analysis Within a Large Health Care System.

BACKGROUND: This will be the largest multi-institutional study looking at incidence of and duration to symptomatic hernia formation for major abdominal operations separated by malignant and benign disease process. METHODS: An IRB-approved retrospective study within the MedStar Hospital database was conducted, incorporating all isolated colectomy, hepatectomy, pancreatectomy, and gastrectomy procedures between the years 2002 and 2016. All patients were identified using ICD-9 and ICD-10 codes for relevant procedures, and then separated based on malignant or benign etiology. The rate of symptomatic incisional hernia rates was determined for each cohort based on subsequent hernia procedural codes identified. RESULTS: During this 15-year span, a total of 6448 major abdominal operations were performed at all 10 institutions, comprising 3835 colectomies, 1122 hepatectomies, 1165 pancreatectomies, and 326 gastrectomies. Total incidence of symptomatic incisional hernia occurrence requiring repair was 325 (5.0%). Separated by group, the overall incisional hernia repair rates for patients undergoing colectomy, hepatectomy, pancreatectomy, and gastrectomy are as follows, respectively: 6.4% (247), 2.5% (28), 3.6% (42), and 2.8% (9), P < 0.0001. The subsequent median duration to hernia repair was 498 d (interquartile range [IQR]: 312-924) for colectomy, 421 d (IQR: 340-518) for hepatectomy, 378 d (IQR: 284-527) for pancreatectomy, and 630 d (IQR: 419-1204) for gastrectomy (P = 0.03401). CONCLUSIONS: Symptomatic incisional hernia repair rates after major gastrointestinal and hepatobiliary surgery range from 2.1% to 6.4%. There was no significant increase in hernia rates in patients undergoing surgery for malignancy.

Outcomes using indocyanine green angiography with perforator-sparing component separation technique for abdominal wall reconstruction.

BACKGROUND: Usage of intraoperative indocyanine green (ICG) to assess skin flaps prior to abdominal wall closure has been shown to decrease postoperative wound-related complications. Primary outcome assessed is the utility of ICG in intraoperative decision making. Secondary outcomes analyzed are the incidence of surgical site occurrence (SSO) and hernia recurrence rates. METHODS: A retrospective study using the MedStar Georgetown University Hospital database was conducted, incorporating all consecutive patients undergoing complex incisional hernia repair from 2008 to 2018. 146 patients underwent perforator-sparing component separation (PSCST), 88 underwent flap assessment using intraoperative ICG angiography; they were then analyzed based on patient comorbidities, Ventral Hernia Working Group grade, operative factors, and complications. RESULTS: A total of 146 patients were analyzed with no statistical difference in patient characteristics between the SPY and no SPY group except in BMI (30.2 vs. 33.2 kg/m2, p = 0.036). The no SPY group also had higher numbers of patients undergoing concurrent panniculectomy (12 vs. 1, p < 0.001), and extensive lysis of adhesions (30 vs. 31, p = 0.048). Of the 88 patients undergoing intraoperative SPY, 37 (42%) patients had a change of intraoperative management as defined by further subcutaneous skin flap debridement. Despite this change, there was no statistical difference in incidence of SSO between SPY and no SPY (24.3% vs. 11.8%, p = 0.12), and no difference in hernia recurrence rates 5.6% (n = 5) versus 13.7% (n = 8), p = 0.09. CONCLUSION: Intraoperative ICG assessment of subcutaneous skin flaps with a perforator-sparing component separation does not result in a decrease in surgical site occurrences.

Immediate, Multistaged Approach to Infected Synthetic Mesh: Outcomes After Abdominal Wall Reconstruction With Porcine Acellular Dermal Matrix.

BACKGROUND: Infection of synthetic mesh after abdominal wall hernia repair is a complex problem. The purpose of this study was to determine whether a staged approach to abdominal wall reconstruction (AWR) using a porcine acellular dermal matrix (PADM) is beneficial in the setting of infected synthetic mesh. METHODS: The authors performed a retrospective review of 27 patients who underwent immediate, staged complex AWR using PADM from 2007 to 2012. RESULTS: After a component separation, primary fascial closure was achieved in 21/27 (78%) patients, whereas 6/22 (22%) received a bridged hernia repair with PADM. Wound-related complications developed in 7/27 (26%) patients including wound dehiscence 6/27 (22%), surgical site infection 5/27 (19%), and hematoma 1/27 (4%). The hernia recurrence rate observed by 32 months was 19%. A bridged hernia repair and the development of a postoperative infection were associated with hernia recurrence, P<0.05. CONCLUSIONS: A 2-stage approach to AWR with PADM can provide a safe and effective solution for patients with infected synthetic mesh.

Age is just a number: The role of advanced age in predicting complications following ventral hernia repair with component separation.

BACKGROUND: While advanced age is often considered a risk factor for complications following abdominal surgery, its impact on outcomes after complex open ventral hernia repair (VHR) with component separation technique (CST) remains unclear. METHODS: A single-center retrospective review of patients who VHR with CST from November 2008 to January 2022 was performed and cohorts were stratified by presence of advanced age (≥60 years). RESULTS: Of 219 patients who underwent VHR with CST, 114 patients (52.1 â€‹%) were aged ≥60 years. Multivariate analysis demonstrated BMI to be an independent predictor for any complication (OR 1.1, p â€‹= â€‹0.002) and COPD was positively associated with seroma development (OR 20.1, p â€‹= â€‹0.012). Advanced age did not independently predict postoperative outcomes, including hernia recurrence (OR 0.8, p â€‹= â€‹0.766). CONCLUSIONS: VHR with CST is generally safe to perform in patients of advanced age. Every patient's comorbidity profile should be thoroughly assessed preoperatively for risk stratification regardless of age.

Predicting abdominal closure after component separation for complex ventral hernias: maximizing the use of preoperative computed tomography.

BACKGROUND: Component separation techniques (CSTs) have allowed for midline fascial reapproximation in large midline ventral hernias. In certain cases, however, fascial apposition is not feasible, resulting in a bridged repair that is suboptimal. Previous estimates on myofascial advancement are based on hernia location and do not take into account variability between patients. Examination of preoperative computed tomography (CT) may provide insight into these variabilities and may allow for prediction of abdominal closure with CST. STUDY DESIGN: A retrospective review was conducted of patients who underwent abdominal wall reconstruction from 2007 to 2012 with CST. Preoperative CT was obtained, and specific parameters were analyzed using image analysis software. Logistic regression was used to predict ideal operative closure. Multivariate analyses were adjusted for age and sex. An a priori value was set at P < 0.05. RESULTS: Fifty-four patients met the criteria and had preoperative CT available for analysis. Forty-eight patients had fascial reapproximation achieved, whereas 6 patients had a bridged repair. Age, sex, weight, and body mass index were similar between groups (P > 0.05). Significant differences were seen between groups in 3 variables: transverse defect size (19.8 vs 10 cm, P < 0.05), defect area (420 vs 184.2 cm, P < 0.05), and percent abdominal wall defect (18.9% vs 10.6%, P < 0.05). CONCLUSIONS: Preoperative determination of abdominal wall defect ratios and hernia defect areas may represent a more accurate method to predict abdominal wall closure after CST. Predicting midline approximation after CST is critical because outcomes after bridged repair can result in higher recurrence rates.

Indications and outcomes following complex abdominal reconstruction with component separation combined with porcine acellular dermal matrix reinforcement.

PURPOSE: Component separation (CS) is an effective technique for complex abdominal wall reconstruction (AWR). Reinforcement of the repair with mesh can add durability. The purpose of this study was to evaluate the indications and outcomes following CS combined with a porcine acellular dermal matrix (PADM) for reinforcement. METHODS: A retrospective review of all patients who underwent complex AWR at the authors' institution was completed between 2007 and 2010. Patients with complex hernias who underwent CS in conjunction with PADM as an underlay were included. The PADM used in this cohort was Strattice (LifeCell Corporation, Branchburg, NJ). Patient demographics, indications, perioperative details, postoperative care, and long-term outcomes were reviewed. RESULTS: A total of 78 patients were identified as having PADM implanted for AWR. Of this cohort, 41 patients met the criteria as having a CS to achieve midline closure, with the PADM placed as reinforcement in an underlay manner. These patients were classified as grade II (33; 80.5%), grade III (4; 9.8%), and grade IV (4; 9.8%). Average patient age was 57.6 years (range, 33-80), and average body mass index (BMI) was 35.8 kg/m2 (range, 21.6-52.1). Patient comorbidities included coronary artery disease (19; 46.3%), diabetes mellitus (14; 34.2%), chronic obstructive pulmonary disease (COPD) (6; 14.6%), and chronic steroid use (2; 4.9%). Previous mesh infection occurred in 9 (28.1%). The mean defect diameter was found to be 14.3 cm. Perforator preservation of the subcutaneous flaps was performed in 34 (82.9%) patients. A concomitant panniculectomy was performed in 9 (22%) patients. A staged approach was used in 3 (7.3%) patients. The overall complication rate was 24.4%. Strattice exposure occurred in 5 (12.2%) patients. All patients went on to heal wounds without explantation.No hernia recurrences or symptomatic bulges were observed in the follow-up period of 474 days (range, 194-1017 days). No significant predictors of complications were identified. CONCLUSIONS: Strattice is an effective adjunct to AWR when used as reinforcement during CS for a wide variety of indications. Complication rates remain low in complex patients. In addition, Strattice appears to add durability to midline reconstructions with no recurrences during the follow-up period.

Abdominal wall intramuscular desmoid fibromatosis: a case report.

Desmoid tumors are rare benign myofibroblastic neoplasms that do not have metastatic potential. In this study, we report a case of a desmoid tumor in the left rectus abdominis muscle of a female patient. Computed tomography, abdominal ultrasound and magnetic resonance imaging were obtained preoperatively. We performed a complete resection with negative margins. Microscopic evaluation revealed a desmoid tumor. To definitively diagnose abdominal wall masses, imaging modalities must be used in conjunction with clinical history and histologic findings. For these masses, surgical resection is the preferred line of treatment.

Negative Pressure Wound Therapy Prevents Hernia Recurrence in Simultaneous Ventral Hernia Repair and Panniculectomy.

Simultaneous ventral hernia repair with panniculectomy (VHR-PAN) is associated with a high rate of wound complications. Closed incision negative pressure wound therapy (ciNPWT) has been shown to lower complications in high-risk wounds. There is a debate in the literature as to whether ciNPWT is effective at preventing complications in VHR-PAN. The aim of our study was to evaluate if ciNPWT improves outcomes of VHR-PAN. Methods: A retrospective review of patients who underwent VHR-PAN between 2009 and 2021 was conducted. Patients were divided into two groups: (1) those who received standard sterile dressings (SSD), or (2) ciNPWT. Primary outcomes were postoperative complications, including surgical site occurrences (SSO) and hernia recurrence. Results: A total of 114 patients were identified: 57 patients each in the SSD group and ciNPWT group. The groups were similar in demographics and comorbidities. There were more smokers in the SSD group (22.8% versus 5.3%, P = 0.013). Hernia defect size was significantly larger in patients who received ciNPWT (202.0 versus 143.4 cm2, P = 0.010). Overall SSO was similar between the two groups (23.2% versus 26.3%, P = 0.663). At a mean follow-up of 6.6 months, hernia recurrence rate was significantly higher in the SSD group compared with that in the ciNPWT group. (10.5% versus 0%, P = 0.027). Smoking, diabetes, component separation, mesh type, and location were not significantly associated with hernia recurrence. Conclusions: Application of incisional NPWT is beneficial in decreasing hernia recurrence in VHR-PAN, compared with standard dressings. Larger prospective studies are warranted to further elucidate the utility of ciNPWT in abdominal wall reconstruction.

Abdominal wall reconstruction with implantable meshes.

Abdominal wall defects present a difficult problem for the reconstructive surgeon. Over the years, numerous implantable materials have becomes available to aid the surgeon in recreating the abdominal wall. This spectrum of implants includes permanent synthetic meshes, absorbable meshes, composite meshes and biomaterials. This review includes the pros and cons for the commercially available abdominal wall implants as well as a review of the literature regarding outcomes for each material. This review will provide the surgeon with current evidence-based information on implantable abdominal materials to be able to make a more informed decision about which implant to use.

Retrievable inferior vena cava filters in high-risk patients undergoing bariatric surgery.

BACKGROUND: Placement of retrievable inferior vena cava filters (rIVCF) may be beneficial in high-risk morbidly obese patients undergoing bariatric procedures. Patients with a previous history of venous thromboembolism (VTE) are at high risk for postoperative deep venous thrombosis (DVT) and pulmonary embolism (PE). METHODS: A prospective database of bariatric surgery patients was studied from April 2003 to May 2007. A total of 791 patients underwent bariatric procedures, of which 30 (4%) had a previous history of VTE. These patients underwent preoperative venous duplex and concurrent placement of a rIVCF. Patient demographics and clinical outcomes were examined. RESULTS: Thirty patients (12 (40%) men) had a mean age of 49 +/- 8 years and a mean body mass index of 50 +/- 8 kg/m(2). Sixteen patients (53%) underwent laparoscopic Roux-en-Y gastric bypass, ten (33%) underwent laparoscopic adjustable gastric band, and four (14%) underwent open Roux-en-Y gastric bypass. Mean operative time, including rIVCF placement, was 162 +/- 66 minutes. All patients had successful rIVCF placement with standard perioperative chemoprophylaxis. Twenty-nine patients (97%) had a follow-up ultrasound on postoperative day (POD) 19 +/- 25. Six patients (21%) had recurrent DVT. Twenty-seven patients (90%) underwent a follow-up venogram, and four patients (15%) had significant thrombus in the rIVCF. Retrieval was successful in 21 patients (70%). Nine patients (30%) did not undergo retrieval: four had significant thrombus in the filter, four had an above-knee DVT, and one due to technical reasons. We observed one complication with a DVT at the access site and no PE or mortality. CONCLUSIONS: We observed a 21% incidence of recurrent DVT and 15% incidence of thrombus in the IVCF, yet no PE occurred. IVCF retrieval was successful in 70% with one complication. Concurrent IVCF placement is safe, feasible, and an effective preventative measure in high-risk morbidly obese patients. We recommend the use of rIVCFs in conjunction with standard VTE prophylaxis in this patient population.

A Current Review of Biologic Meshes in Abdominal Wall Reconstruction.

It is well accepted that the use of mesh has facilitated and improved outcomes following repair of the complex abdominal hernias. Current mesh options include biologic, synthetic, and resorbable materials. The use of biologic materials for the repair and reinforcement of abdominal wall hernia has generated significant discussion. There are a variety of biologic mesh materials that are currently available that are derived from various sources including human, porcine, or bovine. All are processed for heterogeneous use, include variable amounts of collagen and elastin, and may or may not be crosslinked. The mechanism of action for biologic mesh is the incorporation, revascularization, and recellularization into the surrounding soft tissue. The presumed benefit is that the added soft-tissue support will reduce the incidence of surgical-site occurrences including recurrence. This article will review the salient studies that have incorporated biologic materials for the repair of complex abdominal hernia.

The Perfect Plane: A Systematic Review of Mesh Location and Outcomes, Update 2018.

BACKGROUND: The principal approach to abdominal wall reconstruction requires implantation of mesh to decrease ventral hernia recurrence. This study compared current surgical outcomes and complications by location of anatomic mesh placement following ventral hernia repair with onlay, interposition, retromuscular, or underlay mesh reconstruction. METHODS: A systematic search of the PubMed database published from 2013 to 2018 was performed to identify patients who underwent abdominal wall reconstruction using either biologic or prosthetic mesh for ventral hernia repair. Demographic information and outcomes were obtained from each study. RESULTS: Fifty-one articles met inclusion criteria, resulting in 6,227 patients who underwent mesh repair of a ventral hernia. Mesh position included onlay in 7.6% of patients, interposition in 13.2%, retromuscular in 35.9%, and underlay placement in 43.4%. Prosthetic mesh was used in 68.5% of repairs and biological mesh in 31.5%. The mean patient age was 53.1 years (range, 18-95 years), and mean BMI was 29.1 kg/m(2) (range, 15-70.9 kg/m(2)). The mean follow-up was 37.5 ± 2.3 months. The overall mean recurrence rate was 8.3%, with retromuscular (5.8%) and underlay (10.9%) mesh placement trending toward less recurrence than onlay (12.9%) and interposition (21.6%) mesh placement (P = 0.023). Inferior recurrence rates were identified in the onlay and interposition placement of biologic mesh (28.6% and 29.1%, respectively), and analysis of open approaches yielded significant differences with onlay and interposition repairs having the highest hernia recurrence rates (10.9% and 25.4%, respectively). Laparoscopic interposition mesh location showed highest recurrence (10%) as compared with retromuscular (0.1%) and underlay (4.2%) (P = 0.041). CONCLUSIONS: Mesh reinforcement of a ventral hernia repair continues to be safe and efficacious, and the anatomic location of mesh implantation appears to influence outcomes. Retromuscular or underlay mesh repair is associated with a lower recurrence rate.

Laparoscopic-assisted Peritoneal Shunt Insertion for Ventriculoperitoneal and Lumboperitoneal Shunt Placement: An Institutional Experience of 53 Consecutive Cases.

PURPOSE: The purpose of this study was to describe operative times, complication rates, and outcomes following laparoscopic placement of the peritoneal catheter in ventriculoperitoneal (VP) and lumboperitoneal (LP) shunt insertion. METHODS: A retrospective review was performed of those who underwent laparoscopic-assisted VP or LP shunt insertion from July 2007 to August 2011. RESULTS: The study included 53 consecutive patients (35 women and 18 men). Mean age was 51 years (range, 16 to 83 y), mean BMI was 27.6 (range, 16 to 54), and 35.8% of the patients had previous abdominal surgery. Mean operative time for VP shunt placement was 68.2 ± 19.0 minutes, and for LP shunt placement 84 ± 12.4 minutes. There were no intraoperative complications, and conversion to minilaparotomy was 0%. There were 2 distal catheter-associated complications. CONCLUSIONS: Laparoscopic-assisted VP/LP shunt placement is associated with a low incidence of distal catheter malfunction. Direct visualization of shunt placement into the peritoneal cavity is a major advantage making it a viable alternative over traditional techniques.

Patient-centered outcomes following laparoscopic ventral hernia repair: a systematic review of the current literature.

BACKGROUND: The purpose of this study was to systematically review patients who underwent laparoscopic ventral hernia repair (LVHR) and assess quality of life, pain, functionality, and patient satisfaction. DATA SOURCES: MEDLINE, PubMed, and Cochrane database search identified 880 relevant articles. After the limits were applied, 14 articles were accepted for review. The analysis included health-related quality of life (HRQoL) measures including quality of life, pain, function, satisfaction, and mental and emotional well-being. CONCLUSIONS: Fourteen studies were reviewed. Mean study size was 92.6 subjects (24 to 306) and mean defect size was 71.7 cm(2). LVHR improved the overall HRQoL in 6 of the 8 studies. Thirteen studies assessing pain demonstrated improved pain scores relative to preoperative levels and long-term follow up. LVHR was not associated with long-term pain. Functionality improved in 12 studies. Return to work ranged from 6 to 18 days postoperatively in 50% of studies and physical function scores improved in the remaining 50% of the studies. Patient satisfaction improved after LVHR in all studies assessing patient satisfaction. Fixation methods did not influence HRQoL. Laparoscopic repair was associated with improving mental and emotional well-being in 6 of the 7 studies.

A patient-centered appraisal of outcomes following abdominal wall reconstruction: a systematic review of the current literature.

BACKGROUND: Published assessment tools have attempted to investigate patient-centered outcomes after abdominal wall defect repairs, including quality-of-life measures, functional outcomes, pain assessment, and overall satisfaction scores; however, health-related quality of life following hernia repair remains unclear. METHODS: The MEDLINE, PubMed, and Cochrane databases were queried and 880 articles were identified. Of these, 22 met inclusion/exclusion criteria. Analysis included health-related quality-of-life metrics focusing on quality of life, pain, physical function, overall satisfaction with surgery, impact of component separation, use of synthetic or biologic mesh, and emotional sequelae of an abdominal wall defect and repair. RESULTS: Twenty-two studies were reviewed; the mean study size was 117.7 patients (range, 14 to 402 patients). Mean and median ventral hernia defect sizes were 104.5 cm and 71.5 cm, respectively. All studies reported open repairs using synthetic mesh. The Short Form-36 was used most often (11 of 22) in comparison to other assessment methods. Patients had global improvement in quality of life, functionality, impact on social function, and patient satisfaction. Hernia recurrence was found to have a major negative impact on quality of life. Midline repair improved overall pain and abdominal wall functionality in both presurgical patients and those with hernia recurrence. Component separation techniques appear to have a positive impact on global health-related quality of life. CONCLUSIONS: Adopting an abdominal wall procedure-specific quality-of-life assessment tool as the standard is strongly recommended to gain a comprehensive understanding of abdominal wall defects and repairs. The available literature in open abdominal wall repair suggests an improved quality of life. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Proceed™ mesh for laparoscopic ventral hernia repair.

BACKGROUND AND OBJECTIVES: Laparoscopic technique to repair ventral hernia offers advantages over conventional open surgery such as shorter recovery time, decreased pain, and lower recurrence rates. There are a myriad of meshes available for laparoscopic repair of ventral hernias. This study evaluated the outcomes of laparoscopic repair of ventral hernias with Proceed mesh (Ethicon, Somerville, NJ, USA) in a single academic institution. METHODS: An institutional review board-approved retrospective review was performed for 100 consecutive patients with ventral hernia who underwent a laparoscopic approach at our institution from August 2006 to February 2009. All patients were operated on by a single surgeon using a standard technique with transabdominal suture fixation and tacks. RESULTS: The study included 100 consecutive patients (57 female and 43 male patients). The mean age was 55 years (range, 16-78 years), and the mean body mass index was 33.3 kg/m(2) (range, 19.6-68.9 kg/m(2)). Of the repairs, 27% were performed for a recurrent hernia. The mean and median size of the defect were 128 cm(2) and 119.5 cm(2) (range, 4-500 cm(2)), respectively. To ensure appropriate mesh overlap, the mean size of mesh was 253 cm(2) (range, 36-700 cm(2)). There were 4 conversions. The mean operative time was 117 minutes (range, 35-286 minutes). The mean length of stay was 1.9 days. There were no major abdominal complications. With a mean follow-up period of 50 months (range, 38-68 months), we have not recorded any recurrences. No mesh-related complications have been documented. CONCLUSIONS: The laparoscopic approach to ventral hernia repairs using Proceed mesh is associated with a low conversion rate and no major complications. At 50 months of follow-up, the recurrence rate is 0%. There were no mesh-related complications.

The use of porcine acellular dermal matrix in a bridge technique for complex abdominal wall reconstruction: an outcome analysis.

BACKGROUND: Outcomes using the porcine acellular dermal matrix (PADM) in abdominal wall reconstruction (AWR) have been reported when used for midline reinforcement; however, there have been no reports focused on outcomes when used as a bridging mesh. METHODS: A retrospective review was conducted of all patients who underwent AWR with a non-cross-linked PADM as a bridged repair without midline fascial approximation. RESULTS: Nine patients were identified with an average follow-up of 546 days. The average preoperative hernia defect diameter was 22.4 cm. After PADM placement, the average defect diameter was 9.8 cm. Complications occurred in 55.6% of patients, with PADM exposure occurring in all of these patients. No PADM was explanted, and all patients eventually healed. Abdominal wall eventration and/or recurrence occurred in 8 of 9 (88.9%) patients. CONCLUSIONS: When fascial approximation cannot be achieved, PADM bridging may be the best option to avoid complications associated with synthetic mesh. However, there is a high potential for abdominal wall eventration and/or recurrence.

Critical analysis of Strattice performance in complex abdominal wall reconstruction: intermediate-risk patients and early complications.

The purpose of this study was to analyze the performance of a porcine-derived acellular dermal matrix (Strattice Reconstructive Tissue Matrix) in patients at increased risk for perioperative complications. We reviewed medical records for patients with complex abdominal wall reconstruction (AWR) and Strattice underlay from 2007 to 2010. Intermediate-risk patients were defined as having multiple comorbidities without abdominal infection. Forty-one patients met the inclusion criteria (mean age, 60 years; mean body mass index, 35.5 kg/m(2)). Comorbidities included coronary artery disease (63.4%), diabetes mellitus (36.6%), and chronic obstructive pulmonary disease (17.1%). Fascial closure was achieved in 40 patients (97.6%). Average hospitalization was 6.4 days (range, 1-24 days). Complications included seroma (7.3%), wound dehiscence with Strattice exposure (4.9%), cellulitis (2.4%), and hematoma (2.4%). All patients achieved abdominal wall closure with no recurrent hernias or need for Strattice removal. Patients with multiple comorbidities at intermediate risk of postoperative complications can achieve successful, safe AWR with Strattice.

Use of intraoperative indocyanin-green angiography to minimize wound healing complications in abdominal wall reconstruction.

Complication rates following abdominal wall reconstruction (AWR) remain high. Early complications are related to skin necrosis and delayed healing, whereas late complications are related to recurrence. When concomitant body contouring procedures are performed, complication rates can be further increased. It is hypothesised that fluorescent angiography using indocyanin green (ICG) can identify poorly perfused tissues and thus reduce the incidence of delayed healing. A retrospective review was conducted of all patients who underwent AWR with concomitant panniculectomy from 2007-2012. Intraoperative ICG angiography with the SPY system (LifeCell Corp.) was used to determine the amount of resection for body contouring in patients who underwent reconstruction in a cohort of patients. SPY-Q was used to assess relative perfusion of analysed areas. Preoperative, postoperative, and operative details were analyzed. Seventeen patients met inclusion criteria, 12 patients were included in the non-ICG cohort, while five patients were included in the ICG cohorts. Wound-healing complications occurred in 5/12 (42%) patients in the non-ICG cohort vs 1/5 (20%) of the ICG cohorts. A description of the sole patient with complications in the ICG cohort is illustrated. Operative debridement and wound infection development occurred more frequently in the non-ICG cohort compared with the ICG cohort (17%, 17% vs 0%, 0%, respectively). Average time to wound healing was 41.1 days. Intraoperative ICG angiography can accurately detect perfusion abnormalities and can decrease wound healing related complications in complex hernia repair with concomitant panniculectomy. Assessing and ensuring skin viability can decrease the need for operative debridement.