Outcomes of transversus abdominis release (TAR) with permanent synthetic retromuscular reinforcement for bridged repairs in massive ventral hernias: a retrospective review.
Hernia
; 24(2): 341-352, 2020 04.
Article
em En
| MEDLINE
| ID: mdl-31549325
ABSTRACT
PURPOSE:
In a subset of patients with massive and multiply recurrent hernias, despite performing a transversus abdominis release (TAR), anterior fascial re-approximation is not feasible and a bridged repair is required. We aim to report on the outcomes of this patient population at our institution.METHODS:
Patients that underwent a TAR-bridged repair at the Cleveland Clinic were identified retrospectively within the Americas Hernia Society Quality Collaborative (AHSQC) database. Outcomes of interest were quality-of-life metrics measured through HerQLes and PROMIS pain intensity 3a and composite recurrence measured by patient-reported outcomes, physical examination, or CT imaging.RESULTS:
Ninety-six patients met inclusion criteria. The mean hernia width was 26 ± 8 cm. The majority (93%) were incisional hernias and 71% were recurrent with 21% having five prior hernia repairs. Of those eligible for recurrence and QoL analysis, 54 (70%) had data points available. HerQLes scores showed a steady improvement throughout postoperative recovery (26 ± 21 at baseline, 44 ± 26 at 30-day follow-up, and 60 ± 33 at 6 months-3 years; P < 0.001), as did the PROMIS Pain Intensity 3a scores (46 ± 11 at baseline, 45 ± 11 at 30-day follow-up, and 39 ± 11 at 6 months-3 years; P = 0.001). At a mean follow-up of 20 ± 10 months, a composite recurrence of 46% was reported, primarily from patients reporting a "bulge" at the site.CONCLUSION:
Performing a bridged TAR repair with synthetic mesh in patients with complex hernias is associated with high rates of patient-reported bulge perception. Despite this, there was a significant improvement in quality-of-life metrics. When counseling these patients during preoperative evaluation, the results of our study should be shared in candor to aid in informed decision-making.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Telas Cirúrgicas
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Músculos Abdominais
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Herniorrafia
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Hérnia Incisional
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Hérnia Ventral
Tipo de estudo:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article