M. Bobbs1, N. Kugler1, T. Webb1, J. S. Paul1 1Medical College Of Wisconsin,Milwaukee, WI, USA
Introduction: The Modified Hernia Grade System (MHGS) was developed to risk stratify complex ventral hernia repairs. MHGS Grade 3 patients have mesh infections, dirty or contaminated fields, and/or violation of the alimentary tract. Reported surgical site infection rates (SSI) are over 40% following single-stage ventral hernia repair in contaminated fields. We developed a dual-stage (DSVHR) approach for MHGS Grade 3 patients to decrease the SSI and recurrence rates.
Methods: Retrospective review of adult general surgery patients undergoing DSVHR between January 2010 and June 2014. All patients were MHGS Grade 3. Primary endpoint was 30-day superficial and deep SSI. Secondary endpoints included other surgical site occurrences (SSO), 6-month recurrence, and mesh excision rates.
Results:Fifteen patients underwent DSVHR. Mean age was 56 years and median BMI of 38.3 kg/m2. Operative indication included ECF (n=6), ECF with infected mesh (n=2), infected mesh (n=2), and ventral hernia repair requiring bowel resection (n=5). Thirty-one operative procedures were performed with median of 2.5 days between procedures. Midline was re-established in 12 patients; five patients had underlay biologic mesh placement; seven underwent component separation with retrorectus mesh placement [synthetic (n=2), biologic (n=5)]. The remaining patients underwent bridging repair with biologic mesh. One patient developed recurrence after 6 months. One patient had a recurrence of their ECF. Four (27%) patients developed a SSI, four (27%) had a SSO. There were no post-operative mesh infections.
Conclusion: DSVHR in MHGS Grade 3 patients is associated with a lower surgical site infection rate than previously reported for those undergoing single stage repairs.