I. L. Bondre1, J. L. Holihan1, E. P. Askenasy2, J. A. Greenberg3, J. Keith6, R. G. Martindale5, J. S. Roth4, C. J. Wray1, L. S. Kao1, M. K. Liang1 1University Of Texas Health Science Center At Houston,Houston, TX, USA 2Baylor College Of Medicine,Houston, TX, USA 3University Of Wisconsin,Madison, WI, USA 4University Of Kentucky,Lexington, KY, USA 5Oregon Health And Science University,Portland, OR, USA 6University Of Iowa,Iowa City, IA, USA
Introduction:
While there is little controversy regarding the improved outcomes associated with mesh use in uncomplicated ventral hernia repair(VHR), data is lacking to support the choice between suture, light-weight synthetic mesh, or biologic mesh in contaminated VHR. We hypothesize that in contaminated VHR, suture repair is associated with a lower rate of surgical site infection (SSI) and a higher rate of hernia recurrence compared to light-weight synthetic and biologic mesh.
Methods:
We reviewed a multi-center, retrospective database of all open VHR performed at seven institutions between 2010-2011. All patients with a Centers for Disease Control and Prevention (CDC) wound classification of II-III were included. The primary outcome was SSI as defined by the CDC. The secondary outcome was hernia recurrence (assessed clinically and radiographically). Multivariable analysis using stepwise regression was performed including variables selected a priori (ASA, BMI, current smoking, acute, primary versus incisional hernia, prior hernia repair, wound class II or III, fascial release, fascial closure, repair technique-suture or light-weight mesh or biologic mesh, and follow-up duration). Inverse probability weighting (which corrects for selection bias and missing data) was also performed adjusting for the listed variables as well as defect size and institution.
Results:
204 contaminated VHRs were reviewed for a median follow-up of 12.8 months (range 1-49); there were 72(35%) suture, 66(32%) light-weight synthetic mesh, and 66(32%) biologic mesh repairs. On univariate analysis, there were differences in the three groups including institution, ASA score, prior hernia repair, wound class, size, and fascial release. The unadjusted outcomes of SSI (9.7%,18.2%,12.1%;p=0.32) and recurrence (26.4%,13.6%,19.7%;p=0.17) were not statistically different between the groups. On multivariable analysis, repair technique was not associated with SSI but did impact recurrence (Table). Using inverse probability weighting, there was no difference in SSI between the study groups. The rate of recurrence for suture repair was 38.6%; synthetic mesh reduced the recurrence rate to 8.8% (CI2.5-15.2%) while biologic mesh had no impact (31.8%,CI9.9%-53.7%).
Conclusion:
In contaminated ventral hernias, mesh repair (lightweight synthetic or biologic) compared to suture repair, does not increase the surgical site infection rate but may decrease the recurrence rate. While we attempted to risk-adjust our outcomes, this study is limited by selection bias and its retrospective nature. In the absence of higher level data, the results of this multi-center study suggest that light-weight synthetic mesh may be a safe choice in contaminated ventral hernia repair.
