Abdominal Wall Reconstruction Utilizing the Combination of Absorbable and Permanent Mesh in a Retromuscular Position: A Multicenter Prospective Study.
Author: García Ureña, Miguel Ángel; López Monclús, Javier; Cuccurullo, Diego; Blázquez Hernando, Luis Alberto; García Pastor, Providencia; Reggio, Stefano; Jiménez Cubedo, Elena; San Miguel Méndez, Carlos; Cruz Cidoncha, Arturo; Robin Valle de Lersundi, Álvaro
Abstract: Background Optimal mesh reinforcement for abdominal wall reconstruction (AWR) in complex hernias remains
questionable. Use of biologic, absorbable and synthetic meshes has been described. The idea of using an absorbable
mesh (AM) under a permanent mesh (PM) in a retromuscular position may help in these challenging situations.
Methods Between 2011 and 2016, consecutive patients undergoing open AWR utilizing an AM as posterior layer
reinforcement and configuration of a large PM were identified in a multicenter prospectively maintained database in
four hospitals. Main outcomes included demographics, ventral hernia classifications, perioperative data, complications and recurrences.
Results A total of 169 complex incisional hernias were analyzed. Mean age was 60.9, with mean body mass index
30.7 (range: 20–46). Location of incisional hernias (IH) was: 80 midline, 59 lateral and 30 midline and lateral. 78%
were grade I and II in Ventral Hernia Working Group classification. 52% of patients were discharged with no
complication. There were 19% seromas, 13% hematomas, 12% surgical-site infection and 10% skin dehiscence. Only
partial mesh removal was necessary in one patient. After a mean follow-up of 26 months (range 15–59), there were
five (3.2%) recurrences. Reoperations on patients showed a band of fibrosis separating the peritoneum from the PM.
Conclusion The combination of AM with very large PM in the same retromuscular position in AWR seems to be
safe. The efficacy with recurrence rates below 4% in complex midline and lateral IH may be explained by the use of
larger PMs that are extended and configured with the support of AMs. Reoperations on patients have confirmed the
previous experimental reports on the use of the AM.
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