Evaluation of surgical outcomes of retro-rectus versus intraperitoneal reinforcement with bio-prosthetic mesh in the repair of contaminated ventral hernias

M. J. Rosen, G. Denoto, K. M.F. Itani, Charles E. Butler, D. Vargo, J. Smiell, R. Rutan

Research output: Contribution to journalArticle

54 Scopus citations

Abstract

Introduction Hernia repairs in contaminated Welds are often reinforced with a bioprosthetic mesh. When choosing which of the multiple musculofascial abdominal wall planes provides the most durable repair, there is little guidance. We hypothesized that the retro-rectus plane would reduce recurrence rates versus intraperitoneal placement due to greater surface area contact of mesh with well-vascularized tissue. Methods Forty-nine of the 80 patients in an ongoing, prospective, multicenter study of contaminated ventral hernia repairs (RICH study, NCT00617357) achieved fascial closure after musculofascial centralization and reinforcement with non-crosslinked porcine acellular dermal matrix (Strattice, LifeCell, Branchburg, NJ) and were retrospectively analyzed. The Strattice was placed in the retro-rectus position in 23 patients and in the intraperitoneal position in 26. Results Subjects were comparable in age, obesity, prior wound infection, presence of a stoma, and infected mesh removal (p ≥ 0.05). More smokers were present in the intraperitoneal group (p = 0.02). Retro-rectus defects were signiWcantly wider and had larger area than the intraperitoneal repairs. At the 1-year follow-up, 44 (90%) of patients were available for review. There was no diVerence in wound infections, seromas, or hematomas. Recurrent hernias were identiWed in 10% of retro-rectus repairs and 30% of intraperitoneal repairs (p = 0.14). Conclusions In this retrospective analysis of a prospective multicenter study of large, contaminated ventral hernias, despite a larger hernia defect in the retro-rectus group, placement of the mesh in the retro-rectus compartment resulted in a similar recurrence rate to intraperitoneal mesh placement. Ongoing evaluation is important to establish longer-term outcomes and the validity of these Wndings.

Original languageEnglish (US)
Pages (from-to)31-35
Number of pages5
JournalHernia
Volume17
Issue number1
DOIs
StatePublished - Feb 1 2013

Keywords

  • Biologic mesh
  • Contaminated hernia repair
  • Retro-rectus mesh
  • Sublay mesh

ASJC Scopus subject areas

  • Surgery

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