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. 2018 Aug 2;2(6):464-469.
doi: 10.1002/bjs5.93. eCollection 2018 Dec.

Biological mesh is a safe and effective method of abdominal wall reconstruction in cytoreductive surgery for peritoneal malignancy

A Tzivanakis  1 , S P Dayal  1 , S J Arnold  1 , F Mohamed  1 , T D Cecil  1 , A K Venkatasubramaniam  1 , B J Moran  1
Affiliations

Biological mesh is a safe and effective method of abdominal wall reconstruction in cytoreductive surgery for peritoneal malignancy

A Tzivanakis et al. BJS Open. .

Abstract

Background: Patients with peritoneal malignancy often have multiple laparotomies before referral for cytoreductive surgery (CRS). Some have substantial abdominal wall herniation and tumour infiltration of abdominal incisions. CRS involves complete macroscopic tumour removal and hyperthermic intraperitoneal chemotherapy (HIPEC). Abdominal wall reconstruction is problematic in these patients. The aim of this study was to establish immediate and long-term outcomes of abdominal wall reconstruction with biological mesh in a single centre.

Methods: A dedicated peritoneal malignancy database was searched for all patients who had biological mesh abdominal wall reconstruction between 2004 and 2015. Short- and long-term outcomes were reviewed. All patients had annual abdominal CT as routine peritoneal malignancy follow-up.

Results: Some 33 patients (22 women) with a mean age of 53·4 (range 19-82) years underwent abdominal wall reconstruction with biological mesh. The majority (23) had CRS for pseudomyxoma (19 low grade), six for colorectal peritoneal metastasis and four for appendiceal adenocarcinoma; 18 had undergone CRS and HIPEC previously. Twenty-five of the 33 patients had abdominal wall tumour involvement and eight had concurrent hernias. The mean duration of surgery was 486 (range 120-795) min and the mean mesh size used was 345 (50-654) cm2. Ten patients developed wound infections and four had a seroma. Two developed early enterocutaneous fistulas. Mean follow-up was 48 months. Five patients developed an incisional hernia. Four died from progressive malignancy. A further 15 patients had disease recurrence, but only one had isolated abdominal wall recurrence.

Conclusion: Biological mesh was safe and effective for abdominal wall reconstruction in peritoneal malignancy. Postoperative wound infections were frequent but nevertheless incisional hernia rates were low with no instances of mesh-related bowel erosion or fistulation.

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Figures

Figure 1
Figure 1
CT images demonstrating a abdominal wall infiltration by tumour (red arrow) and b incisional hernia with disease within hernia sac (yellow arrow)
Figure 2
Figure 2
Extensive abdominal wall excision with reconstruction using biological mesh: a abdominal wall excision to achieve complete cytoreduction, b residual large abdominal wall defect and c abdominal wall reconstruction using biological mesh
Figure 3
Figure 3
Images from a patient with an infected seroma that was debrided surgically: a at presentation, b 3 months, c 6 months and d 6 years after surgery
See this image and copyright information in PMC

References

    1. Mohamed F, Cecil T, Moran B, Sugarbaker P. A new standard of care for the management of peritoneal surface malignancy. Curr Oncol 2011; 18: e84–e96. - PMC - PubMed
    1. Moran BJ, Cecil TD. Treatment of surgically resectable colorectal peritoneal metastases. Br J Surg 2014; 101: 5–7. - PubMed
    1. Elias D, Goéré D, Dumont F, Honoré C, Dartigues P, Stoclin A et al Role of hyperthermic intraoperative peritoneal chemotherapy in the management of peritoneal metastases. Eur J Cancer 2014; 50: 332–340. - PubMed
    1. Youssef H, Newman C, Chandrakumaran K, Mohamed F, Cecil TD, Moran BJ. Operative findings, early complications, and long‐term survival in 456 patients with pseudomyxoma peritonei syndrome of appendiceal origin. Dis Colon Rectum 2011; 54: 293–299. - PubMed
    1. Moran B, Baratti D, Yan TD, Kusamura S, Deraco M. Consensus statement on the loco‐regional treatment of appendiceal mucinous neoplasms with peritoneal dissemination (pseudomyxoma peritonei). J Surg Oncol 2008; 98: 277–282. - PubMed