Absorbable mesh in a contaminated field: hernia repair outcomes

Abstract

Hernia repair mesh aids in the stability of incisional hernia repair and can reduce the need for subsequent operations. There is, however, debate among surgeons over which type of hernia mesh-synthetics, biologics, or biosynthetics-is indicated as best for specific patients. A retrospective case review comparing surgical outcomes based on wound class and mesh materials may provide insights into this question. This study evaluates patient outcomes using biosynthetic mesh based upon CDC wound classification. Following Institutional Review Board approval, the local National Surgery Quality Improvement (NSQIP) databases were queried for open ventral hernia repaired with absorbable mesh implants from January 2013-December 2017. Factors for comparison included patient demographics, operative details, and an analysis of clinical outcomes. Our study identified 112 ventral hernia repair cases with absorbable mesh placement, 32% (n = 36) were wound classes II-IV. Higher wound class correlated statistically with diabetes (33.3%), prior hernia repair (61.1%), and parastomal hernia (44.4%). Higher wound classes were associated with more emergent presentations, involved bowel resection more frequently, required larger mesh implants, increased post-operative surgical site infections, and wound disruption. Increasing wound class was also associated with longer hospital stays and greater need for readmission (38.9% vs. 11.8%). Compared to patients with clean wounds, biosynethic mesh repair patients with contaminated wounds exhibited more emergent presentations, increased incidence of bowel resection, increased mesh size, and more readmissions. Despite these peri-operative outcomes, hernia recurrence rates among biosynethic mesh hernia repair were similar in CDC class II-IV patients as class I.

Keywords: Biosynthetic mesh; Hernia repair; Incisional hernias; Wound care.