Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb;28(1):97-107.
doi: 10.1007/s10029-023-02856-2. Epub 2023 Aug 30.

Staged abdominal wall reconstruction in the setting of complex gastrointestinal reconstruction

C G DeLong  1 , K T Crowell  2 , A T Liu  1 , M J Deutsch  3 , J S Scow  3 , E M Pauli  4 , C M Horne  5
Affiliations

Staged abdominal wall reconstruction in the setting of complex gastrointestinal reconstruction

C G DeLong et al. Hernia. 2024 Feb.

Abstract

Purpose: Literature on one- versus two-staged abdominal wall reconstruction (AWR) with complex gastrointestinal reconstruction (GIR) is limited to single-arm case series with a focus on patients who complete all planned stages. Herein, we describe our experience with both one- and two-staged approaches to AWR/GIR, with attention to those who did not complete both intended stages.

Methods: A retrospective review of prospectively collected data was conducted to identify patients who underwent a one- or two-stage approach to GIR/AWR from 2013 to 2020. The one-stage approach included GIR and definitive sublay mesh herniorrhaphy. The two-stage approach included Stage 1 (S1)-GIR and non-definitive herniorrhaphy and Stage 2 (S2)-definitive sublay mesh herniorrhaphy.

Results: Fifty-four patients underwent GIR/AWR: 20 (37.0%) underwent a planned 1-stage operation while 34 (63.0%) underwent S1 of a planned 2-stage approach. Patients assigned to the 2-stage approach were more likely to be smokers, have a history of mesh infection, have an enterocutaneous fistula, and a contaminated wound class (p<0.05). Of the 34 patients who underwent S1, 12 (35.3%) completed S2 during the mean follow-up period of 44 months while 22 (64.7%) did not complete S2. Of these, 10 (45.5%) developed hernia recurrence but did not undergo S2 secondary to elective nonoperative management (40%), pending preoperative optimization (30%), additional complex GIR (10%), hernia-related incarceration requiring emergent surgery (10%), or unrelated death (10%). No differences in outcome including SSI, SSO, readmission, and recurrence were noted between the 12 patients who completed the two-stage approach and the 20 patients who completed a one-stage approach, despite increased risk factors for complications in the 2-stage group (p>0.05).

Conclusion: Planned two-stage operations for GIR/AWR may distribute operative complexity and post-operative morbidity into separate surgical interventions. However, many patients may never undergo the intended definitive S2 herniorrhaphy. Future evaluation of 1- versus 2-stage GIR/AWR is needed to clarify indications for each approach. This work must also consider the frequent deviations from intended clinical course demonstrated in this study.

Keywords: Gastrointestinal surgery; Hernia; Mesh; Staged repair.

PubMed Disclaimer

Comment in

References

    1. Nguyen MT, Berger RL, Hicks SC et al (2014) Comparison of outcomes of synthetic mesh vs suture repair of elective primary ventral herniorrhaphy : a systematic review and meta-analysis. JAMA Surg 149(5):415–421. https://doi.org/10.1001/jamasurg.2013.5014 - DOI - PubMed
    1. Mathes T, Walgenbach M, Siegel R (2016) Suture versus mesh repair in primary and incisional ventral hernias: a systematic review and meta-analysis. World J Surg 40(4):826–835. https://doi.org/10.1007/s00268-015-3311-2 - DOI - PubMed
    1. Majumder A, Winder JS, Wen Y, Pauli EM, Belyansky I, Novitsky YW (2016) Comparative analysis of biologic versus synthetic mesh outcomes in contaminated hernia repairs. Surg (United States) 160(4):828–838. https://doi.org/10.1016/j.surg.2016.04.041 - DOI
    1. Breuing K, Butler CE, Ferzoco S et al (2010) Incisional ventral hernias: Review of the literature and recommendations regarding the grading and technique of repair. Surgery 148(3):544–558. https://doi.org/10.1016/j.surg.2010.01.008 - DOI - PubMed
    1. Bondre IL, Holihan JL, Askenasy EP et al (2016) Suture, synthetic, or biologic in contaminated ventral hernia repair. J Surg Res 200(2):488–494. https://doi.org/10.1016/j.jss.2015.09.007 - DOI - PubMed

LinkOut - more resources