TY - JOUR
T1 - Repair of massive ventral hernias with “quilted” mesh
AU - Posielski, N. M.
AU - Yee, S. T.
AU - Majumder, A.
AU - Orenstein, S. B.
AU - Prabhu, A. S.
AU - Novitsky, Y. W.
N1 - Publisher Copyright:
© 2015, Springer-Verlag France.
PY - 2015/6/1
Y1 - 2015/6/1
N2 - Introduction: Prosthetic reinforcement is a critical component of hernia repair. For massive defects, mesh overlap is often limited by the dimensions of commercially available implants. In scenarios where larger mesh prosthetics are required for adequate reinforcement, it may be necessary to join several pieces of mesh together using non-absorbable suture. Here, we report our outcomes for abdominal wall reconstructions in which “quilted” mesh was utilized for fascial reinforcement. Methods: Patients undergoing open incisional hernia repair utilizing posterior component separation and transversus abdominis muscle release, with use of quilted synthetic mesh placed in the retromuscular position, were reviewed. Main outcome measures included patient, hernia, and operative characteristics and post-operative outcomes, including surgical site occurrence (SSO), surgical site infection (SSI), and recurrence. Results: Thirty-two patients (mean age 55.7 ± 9.3, BMI 38.3 ± 5.8 kg/m2) underwent open ventral hernia repair with “quilted” mesh placed in the retromuscular position. The mean defect area was 760.1 ± 311.0 cm2 with a mean width of 24.7 ± 6.4 cm. Quilted meshes consisted of two-piece (69 %), three-piece (19 %) and four-piece (12 %) configurations. Wound morbidity consisted of eight (25 %) SSOs, including four (13 %) SSIs, all of which resolved without mesh excision. With mean follow-up of 9.0 ± 13.6 months, there were two (6.3 %) lateral recurrences, both unassociated with mesh-to-mesh suture line failure. Conclusions: Massive ventral hernias that require giant mesh prosthetics, currently not commercially available, may be successfully repaired using multiple mesh pieces sewn together in a quilt-like fashion. Such retromuscular repairs are durable, without added morbidity due to the mesh-to-mesh suture line. However, additional operative time is required for quilting the mesh together, prompting strong calls for manufacturing of larger mesh prosthetics.
AB - Introduction: Prosthetic reinforcement is a critical component of hernia repair. For massive defects, mesh overlap is often limited by the dimensions of commercially available implants. In scenarios where larger mesh prosthetics are required for adequate reinforcement, it may be necessary to join several pieces of mesh together using non-absorbable suture. Here, we report our outcomes for abdominal wall reconstructions in which “quilted” mesh was utilized for fascial reinforcement. Methods: Patients undergoing open incisional hernia repair utilizing posterior component separation and transversus abdominis muscle release, with use of quilted synthetic mesh placed in the retromuscular position, were reviewed. Main outcome measures included patient, hernia, and operative characteristics and post-operative outcomes, including surgical site occurrence (SSO), surgical site infection (SSI), and recurrence. Results: Thirty-two patients (mean age 55.7 ± 9.3, BMI 38.3 ± 5.8 kg/m2) underwent open ventral hernia repair with “quilted” mesh placed in the retromuscular position. The mean defect area was 760.1 ± 311.0 cm2 with a mean width of 24.7 ± 6.4 cm. Quilted meshes consisted of two-piece (69 %), three-piece (19 %) and four-piece (12 %) configurations. Wound morbidity consisted of eight (25 %) SSOs, including four (13 %) SSIs, all of which resolved without mesh excision. With mean follow-up of 9.0 ± 13.6 months, there were two (6.3 %) lateral recurrences, both unassociated with mesh-to-mesh suture line failure. Conclusions: Massive ventral hernias that require giant mesh prosthetics, currently not commercially available, may be successfully repaired using multiple mesh pieces sewn together in a quilt-like fashion. Such retromuscular repairs are durable, without added morbidity due to the mesh-to-mesh suture line. However, additional operative time is required for quilting the mesh together, prompting strong calls for manufacturing of larger mesh prosthetics.
KW - AWR
KW - Abdominal wall reconstruction
KW - Herniorrhaphy
KW - Incisional hernia
KW - Quilted mesh
KW - TAR
KW - Ventral hernia repair
UR - http://www.scopus.com/inward/record.url?scp=84930085182&partnerID=8YFLogxK
U2 - 10.1007/s10029-015-1375-4
DO - 10.1007/s10029-015-1375-4
M3 - Article
C2 - 25854510
AN - SCOPUS:84930085182
SN - 1265-4906
VL - 19
SP - 465
EP - 472
JO - Hernia
JF - Hernia
IS - 3
ER -