Incisional Negative-Pressure Therapy Decreases Complications in Ventral Hernia Repair with Simultaneous Panniculectomy
Silviu C. Diaconu1, Colton McNichols2, Eseigboria Ikheloa2, Stephen S. Cai2, Jhade Woodall2, Michael P. Grant1, Arthur J. Nam1, Yvonne M. Rasko2.
1R Adams Cowley Shock Trauma Center, Baltimore, MD, USA, 2University of Maryland Medical Center, Baltimore, MD, USA.
Background: Ventral hernia repair with simultaneous panniculectomy is associated with high wound complication rates.1 Some surgeons believe negative-pressure therapy (NPT) after primary closure of the surgical incision may lower wound complications. Although NPT has been shown to decrease complications in sternal and groin incisions, the benefit in ventral hernia repair is unknown and NPT in ventral hernia repair with simultaneous panniculectomy has not been studied.2-4The purpose of this study is to retrospectively analyze if patients undergoing ventral hernia repair with simultaneous panniculectomy have improved outcomes with NPT.
METHODS: An eight-year retrospective study (2007-2015) was performed on patients undergoing ventral hernia repair with panniculectomy at University of Maryland Medical Center / R Adams Cowley Shock Trauma Center. Patients who underwent ventral hernia repair with simultaneous panniculectomy and incisional negative-pressure therapy using the Prevena V.A.C system (KCI, San Antonio, Tx) were compared to patients who underwent ventral hernia repair with simultaneous panniculectomy and standard sterile dressings (SSD). Patient characteristics and post-operative complications were compared between these groups. Wound complications were defined as skin dehiscence, skin necrosis, development of chronic wound, surgical site infection, seroma, and hematoma.
RESULTS: A total of 106 patients were analyzed; 64 in the NPT group and 42 in the SSD group. The two groups were similar in terms of BMI (39±9 kg/m2 vs 37±8 kg/m2, p=0.288), gender (84% female vs 79% female, p=0.446), and smoking status (30% vs 22%, p=0.382). Patients in the NPT group were older (56 vs 50, p=0.013), had larger hernia size (120 cm2 vs 55cm2, p=0.029), were more likely to have a history of recurrent hernias (80% vs 55%, p=0.006) and required component separation at the time of VHR (80% vs 50%, p=0.001). Nevertheless, despite having higher risk factors, patients in the NPT group had less wound complications (45% vs 69%, p=0.016).
CONCLUSIONS: This study showed that incisional negative pressure therapy in ventral hernia repair with simultaneous panniculectomy decreases wound complications.
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