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Complex Abdominal Wall Reconstruction: A Review of Outcomes
Cathy Henry, MD, Kurtis Moyer, MD, Eric Bradburn, DO.
Penn State Hershey Medical Center, Hershey, PA, USA.

Background:Complex abdominal wall reconstruction (AWR) addresses recurrent ventral hernias occurring in patients with multiple previous abdominal surgeries associated with morbid obesity, diabetes, and a history of tobacco use. Reconstruction of these complex abdominal wall defects is challenging. Repair techniques are numerous and include primary repair, separation of components (SOC), and use of various biologic and synthetic meshes. In recurrent cases where there is often significant risk of contamination or wound dehiscence, biologic mesh has become popular in AWR as a reinforcement of the repair.
Objective: This review examines outcomes in patients undergoing AWR with various techniques including the use of commercially available biologic meshes in an attempt to provide a safe, reliable and cost effective approach to these difficult patients.
Methods: We provide a retrospective review of complex AWR performed by two surgeons at a single institution from July 2008 to October of 2011. Chart review identified demographic information, the type of repair performed and complication rates. For this study we look specifically at the outcome differences for primary repair utilizing SOC with and without mesh reinforcement, specifically addressing SOC with an acellular dermis inlay, primary repair with either underlay or overlay mesh, and patients in whom primary fascia closure could not be obtained and an interposition biologic mesh was used.
Results: A total of 66 patients were identified. The average BMI in this population was 35.5. The average age was 53.7, with 62% females and 38% males. The overall rate of tobacco use (past and present) was 48%. Twenty-eight percent were diabetic. The overall hernia recurrence rate was 16% (11 out of 66). Patients having separation of components with inlay mesh (n=22) had a hernia recurrence rate of 9% (2 patients). Both of the recurrences utilized a human acellular dermis. The remainder of the repairs utilized a porcine dermal mesh. Hernia recurrence in those with primary fascial repair with or without SOC and biologic mesh reinforcement as an underlay or onlay is 12% (3 out of 25). Hernia recurrence in those with primary fascia closure using SOC without mesh reinforcement is 22% (2 out of 9). Hernia recurrence for those without primary fascia repair and use of a biologic mesh interposition is 40% (4 out of 10).
Conclusion: The results of this review show that hernia recurrence rates are decreased when primary fascia repair can be achieved. Further reduction occurs when mesh reinforcement is utilized. The lowest recurrence rates were seen in the group with SOC and a porcine biologic mesh inlay. Although the small sample size precludes identifying statistical significance (p>0.05), the data shown here trends towards significant reduction in hernia recurrence rates when utilizing these methods in AWR.


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