A dual-stage approach to contaminated, high-risk ventral hernia repairs

详细信息    查看全文

• 作者：Nathan W. Kugler ; MD ; ^{nkugler@mcw.edu" class="auth_mail" title="E-mail the corresponding author} ; Melanie Bobbs ; BS ; Travis Webb ; MD ; Thomas W. Carver ; MD ; David Milia ; MD ; Jasmeet S. Paul ; MD
• 关键词：Ventral hernia repair ; Ventral hernia ; Hernia ; Contaminated ; Dirty ; Infected ; High-risk ; Surgical site infection
• 刊名：Journal of Surgical Research
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：204
• 期：1
• 页码：200-204
• 全文大小：237 K

文摘

The Modified Hernia Grading System (MHGS) was developed to risk stratify complex ventral hernia repairs (VHRs). MHGS grade 3 patients have mesh infections, dirty or contaminated fields, and/or violation of the alimentary tract. Reported surgical site infection (SSI) rates are over 40% after single-stage VHR in contaminated fields. In an attempt to decrease the SSI rate in MHGS grade 3 patients, we developed a dual-stage VHR (DSVHR) approach.

Methods

We reviewed adult general surgery patients undergoing DSVHR between January 2010 and June 2014. All patients were MHGS grade 3. Primary end point was 30-d superficial and deep SSI. Secondary end points included other surgical site occurrences, 6-mo recurrence, and mesh excision rates.

Results

Fifteen patients underwent DSVHR. Mean age was 56 y, and median body mass index was 38.3 kg/m². Operative indication included enterocutaneous fistulas (ECF; n = 6), ECF with infected mesh (n = 2), infected mesh (n = 2), and VHR requiring bowel resection (n = 5). Thirty-one operative procedures were performed with median of 2.5 d between procedures. Fascial closure was re-established in 12 patients; five patients had underlay biologic mesh placement; seven underwent component separation with retrorectus mesh placement (synthetic [n = 2], biologic [n = 5]). The remaining patients underwent bridging repair with biologic mesh. One patient developed a recurrence after 6 mo, whereas a single patient had a recurrence of their ECF. Four (27%) patients developed a SSI, with an additional four (27%) experiencing a surgical site occurrence. There were no postoperative mesh infections.

Conclusions

DSVHR in MHGS grade 3 patients is associated with a lower SSI rate than previously reported for those undergoing single-stage repairs.