2016, Number 1
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Cir Plast 2016; 26 (1)
Grade 3 complex incisional hernia repair with components separation and reinforcement with synthetic mesh, biologic mesh, or rectus muscle plication
Espinosa-de-los-Monteros A, Avendaño-Peza H, Gómez-Arcive Z, Arista-de la Torre L
Language: Spanish
References: 21
Page: 19-26
PDF size: 3128.08 Kb.
ABSTRACT
In patients with large or lateral hernias, previous history of abdominal wall infection, or the presence of contamination during repair represent a higher level of complexity because special techniques and materials are required, and prognosis is worse. The purpose of this study is to evaluate post-surgery morbidity and recurrence rates on the group of patients treated with the components separation and reinforcement technique. A total of 63 patients with these characteristics were treated during five years. Of these, 21 had reinforcement with synthetic mesh, 19 with biologic mesh, nine with rectus muscle plication, and 14 were not reinforced. Twenty-one patients had previous history of abdominal wall infection but without contamination at the time of repair (3A), while 42 patients had contamination at the moment of surgery (3B). Depending on the variable studied, differences between the groups were analyzed with either Fisher’s exact test or Mann-Whitney’s U. Postoperative morbidity was 51% and 1-year recurrence-free survival was 92%. There were significantly more wound complications in malnourished patients. Subgroup 3B patients showed significantly more intra-abdominal complications and more need for synthetic mesh removal. No meshes were removed in subgroup 3A. No biologic meshes required removal in any subgroup. We conclude that the best results are achieved when synthetic mesh reinforcement is used in subgroup 3A, and when biologic mesh is used as a reinforcement in subgroup 3B.
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