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The early outcomes of complex abdominal wall reconstruction with polyvinylidene (PVDF) mesh in the setting of active infection: a prospective series

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Abstract

Purpose

The use of synthetic mesh to repair infected abdominal wall defects remains controversial. Polyvinylidene fluoride (PVDF) mesh was introduced in 2002 as an alternative to polypropylene, with the advantages of improved biostability, lowered bending stiffness, and minimum tissue response. This study aimed to evaluate the short-term outcomes of using PVDF mesh to treat infected abdominal wall defects in the elective setting.

Methods

This prospective clinical trial started in 2016 and was designed to evaluate the short- and mid-term outcomes of 38 patients submitted to abdominal wall reconstruction in the setting of active mesh infection and/or enteric fistulas (AI) when compared to a group of 38 patients submitted to clean ventral hernia repairs (CC). Patients were submitted to single-staged repairs, using onlay PVDF mesh (DynaMesh®—CICAT) reinforcement to treat their defects.

Results

Groups had comparable demographic characteristics. The AI group had more previous abdominal operations and required a longer operative and anesthesia time. At 30 days, surgical site occurrences were observed in 16 (42.1%) AI vs. 17 (44.7%) CC, p = 0.817; surgical site infection occurred in 4 (10.5%) AI vs. 6 (15.8%) CC, p = 0.497; and a higher number of procedural interventions were required in the CC group, 15.8 AI vs. 28.9% CC, p = 0.169. Both groups did not have chronic infections at 1 year of follow-up, and one hernia recurrence was observed in the AI group.

Conclusions

The use of PVDF mesh in the infected setting presented favorable results with a low incidence of wound infection.

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References

  1. Hodgkinson JD, Maeda Y, Leo CA et al (2017) Complex abdominal wall reconstruction in the setting of active infection and contamination: a systematic review of hernia and fistula recurrence rates. Colorectal Dis 19:319–330. https://doi.org/10.1111/codi.13609

    Article  CAS  PubMed  Google Scholar 

  2. Birolini C, de Miranda JS, Utiyama EM, Rasslan S (2015) A retrospective review and observations over a 16-year clinical experience on the surgical treatment of chronic mesh infection. What about replacing a synthetic mesh on the infected surgical field? Hernia 19:239–246. https://doi.org/10.1007/s10029-014-1225-9

    Article  CAS  PubMed  Google Scholar 

  3. Birolini C, de Miranda JS, Tanaka EY et al (2020) The use of synthetic mesh in contaminated and infected abdominal wall repairs: challenging the dogma-a long-term prospective clinical trial. Hernia 24:307–323. https://doi.org/10.1007/s10029-019-02035-2

    Article  CAS  PubMed  Google Scholar 

  4. Klinge U, Klosterhalfen B, Ottinger AP et al (2002) PVDF as a new polymer for the construction of surgical meshes. Biomaterials 23:3487–3493. https://doi.org/10.1016/s0142-9612(02)00070-4

    Article  CAS  PubMed  Google Scholar 

  5. Klink CD, Junge K, Binnebösel M et al (2011) Comparison of long-term biocompability of PVDF and PP meshes. J Invest Surg 24:292–299. https://doi.org/10.3109/08941939.2011.589883

    Article  CAS  PubMed  Google Scholar 

  6. Berger D, Bientzle M (2009) Polyvinylidene fluoride: a suitable mesh material for laparoscopic incisional and parastomal hernia repair! A prospective, observational study with 344 patients. Hernia 13:167–172. https://doi.org/10.1007/s10029-008-0435-4

    Article  CAS  PubMed  Google Scholar 

  7. Sommer T, Friis-Andersen H (2013) DynaMesh® in the repair of laparoscopic ventral hernia: a prospective trial. Hernia 17:613–618. https://doi.org/10.1007/s10029-013-1090-y

    Article  CAS  PubMed  Google Scholar 

  8. Barski D, Arndt C, Gerullis H et al (2017) Transvaginal PVDF-mesh for cystocele repair: a cohort study. Int J Surg 39:249–254. https://doi.org/10.1016/j.ijsu.2017.02.006

    Article  PubMed  Google Scholar 

  9. Alemrajabi M, Darabi B, Banivaheb B et al (2020) Polyvinylidene fluoride mesh use in laparoscopic ventral mesh rectopexy in patients with obstructive defecation syndrome for the first time. J Invest Surg 1–6. https://doi.org/10.1080/08941939.2020.1767734

  10. Sánchez-Arteaga A, Tallón-Aguilar L, Tinoco-González J et al (2021) Use of polyvinylidene fluoride (PVDF) meshes for ventral hernia repair in emergency surgery. Hernia 25:99–106. https://doi.org/10.1007/s10029-020-02209-3

    Article  PubMed  Google Scholar 

  11. Garner JS (1986) CDC guideline for prevention of surgical wound infections, 1985. Supersedes guideline for prevention of surgical wound infections published in 1982. (Originally published in November 1985). Revised. Infect Control 7:193–200

    Article  CAS  PubMed  Google Scholar 

  12. Muysoms F, Campanelli G, Champault GG et al (2012) EuraHS: the development of an international online platform for registration and outcome measurement of ventral abdominal wall hernia repair. Hernia 16:239–250. https://doi.org/10.1007/s10029-012-0912-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Tanaka EY, Yoo JH, Rodrigues AJ et al (2010) A computerized tomography scan method for calculating the hernia sac and abdominal cavity volume in complex large incisional hernia with loss of domain. Hernia 14:63–69. https://doi.org/10.1007/s10029-009-0560-8

    Article  CAS  PubMed  Google Scholar 

  14. Haskins IN, Horne CM, Krpata DM et al (2018) A call for standardization of wound events reporting following ventral hernia repair. Hernia 22:729–736. https://doi.org/10.1007/s10029-018-1748-6

    Article  CAS  PubMed  Google Scholar 

  15. Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae

    Article  PubMed  PubMed Central  Google Scholar 

  16. Shubinets V, Carney MJ, Colen DL et al (2018) Management of infected mesh after abdominal hernia repair: systematic review and single-institution experience. Ann Plast Surg 80:145–153. https://doi.org/10.1097/SAP.0000000000001189

    Article  CAS  PubMed  Google Scholar 

  17. Warren J, Desai SS, Boswell ND et al (2020) Safety and efficacy of synthetic mesh for ventral hernia repair in a contaminated field. J Am Coll Surg 230:405–413. https://doi.org/10.1016/j.jamcollsurg.2019.12.008

    Article  PubMed  Google Scholar 

  18. Rosen MJ, Krpata DM, Petro CC et al (2022) Biologic vs synthetic mesh for single-stage repair of contaminated ventral hernias: a randomized clinical trial. JAMA Surg 157:293–301. https://doi.org/10.1001/jamasurg.2021.6902

    Article  PubMed  Google Scholar 

  19. Majumder A, Winder JS, Wen Y et al (2016) Comparative analysis of biologic versus synthetic mesh outcomes in contaminated hernia repairs. Surgery 160:828–838. https://doi.org/10.1016/j.surg.2016.04.041

    Article  PubMed  Google Scholar 

  20. Lee L, Mata J, Landry T et al (2014) A systematic review of synthetic and biologic materials for abdominal wall reinforcement in contaminated fields. Surg Endosc 28:2531–2546. https://doi.org/10.1007/s00464-014-3499-5

    Article  PubMed  Google Scholar 

  21. Atema JJ, de Vries FEE, Boermeester MA (2016) Systematic review and meta-analysis of the repair of potentially contaminated and contaminated abdominal wall defects. Am J Surg 212:982-995.e1. https://doi.org/10.1016/j.amjsurg.2016.05.003

    Article  PubMed  Google Scholar 

  22. Sadava EE, Bras Harriott C, Angeramo CA, Schlottmann F (2021) Synthetic mesh in contaminated abdominal wall surgery: friend or foe? A literature review. J Gastrointest Surg. https://doi.org/10.1007/s11605-021-05155-2

    Article  PubMed  Google Scholar 

  23. Köckerling F, Alam NN, Antoniou SA et al (2018) What is the evidence for the use of biologic or biosynthetic meshes in abdominal wall reconstruction? Hernia 22:249–269. https://doi.org/10.1007/s10029-018-1735-y

    Article  PubMed  PubMed Central  Google Scholar 

  24. Carbonell AM, Criss CN, Cobb WS et al (2013) Outcomes of synthetic mesh in contaminated ventral hernia repairs. J Am Coll Surg 217:991–998. https://doi.org/10.1016/j.jamcollsurg.2013.07.382

    Article  PubMed  Google Scholar 

  25. Laroche G, Marois Y, Schwarz E et al (1995) Polyvinylidene fluoride monofilament sutures: can they be used safely for long-term anastomoses in the thoracic aorta? Artif Organs 19:1190–1199. https://doi.org/10.1111/j.1525-1594.1995.tb02282.x

    Article  CAS  PubMed  Google Scholar 

  26. Conze J, Junge K, Weiss C et al (2008) New polymer for intra-abdominal meshes–PVDF copolymer. J Biomed Mater Res Part B Appl Biomater 87:321–328. https://doi.org/10.1002/jbm.b.31106

    Article  CAS  Google Scholar 

  27. Kallinowski F, Baumann E, Harder F et al (2015) Dynamic intermittent strain can rapidly impair ventral hernia repair. J Biomech 48:4026–4036. https://doi.org/10.1016/j.jbiomech.2015.09.045

    Article  PubMed  Google Scholar 

  28. Groene SA, Prasad T, Lincourt AE et al (2016) Prospective, multi-institutional surgical and quality-of-life outcomes comparison of heavyweight, midweight, and lightweight mesh in open ventral hernia repair. Am J Surg 212:1054–1062. https://doi.org/10.1016/j.amjsurg.2016.09.003

    Article  PubMed  Google Scholar 

  29. Bakker WJ, Aufenacker TJ, Boschman JS, Burgmans JPJ (2021) Heavyweight mesh is superior to lightweight mesh in laparo-endoscopic inguinal hernia repair: a meta-analysis and trial sequential analysis of randomized controlled trials. Ann Surg 273:890–899. https://doi.org/10.1097/SLA.0000000000003831

    Article  PubMed  Google Scholar 

  30. Birolini C, Utiyama EM, Rodrigues AJ, Birolini D (2000) Elective colonic operation and prosthetic repair of incisional hernia: does contamination contraindicate abdominal wall prosthesis use? J Am Coll Surg 191:366–372. https://doi.org/10.1016/s1072-7515(00)00703-1

    Article  CAS  PubMed  Google Scholar 

  31. Lima HVG, Rasslan R, Novo FCF et al (2020) Prevention of fascial dehiscence with onlay prophylactic mesh in emergency laparotomy: a randomized clinical trial. J Am Coll Surg 230:76–87. https://doi.org/10.1016/j.jamcollsurg.2019.09.010

    Article  PubMed  Google Scholar 

  32. Dilek ON, Güler O, Güler AA et al (2001) Prophylactic appendectomy: is it worth to be done? Acta Chir Belg 101:65–67

    Article  CAS  PubMed  Google Scholar 

  33. Newhall K, Albright B, Tosteson A et al (2017) Cost-effectiveness of prophylactic appendectomy: a Markov model. Surg Endosc 31:3596–3604. https://doi.org/10.1007/s00464-016-5391-y

    Article  PubMed  Google Scholar 

  34. AlMarzooqi R, Tish S, Tastaldi L et al (2021) Is concomitant cholecystectomy safe during abdominal wall reconstruction? An AHSQC analysis. Hernia 25:295–303. https://doi.org/10.1007/s10029-020-02208-4

    Article  CAS  PubMed  Google Scholar 

  35. Arnold MR, Kao AM, Gbozah KK et al (2018) Optimal management of mesh infection: evidence and treatment options. Int J Abdom wall Hernia Surg 1:42–49

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. General and Trauma Surgery, Abdominal Wall and Hernia Repair Unit, Hospital das Clinicas, Department of Surgery, University of São Paulo School of Medicine, Avenida Dr. Enéas Carvalho de Aguiar, 255, 05403-010, São Paulo, Brazil

    Claudio Birolini, Eduardo Yassushi Tanaka, Jocielle Santos de Miranda, Abel Hiroshi Murakami, Sergio Henrique Bastos Damous & Edivaldo Massazo Utiyama

Authors
  1. Claudio Birolini
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  2. Eduardo Yassushi Tanaka
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  3. Jocielle Santos de Miranda
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  4. Abel Hiroshi Murakami
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  5. Sergio Henrique Bastos Damous
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  6. Edivaldo Massazo Utiyama
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Contributions

Study conception and design: CB, EYT. Acquisition of data: CB, YET, JSM, AHM. Analysis and interpretation of data: CB, YET, EMU. Drafting of the manuscript: CB. Critical revision of the manuscript: SHBD, EMU.

Corresponding author

Correspondence to Claudio Birolini.

Ethics declarations

Mesh samples were provided by the manufacturer (FEG Textiltechnik, Aachen, Germany) at no cost.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare no competing interests.

Study registration

Plataforma Brasil (www.plataformabrasil.saude.gov.br/login.jsf), CAAE 52383615.0.0000.0068, Identifier 1.412.367

Clinical Trials, registration ID NCT05061264

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Birolini, C., Tanaka, E.Y., de Miranda, J.S. et al. The early outcomes of complex abdominal wall reconstruction with polyvinylidene (PVDF) mesh in the setting of active infection: a prospective series. Langenbecks Arch Surg 407, 3089–3099 (2022). https://doi.org/10.1007/s00423-022-02625-2

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