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Surgical treatment of large incisional hernias with intraperitoneal composite mesh: a cohort study

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Abstract

Purpose

Patients with large incisional hernias have significant morbidity and their management is a challenge for the surgical team because of the large abdominal wall involvement. The choice of surgical technique is still controversial. The purpose of this study is to analyze the predictive factors for recurrence after intraperitoneal mesh repair in patients with large incisional hernias.

Methods

A retrospective cohort observational study with a prospectively collected database was performed in the Hospital Clinico San Carlos (Madrid, Spain). All consecutive patients operated on from January 2009 to December 2014 with incisional hernia of 10 or more centimeters in its transverse diameter were included. An intraperitoneal repair with a composite mesh fixed with discontinuous absorbable suture and fibrin sealant was performed. Demographic data, comorbidities, and early and long term outcomes were analyzed. The primary outcome was the presence of recurrence.

Results

One hundred and twenty patients were included. Mean age was 63.3 years (SD 12.9) and sex ratio was 1.4:1. Seventy-two patients (60%) were ASA III–IV. Forty-five patients (37.5%) had recurrent ventral hernias. Mean defect size was 14.7 cm (SD 3.21) of width. Overall postoperative morbidity rate was 25%. Median hospital stay was 6 days (IQR 4–8). Recurrence rate was 8.3%, after a median follow-up of 16 months (IQR 10–25). Multivariate analysis showed significant association between ASA III–IV, use of Composix Kugel™ mesh, superficial surgical site infection, and the presence of recurrence.

Conclusions

The recurrence rate after intraperitoneal mesh repair in patients with large incisional hernias might be associated with ASA III–IV, use of Composix Kugel™ mesh, and superficial surgical site infection.

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Authors and Affiliations

  1. Surgery Department, Hospital Clinico San Carlos, Universidad Complutense de Madrid, Calle Profesor Martin Lagos s/n, 28040, Madrid, Spain

    B. Lasses Martínez, M. J. Peña Soria, J. J. Cabeza Gómez, D. Jiménez Valladolid, M. Flores Gamarra, A. Torres García & I. Delgado Lillo

  2. Preventive Medicine Department, Hospital Clinico San Carlos, Universidad Complutense de Madrid, Calle Profesor Martin Lagos s/n, 28040, Madrid, Spain

    C. Fernández Pérez

Authors
  1. B. Lasses Martínez
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  2. M. J. Peña Soria
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  3. J. J. Cabeza Gómez
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  4. D. Jiménez Valladolid
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  5. M. Flores Gamarra
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  6. C. Fernández Pérez
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  7. A. Torres García
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  8. I. Delgado Lillo
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Corresponding author

Correspondence to B. Lasses Martínez.

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Conflict of interest

Lasses Martínez B, Peña Soria MJ, Cabeza Gómez JJ, Jiménez Valladolid D, Flores Gamarra M, Fernández Pérez C, Torres García A and Delgado Lillo I, declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Lasses Martínez, B., Peña Soria, M.J., Cabeza Gómez, J.J. et al. Surgical treatment of large incisional hernias with intraperitoneal composite mesh: a cohort study. Hernia 21, 253–260 (2017). https://doi.org/10.1007/s10029-016-1557-8

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  • DOI: https://doi.org/10.1007/s10029-016-1557-8

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