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Complex ventral hernia repair with a human acellular dermal matrix and component separation: A case series.

Garcia A, Baldoni A - Ann Med Surg (Lond) (2015)

Bottom Line: Post-operative complications included 2 adverse events (11%) - one pulmonary embolism and one post-operative hemorrhage requiring transfusion; 6 wound-related complications (32%), 1 seroma (5%) and 1 patient with post-operative ileus (5%).At a median 2-year follow-up, three patients had a documented hernia recurrence (16%) and one patient was deceased due to unrelated causes.Anticipated post-operative complications were managed conservatively and at a median 2-year follow-up, a low rate of hernia recurrence was observed with this approach.

View Article: PubMed Central - PubMed

Affiliation: General Surgery and Abdominal Wall Reconstruction Center of South Florida, 17900 NW 5th St., Suite 201, Pembroke Pines, FL 33029, USA.

ABSTRACT

Unlabelled: We present a case series of 19 patients requiring complex abdominal hernia repairs. Patients presented with challenging clinical histories with 95% having multiple significant comorbidities including overweight or obesity (84%), hypertension (53%), diabetes (42%), cancer (26%), and pulmonary disease (16%). The majority of patients (68%) had prior abdominal infections and 53% had at least one failed prior hernia repair. Upon examination, fascial defects averaged 282 cm(2). Anterior and posterior component separation was performed with placement of a human acellular dermal mesh. Midline abdominal closure under minimal tension was achieved primarily in all cases. Post-operative complications included 2 adverse events (11%) - one pulmonary embolism and one post-operative hemorrhage requiring transfusion; 6 wound-related complications (32%), 1 seroma (5%) and 1 patient with post-operative ileus (5%). Operative intervention was not required in any of the cases and most patients made an uneventful recovery. Increased patient age and longer OR time were independently predictive of early post-operative complications. At a median 2-year follow-up, three patients had a documented hernia recurrence (16%) and one patient was deceased due to unrelated causes.

Conclusion: Patients at high risk for post-operative events due to comorbidities, prior abdominal infection and failed mesh repairs do well following component separation reinforced with a human bioprosthetic mesh. Anticipated post-operative complications were managed conservatively and at a median 2-year follow-up, a low rate of hernia recurrence was observed with this approach.

No MeSH data available.


Related in: MedlinePlus

Intraperitoneal placement of human acellular dermal matrix: this figure shows the U-stitch that is placed through the abdominal wall to the mesh and back to the abdominal wall (see arrow).
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fig3: Intraperitoneal placement of human acellular dermal matrix: this figure shows the U-stitch that is placed through the abdominal wall to the mesh and back to the abdominal wall (see arrow).

Mentions: Bilateral anterior component separation (Fig. 1) with intraperitoneal placement of a non-crosslinked human acellular dermal biologic mesh (FlexHD, Musculoskeletal Transplant Foundation, Edison, NJ) and midline closure was performed in the first 15 cases. The mesh, placed as an intraperitoneal underlay was prepared by delineating the four quadrants prior to implantation (Fig. 2). Using 1.0 PDS suture (Ethicon, Somerville, NJ), the mesh was secured to the anterior abdominal wall with interrupted vertical mattress stitches placed circumferentially to provide support and prevent small bowel entrapment (Fig. 3).


Complex ventral hernia repair with a human acellular dermal matrix and component separation: A case series.

Garcia A, Baldoni A - Ann Med Surg (Lond) (2015)

Intraperitoneal placement of human acellular dermal matrix: this figure shows the U-stitch that is placed through the abdominal wall to the mesh and back to the abdominal wall (see arrow).
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4539183&req=5

fig3: Intraperitoneal placement of human acellular dermal matrix: this figure shows the U-stitch that is placed through the abdominal wall to the mesh and back to the abdominal wall (see arrow).
Mentions: Bilateral anterior component separation (Fig. 1) with intraperitoneal placement of a non-crosslinked human acellular dermal biologic mesh (FlexHD, Musculoskeletal Transplant Foundation, Edison, NJ) and midline closure was performed in the first 15 cases. The mesh, placed as an intraperitoneal underlay was prepared by delineating the four quadrants prior to implantation (Fig. 2). Using 1.0 PDS suture (Ethicon, Somerville, NJ), the mesh was secured to the anterior abdominal wall with interrupted vertical mattress stitches placed circumferentially to provide support and prevent small bowel entrapment (Fig. 3).

Bottom Line: Post-operative complications included 2 adverse events (11%) - one pulmonary embolism and one post-operative hemorrhage requiring transfusion; 6 wound-related complications (32%), 1 seroma (5%) and 1 patient with post-operative ileus (5%).At a median 2-year follow-up, three patients had a documented hernia recurrence (16%) and one patient was deceased due to unrelated causes.Anticipated post-operative complications were managed conservatively and at a median 2-year follow-up, a low rate of hernia recurrence was observed with this approach.

View Article: PubMed Central - PubMed

Affiliation: General Surgery and Abdominal Wall Reconstruction Center of South Florida, 17900 NW 5th St., Suite 201, Pembroke Pines, FL 33029, USA.

ABSTRACT

Unlabelled: We present a case series of 19 patients requiring complex abdominal hernia repairs. Patients presented with challenging clinical histories with 95% having multiple significant comorbidities including overweight or obesity (84%), hypertension (53%), diabetes (42%), cancer (26%), and pulmonary disease (16%). The majority of patients (68%) had prior abdominal infections and 53% had at least one failed prior hernia repair. Upon examination, fascial defects averaged 282 cm(2). Anterior and posterior component separation was performed with placement of a human acellular dermal mesh. Midline abdominal closure under minimal tension was achieved primarily in all cases. Post-operative complications included 2 adverse events (11%) - one pulmonary embolism and one post-operative hemorrhage requiring transfusion; 6 wound-related complications (32%), 1 seroma (5%) and 1 patient with post-operative ileus (5%). Operative intervention was not required in any of the cases and most patients made an uneventful recovery. Increased patient age and longer OR time were independently predictive of early post-operative complications. At a median 2-year follow-up, three patients had a documented hernia recurrence (16%) and one patient was deceased due to unrelated causes.

Conclusion: Patients at high risk for post-operative events due to comorbidities, prior abdominal infection and failed mesh repairs do well following component separation reinforced with a human bioprosthetic mesh. Anticipated post-operative complications were managed conservatively and at a median 2-year follow-up, a low rate of hernia recurrence was observed with this approach.

No MeSH data available.


Related in: MedlinePlus