Welcome to the AHS 2020 ePoster Session. Please scroll down to view all of the submitted posters or press Control-F to search. To view the poster and its abstract, click on the poster image. Many posters also have a brief audio introduction which can be played by going to the bottom of the poster screen.
P027: DOES INCISIONAL HERNIA REPAIR WITH MESH WORSEN INFLAMMATORY DISEASE AND POUCHITIS IN PATIENTS WITH ULCERATIVE COLITIS?
Breanna Perlmutter, MD; Hemasat Alkhatib, MD; Amy Lightner, MD; Stefan Holubar, MD; Aldo Fafaj, MD; Samuel Zolin, MD; Clayton Petro, MD; Ajita Prabhu, MD; David Krpata, MD; Michael Rosen, MD; Cleveland Clinic Foundation
Background: There is a theoretic concern that the use of mesh during incisional hernia repair in patients with Ulcerative Colitis (UC) may provoke an immunologic stress, worsening baseline disease and pouchitis. This study aimed to quantify and compare healthcare resource utilization before and after hernia repair with mesh in patients with UC to evaluate the potential immunologic consequences of mesh use in patients with and without a pouch. We hypothesized that the use of mesh does not worsen disease burden in patients with UC.
Methods: A retrospective review of patients with UC undergoing elective incisional hernia repair with mesh at a single large academic institution from 2014-2018 was conducted. To determine the immunologic consequences of placing mesh in patients with UC, a surrogate of disease burden, healthcare resource utilization, was evaluated. Healthcare resource utilization was approximated by measuring the use of the following resources during a standardized 14 month time period before and after the date of hernia repair: number of Emergency Department (ED) visits (total, GI-related, and non-GI related), hospitalizations (total, GI-related, and non-GI related), endoscopic procedures, bowel resections, and radiologic studies obtained. Patients were grouped by presence of a pouch at the time of hernia repair. Use of biologic medications at the time of hernia repair and after was also evaluated. Resource utilization of each variable was analyzed using paired two sample t-tests and biologic medication use was compared using the McNemar test.
Results: A total of 49 patients were identified, of whom 30 (61%) had a pouch. Forty six patients (94%) had a permanent synthetic mesh placed while 6% received a biologic mesh, and 98% of mesh was placed in the retro-muscular space. In patients without a pouch, there was no significant difference in resource utilization in any category before and after hernia repair (all p>0.05). In those with a pouch, resource utilization decreased after repair with respect to total number of hospitalizations (p=0.007), number of GI-related hospitalizations (p=0.005), number of bowel resections (p=0.002), and number of radiologic studies obtained (p=0.02). There was no significant change in the number of patients using biologic medications before and after hernia repair (McNemar test, p=1).
Conclusions: Contrary to general concerns, the use of mesh in incisional hernia repair in patients with UC does not lead to increased episodes of pouchitis or worsening disease, as healthcare resource utilization either remained statistically unchanged or decreased in every category following hernia repair. Based on these data, retro-muscular mesh use should be considered as a reasonable option during hernia repair in this population without fear of pouchitis exacerbation.
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