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P049: WHY IS PERMANENT HERNIA MESH REMOVED?
Bugra Tugertimur, MD1; Brandie Forman2; Rachel Lewis, MD3; Jarrod Kaufman, MD4; Sheila Grant, PhD5; Dave Grant5; Bruce Ramshaw, MD2; 1Department of Surgery, Lenox Hill Hospital; 2CQInsights; 3Department of Surgery, University of Tennessee Graduate School of Medicine; 4Premier Surgical; 5Department of Bioengineering, University of Missouri
Background: Permanent synthetic hernia mesh is known to decrease hernia recurrence rates for inguinal and ventral hernia repair. Because of this benefit, the majority of adult inguinal and ventral hernia repairs are performed using permanent synthetic hernia mesh. However, hernia mesh can undergo a variety of interactions in the body due to the foreign body response and can be a contributing factor in complications such as chronic pain, infection and recurrence.
Methods: A clinical quality improvement (CQI) program was initiated for hernia patients in two hernia programs to better measure and improve outcomes. From 4/12 to 12/18, 248 hernia meshes were removed from 212 patients. This analysis evaluated the differences between meshes removed after inguinal and ventral hernia repairs and identified some of the patient characteristics in the patients requiring mesh removal.
Results: For inguinal hernia mesh removal there were 172 hernia meshes removed from 136 patients. Bilateral mesh removals were performed in 36 (26%) patients. This patient group had the following characteristics: females (22%), active smokers (11%), active opioid use (42%), mean age 48.2 (20-81) years and mean BMI 26.3 (16.9-43.8). Inguinal mesh was removed for chronic groin pain in 171 of the 172 mesh removals. The other groin mesh was removed for infection. The mean operative time for mesh removal was 137.8 (69-266) minutes. The incidence of hernia recurrence was 9%. For abdominal wall (ventral) mesh removal, there were 76 hernia meshes removed from 76 patients. This patient group had the following characteristics: females (63%), active smokers (15%), active opioid use (46%), mean age 55.4 (28-79) years and mean BMI 32.2 (18.8-53.4). Ventral hernia mesh was removed for chronic abdominal wall pain in 30% of patients, for active mesh infection in 25% of patients and during a repair of a recurrent hernia in 45% of patients. The mean operative time for mesh removal was 270 (68-607) minutes and 88% of these procedures included an abdominal wall reconstruction. The hernia recurrence rate following mesh removal is 10%.
Conclusion: Permanent synthetic hernia mesh requires mesh removal in some patients. Inguinal hernia mesh removal is performed mostly in male patients and for chronic groin pain in the majority of patients. Ventral hernia mesh removal is performed mostly in female patients and the reasons for removal are more equally divided between recurrent hernia, chronic abdominal wall pain and infection.
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