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.
P065: WOUND COMPLICATION AND RECURRENCE RATES AFTER OPEN PARASTOMAL HERNIA REPAIR WITH SYNTHETIC MESH AT A SINGLE ACADEMIC CENTER
Monica Polcz, MD1; Joseph Blankush, MD1; Joseph Broucek, MD1; Jose Diaz, MD1; Meredith Duke, MD, MBA1; Alexander Hawkins, MD, MPH1; Joan Kaiser, RN1; Benjamin Poulose, MD, MPH2; Myrick Shinall, MD, PhD1; Richard Pierce, MD, PhD1; 1Vanderbilt University Medical Center; 2The Ohio State University Wexner Medical Center
Background: Hernia repair in the setting of a contaminated field (CDC Class III) has historically been performed primarily or with biologic mesh reinforcement to limit morbidity from infection. Open parastomal hernia repair, often an elective procedure, is one example of a Class III field commonly encountered by hernia surgeons. Although well-controlled literature regarding the optimal technique for parastomal hernia repair is nonexistent, composite reported data suggests infection and recurrence rates of approximately 10% and 60% after primary repair, respectively; biologic mesh reinforcement carries overall wound complication and recurrence rates of approximately 26% and 16%. Onlay techniques for parastomal hernia repair utilizing midweight macroporous nonabsorbable synthetic mesh have become increasingly utilized with proposed benefit of avoiding entry into a hostile abdomen, simplicity of the technique, and minimal exposure of prosthetic material to bowel. The purpose of this study was to determine the incidence of wound complication and recurrence rates after open parastomal hernia repair utilizing an onlay technique with permanent synthetic mesh at a single academic institution.
Methods: Patients who underwent open parastomal hernia repair with a nonabsorbable synthetic mesh onlay technique between January 2015 – March 2020 at a large tertiary care referral center were retrospectively identified. Demographic information, clinical history, operative details, postoperative complications, and follow-up data were collected for all patients. Rates of surgical site infection (SSI), surgical site occurrence (SSO), and hernia recurrence were calculated.
Results: Of 107 total patients who underwent a parastomal hernia repair, 52 were performed with a permanent synthetic mesh onlay; two of these were excluded due to lack of follow-up. Median follow-up of the remaining 50 subjects was 5.9 (IQR 1-15.1) months and mean age was 59.2 (+ 15.1) years. SSI occurred in 5 (10%) patients. All resolved with antibiotics alone; no mesh removals for infection were reported. SSO was reported in 1 (2%) patient (postoperative seroma). Hernia recurrence occurred in 12 (24%) patients prior to last follow-up, with a median time to recurrence of 7.1 (IQR 4.5-11.6) months. Two of these were early recurrences (within 30 days) requiring reoperation.
Conclusions: In this retrospective study, wound complication rates (SSI/SSO) after open parastomal hernia repair with nonabsorbable midweight macroporous synthetic mesh were comparable to reported literature values for primary repair and biologic mesh reinforcement. Recurrence rates were significantly better than those reported with primary repair and comparable to those seen with biologic prosthetics. This suggests that the use of midweight macroporous permanent mesh appears to be a reasonable choice in Class III wounds and may be a cost-effective alternative to the use of biologic prosthetics in these scenarios.
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