Mesh repair of complex, incisional hernias utilising soft tissue reconstruction and biological mesh insertion
A Consecutive, Single-Team Experience
Presented at: 33rd International Congress of the European Hernia Society, (Ghent, Belgium; 10th-13th May 2011)
Author: Skipworth, JRA, University College London, London, United Kingdom
Co-authors:Ovens, L, Royal Free Hospital, London, United Kingdom
Morkane, C, University College London Hospital, London, United Kingdom
Imber, C, Royal Free Hospital, London, United Kingdom
Floyd, D, Royal Free Hospital, London, United Kingdom
Shankar, A, Royal Free Hospital, London, United Kingdom
Background: Mesh repair of complex, incisional hernias carries a significant risk of complications, particularly infection, which can necessitate mesh removal. A technique of extensive soft tissue reconstruction with component separation and insertion of intraperitoneal StratticeTM biological mesh (Porcine Collagen) was subsequently developed as StratticeTM has been shown to result in a decreased incidence of mesh infection when utilised in animal models.
Methods: A retrospective case notes review of all incisional hernia patients managed via soft tissue reconstruction and StratticeTM mesh insertion was performed. Standardised operative repair of incisional hernias involved intra-peritoneal mesh insertion, soft tissue reconstruction utilising a component separation technique and extensive soft tissue resection with myocutaneous flaps. All cases were performed as a single-stage procedure by a General and Plastic Surgery Consultant.
Results: 35 patients underwent complex, incisional hernia repairs for a combination of midline, transverse and lumbar hernias, via the described technique, between Feb 2009 and January 2011. Patient age ranged from 30 to 85 years, the gender ratio was 52%M: 48%F and mean follow-up is ten months. Six (17%) patients had repair of recurrent incisional hernias, two (6%) patients had more than one mesh inserted for extremely large and multiple defects, and three (9%) patients had been diagnosed with previous mesh infections. Post-operative complications include two (6%) MRSA mesh infections, one (3%) seroma, one (3%) fat necrosis within the wound and one (3%) lower respiratory tract infection. One (3%) patient required reoperation for wound debridement. However, there have been no recurrences to date and no requirements for mesh removal in any patient.
Conclusions: This novel combined General and Plastic Surgery technique utilising StratticeTM mesh allows for safe, reliable and definitive reconstruction of complex and recurrent incisional hernias, with a low incidence of post-operative mesh infections and minimal complications.