Abdominal wall reconstruction with biosynthetic absorbable mesh after infected prosthesis explantation: single stage is
- PDF / 1,014,271 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 2 Downloads / 169 Views
ORIGINAL ARTICLE
Abdominal wall reconstruction with biosynthetic absorbable mesh after infected prosthesis explantation: single stage is better than two‑stage approach of chronic mesh infection J. Bueno‑Lledó1 · M. Ceno2 · C. Pérez‑Alonso1 · J. Martinez‑Hoed1 · S. Pous‑Serrano1 Received: 7 August 2020 / Accepted: 16 September 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Purpose To assess the efficacy of surgical management of chronic mesh infection (CMI) after abdominal wall hernia repair (AWHR) in single-stage approach (complete removal of infected prosthesis and simultaneous replacement with poly-4-hydroxybutyrate mesh or BAM group), comparing results with two-stage treatment (complete mesh excision and abdominal wall repair with synthetic mesh after several months or SPM group). Methods Retrospective comparative study of all patients who underwent surgery for CMI between January 2006 and January 2019 at a tertiary center. We compared results in terms of epidemiological data, hernia and prosthesis characteristics, surgical and postoperative variables of both two groups. Results Over the 13-year study period, 2791 AWHR was performed at our hospital; the overall CMI rate was 2.5%. Of 71 patients, 30 (42.2%) were in BAM group and 41 (57.8%) in SPM group. The median cumulative operative time (252 min versus 132 min) and length of stay (16.6 days versus 6.2 days) were significatively longer in SPM group compared with BAM group, due to the need of two surgical procedures. There were a higher number of postoperative complications in SPM group (p = 0.002), some of them grade III. With mean follow-up of 36.5 months (range 21–59), there were no significant differences in terms of overall hernia recurrence and mesh reinfection in both groups. Conclusion The use of a poly-4-hydroxybutyrate resorbable mesh in single-stage management of CMI may be a safe and better option than two-stage approach, although more studies are needed to confirm our results. Keywords Mesh infection · Mesh explantation · Abdominal wall hernia repair · Absorbable mesh · P4HB scaffold
Introduction Chronic mesh infection (CMI) is one of the most devastating complications after abdominal wall hernia repair (AWHR). It has serious and costly economic consequences for the health system, as well as the negative impact on the patient’s quality of life [1]. Complete removal of the infected mesh (CMR) has been recommended if the infection cannot be resolved by * J. Bueno‑Lledó [email protected] 1
Unit of Abdominal Wall Surgery, Department of Digestive Surgery, Hospital Universitari i Politecnic “La Fe”, University of Valencia, Calle Gabriel Miró 28, puerta 12, 46008 Valencia, Spain
Klinikum Mittelbaden, Balger Strasse 50, 76530 Baden‑Baden, Germany
2
conservative measures and antibiotic therapy. However, simultaneous replacement of a mesh after CMR has not been universally accepted, justifying the high possibility of the prosthesis reinfection, using even biological or synthetic permanent meshes [2]. For this
Data Loading...
