Prospective evaluation of poly-4-hydroxybutyrate mesh in CDC class I/high-risk ventral and incisional hernia repair: 18-month follow-up
| Autor: | Robert G. Martindale, Corey R. Deeken, David B. Earle, Bryan J. Sandler, John G. Linn, Guy R. Voeller, Gregory J. Mancini, Jacob A. Greenberg, William W. Hope, Benjamin K. Poulose, Eduardo Parra-Davila, John Romanelli, James G. Bittner, Matthew I. Goldblatt, John Scott Roth, Raymond M. Dunn, Don J. Selzer, Gary J. Anthone |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Incisional hernia medicine.medical_treatment Hydroxybutyrates 030230 surgery Coronary artery disease Abdominal wall 03 medical and health sciences Postoperative Complications 0302 clinical medicine Recurrence medicine Humans Incisional Hernia Hernia Prospective Studies Hypoalbuminemia Herniorrhaphy Aged business.industry Incidence Middle Aged Surgical Mesh medicine.disease Hernia repair Hernia Ventral United States Surgery Treatment Outcome medicine.anatomical_structure 030220 oncology & carcinogenesis Seroma Quality of Life Female business Follow-Up Studies Abdominal surgery |
| Zdroj: | Surgical Endoscopy. 32:1929-1936 |
| ISSN: | 1432-2218 0930-2794 |
| Popis: | Long-term resorbable mesh represents a promising technology for complex ventral and incisional hernia repair (VIHR). Preclinical studies indicate that poly-4-hydroxybutyrate (P4HB) resorbable mesh supports strength restoration of the abdominal wall. This study evaluated outcomes of high-risk subjects undergoing VIHR with P4HB mesh. This was a prospective, multi-institutional study of subjects undergoing retrorectus or onlay VIHR. Inclusion criteria were CDC Class I, defect 10–350 cm2, ≤ 3 prior repairs, and ≥ 1 high-risk criteria (obesity (BMI: 30–40 kg/m2), active smoker, COPD, diabetes, immunosuppression, coronary artery disease, chronic corticosteroid use, hypoalbuminemia, advanced age, and renal insufficiency). Physical exam and/or quality of life surveys were performed at regular intervals through 18 months (to date) with longer-term, 36-month follow-up ongoing. One hundred and twenty-one subjects (46M, 75F) with an age of 54.7 ± 12.0 years and BMI of 32.2 ± 4.5 kg/m2 (mean ± SD), underwent VIHR. Comorbidities included the following: obesity (n = 95, 78.5%), hypertension (n = 72, 59.5%), cardiovascular disease (n = 42, 34.7%), diabetes (n = 40, 33.1%), COPD (n = 34, 28.1%), malignancy (n = 30, 24.8%), active smoker (n = 28, 23.1%), immunosuppression (n = 10, 8.3%), chronic corticosteroid use (n = 6, 5.0%), advanced age (n = 6, 5.0%), hypoalbuminemia (n = 3, 2.5%), and renal insufficiency (n = 1, 0.8%). Hernia types included the following: primary ventral (n = 17, 14%), primary incisional (n = 54, 45%), recurrent ventral (n = 15, 12%), and recurrent incisional hernia (n = 35, 29%). Defect and mesh size were 115.7 ± 80.6 and 580.9 ± 216.1 cm2 (mean ± SD), respectively. Repair types included the following: retrorectus (n = 43, 36%), retrorectus with additional myofascial release (n = 45, 37%), onlay (n = 24, 20%), and onlay with additional myofascial release (n = 8, 7%). 95 (79%) subjects completed 18-month follow-up to date. Postoperative wound infection, seroma requiring intervention, and hernia recurrence occurred in 11 (9%), 7 (6%), and 11 (9%) subjects, respectively. High-risk VIHR with P4HB mesh demonstrated positive outcomes and low incidence of hernia recurrence at 18 months. Longer-term 36-month follow-up is ongoing. |
| Databáze: | OpenAIRE |
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