Outcomes of Retromuscular Approach for Abdominal Wall Reconstruction in Patients with Inflammatory Bowel Disease

Ventral hernia repair (VHR) in patients with inflammatory bowel disease (IBD) presents unique surgical challenges including impaired wound healing, concomitant intestinal operations, along with likely future abdominal surgeries. Appropriate techniques and mesh choices in these patients remain under...

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Bibliographic Details
Published in:The American surgeon 2016-06, Vol.82 (6), p.565-570
Main Authors: Wang, Jeremy, Majumder, Arnab, Fayezizadeh, Mojtaba, Criss, Cory N., Novitsky, Yuri W.
Format: Article
Language:English
Subjects:
Abdomen
Abdominal Wall - surgery
Abdominal Wound Closure Techniques
Adult
Aged
Cohort Studies
Defects
Disease control
Dissection
Female
Hernia, Ventral - complications
Hernia, Ventral - surgery
Hernias
Herniorrhaphy
Humans
Infections
Inflammatory bowel disease
Inflammatory Bowel Diseases - complications
Inflammatory Bowel Diseases - surgery
Male
Middle Aged
Ostomy
Surgical Mesh
Treatment Outcome
Working groups
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Summary:Ventral hernia repair (VHR) in patients with inflammatory bowel disease (IBD) presents unique surgical challenges including impaired wound healing, concomitant intestinal operations, along with likely future abdominal surgeries. Appropriate techniques and mesh choices in these patients remain under active debate. Herein we report our experience with using a retromuscular approach for major VHR in a consecutive cohort of IBD patients. We identified all patients with IBD undergoing open VHR with retrorectus mesh placement between 2007 and 2013 in our prospectively maintained database. Main outcomes included patient and hernia characteristics, perioperative details, wound complications, and hernia recurrence. A total of 38 patients with IBD met inclusion criteria. Mean hernia defect size was 338 cm2. Synthetic mesh was used in 16 patients and biologic mesh was used in 22 of patients. A surgical site occurrence (SSO) occurred in 13 (34.2%) patients, 7 (18.4%) of which were surgical site infections (SSIs). There were no instances of postoperative intestinal complications or enterocutaneous fistulae. At the mean follow-up 37 months, there were 3 (9.4%) recurrences. Our retromuscular repairs were associated with a low rate of wound morbidity and no intestinal complications. Furthermore, we report a relatively low rate of recurrences, especially in this series of complex multiply recurrent hernias. Overall, our retromuscular approach seems to be safe and effective in hernia patients with IBD.
ISSN:0003-1348
1555-9823
DOI:10.1177/000313481608200620