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Ventral Hernia Repair after Bowel Surgery: Does GI Contamination Matter in the Era of Biologic Mesh?
Ximena Pinell-White, MD1, Mark Gruszynski, BBA1, Albert Losken, MD2.
1Emory University School of Medicine, Atlanta, GA, USA, 2Emory University Division of Plastic Surgery, Atlanta, GA, USA.

Purpose: Ventral hernias are often repaired following planned or unplanned bowel procedures. Gastrointestinal contamination poses a considerable risk of infection, such that synthetic mesh is generally avoided. Biologic materials have recently been introduced for soft tissue replacement and are thought to tolerate infection. The purpose of this review is to evaluate the impact of intestinal contamination on ventral hernias repaired with biologic material.
Methods: This is a retrospective review of all patients who underwent ventral hernia repair with biologic material between 2003 and 2012. Groups were divided based on the whether concomitant bowel surgery was performed or not. Patients with less than 6 months follow-up were excluded. Data were collected on patient demographics, risk factors, concomitant procedures, type of mesh, and outcomes.
Results: There were 82 patients included in this series. Thirty-two patients (39%) had concomitant bowel surgery. Ventral hernia repair was performed predominantly with Alloderm (n=38, 46%) and Strattice (n=32, 39%). There was no difference in hernia recurrence or other complications between patients who underwent concomitant bowel surgery and those who did not.
ComplicationBowel
contamination
(n=32)
No bowel contamination
(n=50)
P value
Delayed wound healing40.6%34.0%0.54
Hernia recurrence28.1%34.0%0.58
Surgical site infection28.1%20.0%0.40
Seroma9.4%12.0%1.00
Skin necrosis12.5%6.0%0.42
Hematoma9.4%4.0%0.37
Enterocutaneous fistula3.1%8.0%0.64
Mesh exposure9.4%2.0%0.29
Any65.6%54.0%0.30

Conclusions: The use of biologic material has made it such that ventral hernias can be safely repaired following bowel surgery without an increased risk of infection, hernia recurrence or other complications.


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