Repair of massive ventral hernias with “quilted” mesh

N. M. Posielski, S. T. Yee, A. Majumder, Sean Orenstein, A. S. Prabhu, Y. W. Novitsky

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Introduction: Prosthetic reinforcement is a critical component of hernia repair. For massive defects, mesh overlap is often limited by the dimensions of commercially available implants. In scenarios where larger mesh prosthetics are required for adequate reinforcement, it may be necessary to join several pieces of mesh together using non-absorbable suture. Here, we report our outcomes for abdominal wall reconstructions in which “quilted” mesh was utilized for fascial reinforcement. Methods: Patients undergoing open incisional hernia repair utilizing posterior component separation and transversus abdominis muscle release, with use of quilted synthetic mesh placed in the retromuscular position, were reviewed. Main outcome measures included patient, hernia, and operative characteristics and post-operative outcomes, including surgical site occurrence (SSO), surgical site infection (SSI), and recurrence. Results: Thirty-two patients (mean age 55.7 ± 9.3, BMI 38.3 ± 5.8 kg/m2) underwent open ventral hernia repair with “quilted” mesh placed in the retromuscular position. The mean defect area was 760.1 ± 311.0 cm2 with a mean width of 24.7 ± 6.4 cm. Quilted meshes consisted of two-piece (69 %), three-piece (19 %) and four-piece (12 %) configurations. Wound morbidity consisted of eight (25 %) SSOs, including four (13 %) SSIs, all of which resolved without mesh excision. With mean follow-up of 9.0 ± 13.6 months, there were two (6.3 %) lateral recurrences, both unassociated with mesh-to-mesh suture line failure. Conclusions: Massive ventral hernias that require giant mesh prosthetics, currently not commercially available, may be successfully repaired using multiple mesh pieces sewn together in a quilt-like fashion. Such retromuscular repairs are durable, without added morbidity due to the mesh-to-mesh suture line. However, additional operative time is required for quilting the mesh together, prompting strong calls for manufacturing of larger mesh prosthetics.

Original languageEnglish (US)
Pages (from-to)465-472
Number of pages8
JournalHernia
Volume19
Issue number3
DOIs
StatePublished - Apr 9 2015

Fingerprint

Ventral Hernia
Herniorrhaphy
Sutures
Morbidity
Surgical Wound Infection
Abdominal Muscles
Recurrence
Abdominal Wall
Operative Time
Hernia
Quilt
Outcome Assessment (Health Care)
Muscles
Wounds and Injuries

Keywords

  • Abdominal wall reconstruction
  • AWR
  • Herniorrhaphy
  • Incisional hernia
  • Quilted mesh
  • TAR
  • Ventral hernia repair

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Posielski, N. M., Yee, S. T., Majumder, A., Orenstein, S., Prabhu, A. S., & Novitsky, Y. W. (2015). Repair of massive ventral hernias with “quilted” mesh. Hernia, 19(3), 465-472. https://doi.org/10.1007/s10029-015-1375-4

Repair of massive ventral hernias with “quilted” mesh. / Posielski, N. M.; Yee, S. T.; Majumder, A.; Orenstein, Sean; Prabhu, A. S.; Novitsky, Y. W.

In: Hernia, Vol. 19, No. 3, 09.04.2015, p. 465-472.

Research output: Contribution to journalArticle

Posielski, NM, Yee, ST, Majumder, A, Orenstein, S, Prabhu, AS & Novitsky, YW 2015, 'Repair of massive ventral hernias with “quilted” mesh', Hernia, vol. 19, no. 3, pp. 465-472. https://doi.org/10.1007/s10029-015-1375-4
Posielski NM, Yee ST, Majumder A, Orenstein S, Prabhu AS, Novitsky YW. Repair of massive ventral hernias with “quilted” mesh. Hernia. 2015 Apr 9;19(3):465-472. https://doi.org/10.1007/s10029-015-1375-4
Posielski, N. M. ; Yee, S. T. ; Majumder, A. ; Orenstein, Sean ; Prabhu, A. S. ; Novitsky, Y. W. / Repair of massive ventral hernias with “quilted” mesh. In: Hernia. 2015 ; Vol. 19, No. 3. pp. 465-472.
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abstract = "Introduction: Prosthetic reinforcement is a critical component of hernia repair. For massive defects, mesh overlap is often limited by the dimensions of commercially available implants. In scenarios where larger mesh prosthetics are required for adequate reinforcement, it may be necessary to join several pieces of mesh together using non-absorbable suture. Here, we report our outcomes for abdominal wall reconstructions in which “quilted” mesh was utilized for fascial reinforcement. Methods: Patients undergoing open incisional hernia repair utilizing posterior component separation and transversus abdominis muscle release, with use of quilted synthetic mesh placed in the retromuscular position, were reviewed. Main outcome measures included patient, hernia, and operative characteristics and post-operative outcomes, including surgical site occurrence (SSO), surgical site infection (SSI), and recurrence. Results: Thirty-two patients (mean age 55.7 ± 9.3, BMI 38.3 ± 5.8 kg/m2) underwent open ventral hernia repair with “quilted” mesh placed in the retromuscular position. The mean defect area was 760.1 ± 311.0 cm2 with a mean width of 24.7 ± 6.4 cm. Quilted meshes consisted of two-piece (69 {\%}), three-piece (19 {\%}) and four-piece (12 {\%}) configurations. Wound morbidity consisted of eight (25 {\%}) SSOs, including four (13 {\%}) SSIs, all of which resolved without mesh excision. With mean follow-up of 9.0 ± 13.6 months, there were two (6.3 {\%}) lateral recurrences, both unassociated with mesh-to-mesh suture line failure. Conclusions: Massive ventral hernias that require giant mesh prosthetics, currently not commercially available, may be successfully repaired using multiple mesh pieces sewn together in a quilt-like fashion. Such retromuscular repairs are durable, without added morbidity due to the mesh-to-mesh suture line. However, additional operative time is required for quilting the mesh together, prompting strong calls for manufacturing of larger mesh prosthetics.",
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N2 - Introduction: Prosthetic reinforcement is a critical component of hernia repair. For massive defects, mesh overlap is often limited by the dimensions of commercially available implants. In scenarios where larger mesh prosthetics are required for adequate reinforcement, it may be necessary to join several pieces of mesh together using non-absorbable suture. Here, we report our outcomes for abdominal wall reconstructions in which “quilted” mesh was utilized for fascial reinforcement. Methods: Patients undergoing open incisional hernia repair utilizing posterior component separation and transversus abdominis muscle release, with use of quilted synthetic mesh placed in the retromuscular position, were reviewed. Main outcome measures included patient, hernia, and operative characteristics and post-operative outcomes, including surgical site occurrence (SSO), surgical site infection (SSI), and recurrence. Results: Thirty-two patients (mean age 55.7 ± 9.3, BMI 38.3 ± 5.8 kg/m2) underwent open ventral hernia repair with “quilted” mesh placed in the retromuscular position. The mean defect area was 760.1 ± 311.0 cm2 with a mean width of 24.7 ± 6.4 cm. Quilted meshes consisted of two-piece (69 %), three-piece (19 %) and four-piece (12 %) configurations. Wound morbidity consisted of eight (25 %) SSOs, including four (13 %) SSIs, all of which resolved without mesh excision. With mean follow-up of 9.0 ± 13.6 months, there were two (6.3 %) lateral recurrences, both unassociated with mesh-to-mesh suture line failure. Conclusions: Massive ventral hernias that require giant mesh prosthetics, currently not commercially available, may be successfully repaired using multiple mesh pieces sewn together in a quilt-like fashion. Such retromuscular repairs are durable, without added morbidity due to the mesh-to-mesh suture line. However, additional operative time is required for quilting the mesh together, prompting strong calls for manufacturing of larger mesh prosthetics.

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KW - TAR

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