Plastic Surgery Research Council
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DOES MESH LOCATION MATTER IN ABDOMINAL WALL RECONSTRUCTION? A SYSTEMATIC REVIEW OF THE LITERATURE AND A SUMMARY OF RECOMMENDATIONS
Presenter: Frank Albino, MD
Co-Authors: Fan KL; Patel KM; Bhanot P; Nahabedian MY
UCLA

Introduction: Mesh implantation decreases rates of ventral hernia recurrence and has become the dominant method of abdominal wall reconstruction. The effect of specific mesh position on outcomes remains unclear. The purpose of this systematic review is to provide a comprehensive comparison of the surgical outcomes and complications following ventral hernia repair with onlay, interposition, retrorectus, or underlay mesh placement.

Methods: Systematic review of English articles(1996 to 2012) in PubMed, MEDLINE, and Cochrane library was performed to identify patients who underwent abdominal wall reconstruction reinforced with prosthetic or biologic mesh in the setting of a ventral hernia repair. Mesh position was divided into onlay, underlay, interposition, or retrorectus. Patient demographic information, medical and surgical histories, perioperative details, surgical technique, complications, and rates of recurrence were obtained from each study.

Results: Sixty relevant articles were included for a total of 5824 patients treated with mesh repair of a ventral hernia. Position included onlay(19.7%), underlay(60.9%), interposition(6.7%), and retrorectus(12.7%). Prosthetic mesh was used in 86.7% of repairs while 13.3% of patients received biologic mesh. Weighted mean incidences of early events were: 19% wound complication, 8% wound infection, 11% seroma or hematoma formation, and 10% re-operation. Late complications included 8% hernia recurrence and 2% mesh explantation. Overall complication rates were higher for onlay(22%) or interposition-based reconstruction(26%) with recurrence rates higher in the setting of an onlay(17.2%) or interposition(17%) reinforcement compared to retrorectus(5.2%) or underlay(7.5%) mesh placement. The rate of infection was also lower in the retrorectus cohort (4.5%) compared to interposition or underlay-based reconstructions, p<0.05.

Conclusions: Mesh reinforcement for ventral hernia repair is safe with evidence of efficacy. Onlay and interposition mesh placement have higher complication and recurrence rates compared to underlay or retrorectus mesh placement.


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