ABSTRACT
Objective To investigate the clinical efficacy of porcine small intestine submucosa-derived (SIS) mesh and polypropylene (PP) mesh applied in anterior abdominal wall incisional hernia repair.Methods The retrospective cohort study was conducted.The clinical data of 59 patients who underwent anterior abdominal wall incisional hernia repair in the First Affiliated Hospital of Sun Yat-Sen University between January 2012 and December 2017 were collected.Of 59 patients,22 undergoing anterior abdominal wall incisional hernia repair with SIS mesh and 37 undergoing anterior abdominal wall incisional hernia repair with PP mesh were respectively allocated into the SIS group and PP group.Surgeons selected surgical procedures according to hernia ring situations of patients.Observation indicators:(l) intra-and post-operative recovery situations;(2) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect long-term complications of patients including foreign body sensation or pain in abdominal wall and hernia recurrence up to May 2018.Measurement data with normal distribution were represented as (x)±s,and comparison between groups was done using t test.Measurement data with skewed distribution were described as M (range),and comparison between groups was done using Mann-Whitney U test.Comparison of count data was analyzed using the chi-square test or Fisher exact probability.Results (1) Intra-and post-operative recovery situations:patients of the SIS group and PP group underwent successfully anterior abdominal wall incisional hernia repair.There were 2,3,3,14 and 5,26,1,5 patients undergoing open Onlay repair,open Sublay repair,laparoscopic intraperitoneal onlay mesh repair,laparoscopic combined with open mesh repair in the SIS group and PP group respectively.The volume of intraoperative blood loss,cases of postoperative incisional seroma and surgical site infection were (23± 11)mL,7,5 in the SIS group and (30± 13)mL,3,1 in the PP group respectively,with statistically significant differences between groups (t=-2.238,P＜0.05).(2) Follow-up:patients of the SIS group and PP group were respectively followed up for 29.3 months (6.0-66.0 months) and 31.0 months (7.0-76.0 months),with no statistically significant difference between groups (Z =-1.388,P＞0.05).During the follow-up,foreign body sensation or pain in abdominal wall and hernia recurrence were detected in 6,6 patients in the SIS group and 4,2 patients in the PP group respectively,with a statistically significant difference in hernia recurrence between groups (P＜0.05) and with no statistically significant difference in foreign body sensation or pain in abdominal wall between groups (P＞0.05).Conclusion Compared with polypropylene mesh,anterior abdominal wall incisional hernia repair using SIS mesh has higher incidence rate of postoperative incisional seroma,surgical site infection and hernia recurrence,but fewer volume of intraoperative blood loss.
ABSTRACT
<p><b>OBJECTIVE</b>To observe the safety and efficacy of biological patch (Biodesign Surgisis mesh, SIS) in hybrid technique for incisional herniorrhaphy.</p><p><b>METHODS</b>Clinical and follow-up data of 14 incisional hernia patients who underwent incisional herniorrhaphy with hybrid technique, using porcine small intestinal submucosa acellular matrix patch, at the First Affiliated Hospital of Sun Yat-sen University from January 1, 2012 to June 31, 2016 were analyzed retrospectively. This Biodesign Surgisis patch for incisional hernia is produced by the Cook company in the United States. The size of patch ranged from 9 cm × 15 cm to 20 cm × 25 cm. During operation, according to abdominal wall defect, the patch was cut to ensure the distance from its edge to the border of abdominal wall defect more than 5 cm.</p><p><b>RESULTS</b>There were four male and tenfemale patients with average age of (67.7±11.6) years and average body mass index(BMI) of (25.5±1.7) kg/m². As for operative history of these 14 cases, 7 cases had gastrointestinal tumor surgery, 2 had appendectomy, 1 had upper abdominal white line hernia repair, 1 had hysterectomy, 1 had cholecystectomy, 1 had splenectomy plus portal vein dissection, and 1 had right kidney and right ureter total resection plus partial excision of bladder wall. Ten casesdeveloped incisional infection after previous surgery. The duration of incisional hernia ranged 1 to 180 months (median, 8 months). Two cases were refractory hernia, 1 was incarcerated hernia, and 11 were reversible hernia. The locations of incisional hernia included 4 cases of right ventral wall, 1 case of left ventral wall, 2 cases of supra-umbilical incision, 4 cases of infra-umbilical midline incision, and 3 cases of peri-umbilical midline incision. There were 3 cases of middle incisional hernia, 5 cases of large incisional hernia and 6 cases of huge incisional hernia. All the patients completed operations eventlessly. The average operative time was (202.5±72.9) minutes. The average length and width of hernia ring were (10.9±4.3) cm and (9.3±3.9) cm, respectively. Clean operation was performed in 11 cases, potential contaminative operation in 2 cases and contaminative operation in 1 case. The amount of operative bleeding was (15.0±4.8) ml. The NRS pain scores within 24 hours after the operation, at POD3 and at POD7 were 5.1±0.9, 4.2±0.7 and 3.7±0.9, respectively. The time to flatus after operation was (2.5±0.9) days and the time to liquid diet was (3.8±1.2) days. No patient died during the perioperative period. The average hospitalization time was (21.5±12.0) days. Postoperative complications occurred in 8 cases, including 4 cases of fever, 8 cases of incision complications, 4 cases of abdominal infection, 4 cases of intestinal obstruction, 5 cases of effusion under patch, 2 cases of pneumonia, and 1 case of acute myocardial infarction. According to the Clavien-Dindo classification, 3 cases were grade zero, 3 cases were grade I(, 6 cases were grade II(, 1 case was grade III(, and 1 case was grade IIII(. Thirteen patients received follow-up and the average follow-up time was (33.2±12.3) (18.2-61.0) months. One patient died of cerebral infarction 38 months after operation. The chronic abdominal pain or discomfort was found in 4 cases. The recurrent incisional hernia developed in 5 cases and the average time of recurrence was (11.0±8.3) months.</p><p><b>CONCLUSIONS</b>Biological patch can be used safely and effectively in hybrid technique for incisional herniorrhaphy. However, the morbidity of postoperative complication and the risk of recurrence are high. Terefore, the long-term outcome is still subject to observation.</p>