Long-term outcomes of sandwich ventral hernia repair paired with hybrid vacuum-assisted closure

Caitlin Hicks, Katherine E. Poruk, Pablo A. Baltodano, Kevin C. Soares, Said C. Azoury, Carisa Miller Cooney, Peter Cornell, Frederic Eckhauser

Research output: Contribution to journalArticle

Abstract

Background Sandwich ventral hernia repair (SVHR) may reduce ventral hernia recurrence rates, although with an increased risk of surgical site occurrences (SSOs) and surgical site infections (SSIs). Previously, we found that a modified negative pressure wound therapy (hybrid vacuum-assisted closure [HVAC]) system reduced SSOs and SSIs after ventral hernia repair. We aimed to describe our outcomes after SVHR paired with HVAC closure. Methods We conducted a 4-y retrospective review of all complex SVHRs (biologic mesh underlay and synthetic mesh overlay) with HVAC closure performed at our institution by a single surgeon. All patients had fascial defects that could not be reapproximated primarily using anterior component separation. Descriptive statistics were used to report the incidence of postoperative complications and hernia recurrence. Results A total of 60 patients (59.3 ± 11.4 y, 58.3% male, 75% American Society of Anesthesiologists class ≥3) with complex ventral hernias being underwent sandwich repair with HVAC closure. Major postoperative morbidity (Dindo-Clavien class ≥3) occurred in 14 (23.3%) patients, but incidence of SSO (n = 13, 21.7%) and SSI (n = 4, 6.7%) was low compared with historical reports. Median follow-up time for all patients was 12 mo (interquartile range 5.8-26.5 mo). Hernia recurrence occurred in eight patients (13.3%) after a median time of 20.6 months (interquartile range 16.4- 25.4 months). Conclusions Use of a dual layer sandwich repair for complex abdominal wall reconstruction is associated with low rates of hernia recurrence at 1 year postoperatively. The addition of the HVAC closure system may reduce the risk of SSOs and SSIs previously reported with this technique and deserves consideration in future prospective studies assessing optimization of ventral hernia repair approaches.

Original languageEnglish (US)
Pages (from-to)282-287
Number of pages6
JournalJournal of Surgical Research
Volume204
Issue number2
DOIs
StatePublished - Aug 1 2016

Keywords

  • Abdominal wall reconstruction
  • Complex ventral hernia repair
  • Negative pressure wound therapy
  • Sandwich
  • VAC
  • Vacuum-assisted closure

ASJC Scopus subject areas

  • Surgery

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