Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
Department of Population Health Sciences, Weill Cornell College of Medicine, New York, NY, USA.
Surg Endosc. 2024 Jul;38(7):4006-4013. doi: 10.1007/s00464-024-10946-0. Epub 2024 Jun 11.
Mediumweight (40-60 g/m) polypropylene (MWPP) mesh has been shown to be safe and effective in CDC class II-III retromuscular ventral hernia repairs (RMVHR). However, MWPP has the potential to fracture, and it is possible that heavyweight (> 75 g/m) polypropylene mesh has similar outcomes in this context. However, there is limited data on HWPP mesh performance in clean-contaminated and contaminated scenarios. We aimed to compare HWPP to MWPP mesh in CDC class II-III wounds during open RMVHR.
The Abdominal Core Health Quality Collaborative database was retrospectively queried for a cohort of patients who underwent open RMVHR with MWPP or HWPP mesh placed in CDC class II/III wounds from 2012 to 2023. Mesh types were compared using a 3:1 propensity score-matched analysis. Covariates for matching included CDC classification, BMI, diabetes, smoking within 1 year, hernia, and mesh width. Primary outcome of interest included wound complications. Secondary outcomes included reoperations and readmissions at 30 days.
A total of 1496 patients received MWPP or HWPP (1378 vs. 118, respectively) in contaminated RMVHR. After propensity score matching, 351 patients remained in the mediumweight and 117 in the heavyweight mesh group. There were no significant differences in surgical site infection (SSI) rates (13.4% vs. 14.5%, p = 0.877), including deep SSIs (0.3% vs. 0%, p = 1), surgical site occurrence rates (17.9% vs. 22.2%, p = 0.377), surgical site occurrence requiring procedural intervention (16% vs. 17.9%, p = 0.719), mesh removal (0.3% vs. 0%, p = 1), reoperations (4.6% vs. 2.6%, p = 0.428), or readmissions (12.3% vs. 9.4%, p = 0.504) at 30 days.
HWPP mesh was not associated with increased wound morbidity, mesh excisions, reoperations, or readmissions in the early postoperative period compared with MWPP mesh in open RMVHR for CDC II/III cases. Longer follow-up will be necessary to determine if HWPP mesh may be a suitable alternative to MWPP mesh in contaminated scenarios.
中重量（40-60 克/平方米）聚丙烯（MWPP）网已被证明在 CDC 分级 II-III 腹横筋膜后入路修补术（RMVHR）中是安全且有效的。然而，MWPP 有断裂的可能性，而在这种情况下，重重量（>75 克/平方米）聚丙烯网可能具有相似的结果。然而，关于 HWPP 网在清洁污染和污染情况下的性能数据有限。我们旨在比较开放 RMVHR 中 CDC 分级 II-III 伤口中 HWPP 与 MWPP 网的情况。
使用腹部核心健康质量协作数据库对 2012 年至 2023 年间接受 MWPP 或 HWPP 网放置在 CDC 分级 II/III 伤口的 RMVHR 患者的队列进行回顾性查询。使用 3:1 倾向评分匹配分析比较网片类型。匹配的协变量包括 CDC 分类、BMI、糖尿病、1 年内吸烟史、疝和网片宽度。主要观察结果为伤口并发症。次要结果包括术后 30 天的再次手术和再入院。
共有 1496 例患者在污染的 RMVHR 中接受 MWPP 或 HWPP（分别为 1378 例和 118 例）。在进行倾向评分匹配后，351 例患者留在中重量组，117 例留在重重量组。手术部位感染（SSI）率（13.4%比 14.5%，p=0.877），包括深部 SSI（0.3%比 0%，p=1）、手术部位发生率（17.9%比 22.2%，p=0.377）、需要手术干预的手术部位发生率（16%比 17.9%，p=0.719）、网片取出率（0.3%比 0%，p=1）、再次手术率（4.6%比 2.6%，p=0.428）或术后 30 天再入院率（12.3%比 9.4%，p=0.504）无显著差异。
与 MWPP 网相比，HWPP 网在开放 RMVHR 中用于 CDC II/III 病例时，在术后早期并未增加伤口发病率、网片切除、再次手术或再入院。需要更长时间的随访，以确定 HWPP 网在污染情况下是否可以替代 MWPP 网。
