Abstract: Primary Fascial Closure With Mesh Reinforcement Results In Lower Complication And Recurrence Rates Than Bridged Mesh Repair For Abdominal Wall Reconstruction: A Propensity Score Analysis (Plastic Surgery The Meeting)

Sunday, September 25, 2016: 1:50 PM

Salvatore Giordano, MD, PhD , Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX

Patrick Bryan Garvey, MD, FACS , Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX

Donald P Baumann, MD, FACS , Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX

Jun Liu, MD, PhD , Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX

Charles E Butler, MD , Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX

Presentation PDF file

Introduction: Abdominal wall reconstruction can be a challenging procedure especially in case of large sized defects. To date, only few studies have compared bridged and mesh reinforced repairs with significant differences among study groups concerning defect sizes. We compared outcomes of bridged mesh repair and mesh-reinforced primary fascial closure repair for abdominal wall reconstruction (AWR).

Methods: This was a retrospective study including 535 consecutive patients who underwent AWR with underlay acellular dermal matrix (ADM) mesh. Four hundred eighty-four (90.47%) patients underwent mesh-reinforced AWR and 51 (9.53%) underwent bridged-repair AWR. Propensity score analysis was used for risk adjustment in multivariate analysis and for one-to-one matching to control for confounding differences between treatment groups. [Au: Suggest stating the p value at which results were considered significant.]

Results: Bridged repairs had poorer long-term results than mesh-reinforced AWR, with a higher recurrent hernia rate (33.3% vs 6.2%, p=0.001), higher overall complication rate (58.8% vs 30.0%, p=0.001), and shorter freedom from hernia recurrence (log-rank <0.001). Bridged-repair AWR patients also experienced higher wound dehiscence rates (25.5% vs 14.3%, p=0.034) and mesh exposure rates (9.8% vs 1.4%, p=0.003) than mesh-reinforced AWR patients.

When the treatment method was adjusted for propensity score among the 100 propensity-score-matched pairs, the recurrent hernia rate (32.0% vs 6.0%, p=0.002), overall complication rate (68.2% vs 31.8%, p=0.001), and freedom from hernia recurrence (log-rank =0.005) remained poorer after bridged-repair AWR. However, we no longer observed differences in wound healing and mesh complications.

Conclusions: Bridged repair for AWR is associated with significantly higher hernia recurrence and overall complication rates than mesh-reinforced AWR, ever after adjusting for differences between the comparison groups. Whenever possible, bridged repair should be avoided in AWR.

30329 Primary Fascial Closure With Mesh Reinforcement Results In Lower Complication And Recurrence Rates Than Bridged Mesh Repair For Abdominal Wall Reconstruction: A Propensity Score Analysis