RESULTS

1. Mesh Repair Of Complex, Incisional Hernias, Utilising Soft Tissue Reconstruction & Biological Mesh Insertion: A Consecutive, Single-Team Experience Skipworth JRA1, Ovens L2, Morkane C1, Mohan A2, Akhavani MA2, Imber C3, Floyd D2, Shankar A3 1Department of Surgery & Interventional Science, University College London, London, UK 2Department of Plastic Surgery, Royal Free Hospital, London, UK 3Department of Hepatopancreaticobiliary Surgery, Royal Free Hospital , London, UK Figure 2. Example of Incisional Hernia Repair BACKGROUND Mesh repair of complex, incisional hernias, with significant loss of abdominal wall tissue resulting from wound/mesh infections and intra-abdominal sequelae of gastrointestinal surgery, carries a significant risk of complications, including infection and recurrence. Such complications may require removal of inserted mesh, resulting in further loss of abdominal wall tissue. A technique of soft tissue reconstruction and insertion of intraperitoneal StratticeTM biological mesh (Porcine Matrix) was subsequently developed. StratticeTM can be left safely in situ, within a contaminated field, when utilised in animal models; however, results in humans remain limited to date. METHODS A retrospective case-notes review of all incisional and ventral hernia patients managed via soft tissue reconstruction and StratticeTM mesh insertion was performed. Standardised operative repair involved intra-peritoneal mesh insertion and soft tissue resection (to produce a healthy field for reconstruction) and reconstruction, utilising a component separation technique. All cases were performed as a single-stage procedure via a combined approach involving both a General and Plastic Surgeon. Figure 3. Complications following incisional/ventral hernia repair RESULTS 35 patients underwent complex hernia repair for a combination of midline, transverse and lumbar hernias between Feb 2009 and January 2011. Patient age ranged from 30-85 years, gender ratio was 52%M : 48%F and mean follow-up was ten months. 19 (54%) patients had grade 3 and 16 (46%) grade 2 hernias (see Figure 1). Six (17%) patients had repair of recurrent incisional hernias, two (6%) patients had more than one mesh inserted for extremely large or multiple defects, and three (9%) patients had been diagnosed with pre-existing infections of in-situ mesh. Post-operative complications were minimal and have been detailed further in Figure 3. Of note is the fact that there have been no hernia recurrences and no requirements for mesh removal to date. Figure 1. Grading of Incisional & Ventral Hernias [Incisional ventral hernias: Review of the literature and recommendations regarding the grading and technique of repair. Ventral Hernia Working Group, Surgery. 2010 Sep;148(3):544-58] Figure 4. Example of Incisional Hernia Repair CONCLUSIONS This technique of component separation combined with mesh insertion, as a single-stage procedure, allows for safe, reliable and definitive reconstruction of complex and recurrent ventral/incisional hernias, with a low incidence of post-operative mesh infections, no hernia recurrences and minimal complications.