ARRS 2022 Abstracts

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2131. Efficacy of Percutaneous Drainage Following Ventral Hernia Repair with Synthetic Mesh vs. Cutis Autograft
Authors * Denotes Presenting Author
  1. Charles Mansour *; Louisiana State University Health Sciences Center New Orleans
  2. Claudia Leonardi; Louisiana State University Health Sciences Center New Orleans
  3. John Paige; Louisiana State University Health Sciences Center New Orleans
  4. Bahri Ustunsoz; Louisiana State University Health Sciences Center New Orleans
  5. Hector Ferral; Louisiana State University Health Sciences Center New Orleans
  6. Alexandra Fairchild; Louisiana State University Health Sciences Center New Orleans
Objective:
Over 350,000 ventral hernia repairs (VHRs) are performed every year, with many involving implantation of synthetic mesh (SM). The most common complication being intra-abdominal fluid collections, which if left untreated can develop into catastrophic infectious complications. Management of these patients with percutaneous drain (PD) placement is not always successful and may require opening of the incision or wound debridement. We hypothesize that the foreign body reaction and biofilm development contributes to the diminished efficacy of percutaneous drainage (PD) with SM. Thus, we designed a study to elucidate both the mechanism and efficacy of PD following VHR with SM.

Materials and Methods:
This is a multi-department, multi-surgeon, retrospective study at a single institution evaluating PD efficacy after VHR. We evaluated outcomes following VHR with either SM or Cutis graft (CG) (autologous dermal graft) [SM from 2015-2020; Cutis Graft (CG) repairs from 2018-2020]. Primary outcomes were: dwell time, resolution of collection, collection size (largest dimension) and microbiology (infected vs sterile). Descriptive statistics for patient demographics and outcomes were compared, with p<.05 considered significant.

Results:
Of 328 CG and 139 SM abdominal wall hernia repairs (AWHR), 21 CG and 7 SM were VHRs requiring PD placement. There was no significant difference in patient demographics between the CG and SM groups. Primary outcomes were as follows: average dwell time [49.6 (CG) vs 68.6 (SM) days], average collection size [11.8 cm (CG) vs 14 cm (SM)], infected fluid rate [62% (CG) vs 71% (SM)], and resolution with PD placement [76.2% (CG) vs 28.6% (SM)]. Patients requiring an additional procedure to treat a complication [42% (CG) vs 27% (SM)] were referred to IR, with the remaining patients in each group requiring opening of the incision for drainage or wound debridement.

Conclusion:
The results of our study suggest that the efficacy of percutaneous drainage is related to the etiology of the fluid collection, more specifically whether the collection is associated with a foreign body.