Purpose: Concerns pertaining to the risk of wound infection and subsequent need for mesh excision or recurrence deters the use of mesh to repair ventral hernia during colorectal resection. We evaluate the risk of infection and hernia recurrence after mesh repair in these patients over a prolonged follow up period.
Methods: A retrospective review of 274 patients with mesh repair for ventral hernia during colorectal surgery from 1991-2007 was done. Patients who did not have a bowel resection and those with only parastomal hernia were excluded. Patients demographics, diagnosis, comorbidity, size of defect, mesh type, surgical technique and early complications were evaluated from medical records. Long term follow up was determined by telephone interviews. Patients who had recurrence were compared with those without recurrence using Fishers exact, Chi-squared and Wilcoxon tests as appropriate statistical tools.
Results: 110 patients (56% male,mean age 59,median BMI 29) met the inclusion criteria. Diagnoses included colorectal cancer (n=34), Crohn’s ( n=25), Diverticulosis (n=18), ulcerative colitis (n=16) and others (n=17). Goretex (n=39), Prolene (n=38), Permacol (n=23), Alloderm(n=4), Bard composite (n=3), Surgisis (n=1) and others (n=2) were used intraperitoneally with mean fascial defect of 10x11 cm. Mean follow up was 4 years. Rate of wound infection was 13.6% and recurrence 40%. Patients who had recurrence (n=44) and non-recurrence (n=66) had similar age(p=0.4), gender (p=0.2), BMI (p=0.4), smoking history (p= 0.8), pulmonary comorbidity (p=0.9), type of mesh (p=0.7) and drain use (p=0.5). A significantly greater proportion of recurrent group had hypertension (p<0.05), diabetes(p<0.01), larger fascial defect (p<0.05), steroid use (p<0.05), emergency surgery (76 vs 24%, p<0.001) and wound infection (7 vs 4%, p<0.05). On long term follow up, additional 6 patients (4 from recurrent group and 2 non-recurrent group) developed wound infection requiring readmission. 78% of patients were satisfied with their surgery. Quality of life for recurrent and non-recurrent group was comparable (p=0.5).
Conclusions: Recurrence following mesh repair of ventral hernia during colorectal resection is associated with emergency surgery, large fascial defects, presence of comorbidities, perioperative steroids and wound infection. In these situations use of synthetic mesh may be best avoided until conditions are more favorable.