SSAT - Optimizing Outcomes of Complex Ventral Hernia Repairs Using a Sandwich Reconstruction Technique With Novel Hybrid-Vac Closure

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Optimizing Outcomes of Complex Ventral Hernia Repairs Using a Sandwich Reconstruction Technique With Novel Hybrid-Vac Closure
Pablo a. Baltodano^*, Kevin C. Soares, Caitlin W. Hicks, Karen K. Burce, Peter Cornell, Carisa M. Cooney, Frederick E. Eckhauser
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD

Background: Dual layer (sandwich) reconstruction for complex ventral hernia repair (VHR) may reduce hernia recurrence rates, but with an increased risk of surgical site occurrences (SSOs) and infections (SSIs). Previously, we demonstrated that a modified negative pressure wound therapy (Hybrid-VAC) system can decrease SSO and SSI rates following VHR with overlay mesh. In the present study, we describe postoperative outcomes following VHR with sandwich reconstruction using the Hybrid-VAC system.
Methods: We conducted a retrospective review of all complex sandwich ventral hernia repairs (biologic mesh underlay and synthetic mesh overlay) with Hybrid-VAC system closure performed at our institution by a single surgeon (11/2010 through 01/2013). All patients had fascial defects that could not be re-approximated primarily utilizing components separation technique or other accepted adjuncts. Descriptive statistics were used to portray the incidence of SSOs, SSIs, major post-operative morbidity, readmission, reoperation, and hernia recurrence.
Results: Twenty-six patients (57.8 ± 12.0 years, 42.3% male, mean follow-up 6.7 months) with complex ventral hernias underwent sandwich reconstruction with Hybrid-VAC closure during the 3-year study period (Table 1). Major-post-operative morbidity (Dindo-Clavien class ≥3) occurred in 8 (30.8%) patients, but incidence of SSO (n=6, 23.1%) and SSI (n=1, 3.9%) was low compared to historical reports. Hernia recurrence was limited to one patient (3.9%), and occurred at 10.7 months secondary to SSO.
Conclusion: As previously described, use of a dual layer sandwich repair technique for complex abdominal wall reconstruction is associated with low rates of hernia recurrence. The addition of a Hybrid-VAC closure system may reduce the risk of SSOs and SSIs previously reported with the sandwich technique, and deserves consideration in future prospective studies assessing optimization of VHR approaches.

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