SSAT - Outcomes in High Risk, Grade 3 Ventral Hernia Repairs Using Hybrid-VAC Closure: a Single Institution Analysis

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Outcomes in High Risk, Grade 3 Ventral Hernia Repairs Using Hybrid-VAC Closure: a Single Institution Analysis
Kevin C. Soares^*, Pablo a. Baltodano, Nelson a. Rodriguez, Caitlin W. Hicks, SaïD C. Azoury, Carisa M. Cooney, Karen K. Burce, Peter Cornell, Frederick E. Eckhauser

Johns Hopkins Hospital, Baltimore, MD

Objectives: Previously we reported decreased surgical site complications with the implementation of a modified negative pressure wound therapy (HVAC) system after ventral hernia repair (VHR). However, the impact of HVAC in high risk VHRs remains unknown. Therefore, we evaluated outcomes in a high risk, potentially contaminated ventral hernia patient cohort paired with HVAC closure.
Methods: We retrospectively reviewed a prospectively maintained database for all modified ventral hernia working group (VHWG) grade 3 ventral hernias. All repairs were performed by a single surgeon. Thirty-day outcome measures included surgical site infections (SSIs), surgical site occurrences (SSOs), morbidity, and reoperation rates.
Results: We evaluated 108 patients between 2011-2014. Mean follow up was 6.2 months. The mean age was 57.1 years and 55% of patients were female. The mean BMI was 35.5 kg/m2 and 63% of patients were ASA class III or above. Twenty-six (24.1%) patients had a history of wound infection and 64.8% were recurrent ventral hernias. The mean defect size was 208.7 cm2. SSOs were seen in 21.3% of patients. This included 7 (6.5%) SSIs (all superficial) and 12 (11.1%) seromas. Approximately 11% of patients experienced Dindo-Clavien classification complication grades of 3 or above. Six patients (5.6%) required a reoperation, all of which were secondary to wound complications. Eleven (10.2%) patients were readmitted to the hospital. The wound-related readmission rate was 8.3%. Ventral hernia recurrence rate was 4.7% and there were no mortalities.
Conclusions: Modified VHWG grade 3 ventral hernias are associated with significant morbidities and are historically associated with elevated SSO rates. The use of the HVAC closure system in these hernia repairs may reduce the risk of surgical site complications. Further prospective studies are warranted to validate these findings.

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