Impact of pericardium bovine patch (Tutomesh®) on incisional hernia treatment in contaminated or potentially contaminated fields: retrospective comparative study

Abstract

This retrospective comparative study analyzes the outcome of patients affected by incisional hernia in potentially contaminated or contaminated field, treated by three operative techniques. 152 patients (62 M:90 F; mean age 65 ± 14 years) underwent incisional hernia repair (January 2002–January 2012) in complicated settings. Criteria of inclusion in the study were represented by the following causes of admission: mesh rejection/infection, obstruction without gangrene but with possible peritoneal bacterial translocation, obstruction with gangrene, enterocutaneous fistula or simultaneous presence of ileo- or colostomy. The patients were divided into three groups: A (n = 76), treated with primary closure technique; B and C (n = 38 each), with reinforcement by synthetic or pericardium bovine mesh (Tutomesh^®), respectively. The prosthetic groups were divided into Onlay and Sublay subgroups. Significant decreases in C vs A were observed for wound infection (3 vs 37 %) and recurrence (0 vs 14 %), and in C vs B for wound infection (3 vs 53 %), seroma (0 vs 34 %) and recurrence (0 vs 16 %). Patients with concomitant bowel resection (BR) (43 %) showed (all P < 0.05) an increase of overall morbidity (55 vs 33 %) and wound infection rate (42 vs 24 %) compared to cases without BR. Morbidity presented no significant differences in C-Onlay or Sublay subgroups. B-Sublay subgroup has (all P < 0.05) lower overall morbidity (20 vs 75 %), wound infection (10 vs 68 %) and seroma (0 vs 46 %) than B-Onlay. The pericardium bovine patch seems to be safe and effective to successfully repair ventral hernia in potentially contaminated operative fields, especially in association with bowel resection.