Abstract | BACKGROUND: A mesh-related intestinal fistula is an uncommon and challenging complication of ventral hernia repair. Optimal management is unclear owing to lack of prospective or long-term data. METHODS: RESULTS: Eighty-two mesh-related intestinal fistulas were treated; none of the fistulas had closed spontaneously, and all fistula persisted at the time of our treatment. Mean age was 61 ± 12 years with 33-month follow-up. Comorbidities were similar between groups. Defects were 2.5-times larger in ventral hernia repair with mesh (324 ± 392 cm2 vs 1301 ± 133 cm2; P = .044). Components separation (64% vs 21%; P = .0003) and panniculectomy (35% vs 7%; P = .0074) were more common in ventral hernia repair with mesh. Mortality occurred in 4 patients. Complications were similar. In patients undergoing ventral hernia repair with non-bridged, acellular, porcine dermal matrix, hernia recurrence was less than in patients without mesh (26% vs 66%; P = .0030). Only partial excision of the mesh involved with the fistula resulted in a substantial increase in developing another fistula (29% vs 6%; P < .05). CONCLUSION:
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Authors | Michael R Arnold, Angela M Kao, Javier Otero, Julia E Marx, Vedra A Augenstein, Ronald F Sing, Paul D Colavita, Kent Kercher, B Todd Heniford |
Journal | Surgery
(Surgery)
Vol. 167
Issue 3
Pg. 590-597
(03 2020)
ISSN: 1532-7361 [Electronic] United States |
PMID | 31883631
(Publication Type: Journal Article)
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Copyright | Copyright © 2019 Elsevier Inc. All rights reserved. |
Topics |
- Aged
- Animals
- Female
- Follow-Up Studies
- Hernia, Ventral
(prevention & control, surgery)
- Herniorrhaphy
(adverse effects, instrumentation, methods)
- Humans
- Incidence
- Intestinal Fistula
(epidemiology, etiology, prevention & control, surgery)
- Male
- Middle Aged
- Postoperative Complications
(epidemiology, etiology, prevention & control, surgery)
- Prospective Studies
- Recurrence
- Reoperation
(adverse effects, instrumentation, methods)
- Secondary Prevention
(instrumentation, methods)
- Surgical Mesh
(adverse effects)
- Suture Techniques
(adverse effects)
- Treatment Outcome
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