Incisional Hernia Incidence, Repair Techniques and Outcomes Based on 1,613 Patients Receiving Abdominally-Based Autologous Breast Reconstruction
Irfan A. Rhemtulla, MD, MS, Robyn Broach, PhD, Fabiola A. Enriquez, BA, Joseph M. Serletti, MD, Stephen J. Kovach, MD.
University of Pennsylvania, Philadelphia, PA, USA.
PURPOSE: As the number of post-mastectomy patients who receive abdominally-based autologous breast reconstruction (ABABR) increases, the frequency of a very unique paramedian incisional hernia (IH) at the donor site is increasing as well. We assessed incidence, repair techniques and outcomes for these patients in order to determine the optimal treatment for this morbid condition.
METHODS: 1,613 consecutive patients who underwent ABABR at the University of Pennsylvania between January 1, 2009 and August 31, 2016 were retrospectively identified. Pre-operative and operative information was collected for these patients. IH incidence, IH repair techniques and post-operative outcomes for all patients receiving IH repair after ABABR at our institution were also determined (21.9 months mean follow-up).
RESULTS: The IH rate after ABABR in our health system was 3.22% (n=52). 15 additional patients were referred from outside hospitals for a total of 67 patients who received IH repair during the study period. Mesh was used in 81% (n=54) of cases, with synthetics (n=40) having significantly lower recurrent IH rates (p<0.01), surgical site infections (SSI) (p=0.03), and reoperations (p<0.01) compared to biologics. Underlay placement was most common (n=29) but had the highest post-operative complications (20.7% recurrent IH, 13.8% SSI, 27.6% reoperation). Retrorectus placement (n=10) had zero post-operative complications and recurrent IHs.
CONCLUSION: Mesh should be used in all cases when possible. Although retrorectus repair with synthetic mesh is optimal, this plane is often non-existent or too scarred-in after ABABR. Thus, intra-peritoneal underlay mesh with primary fascial closure is the next technique that should be considered.
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