An Innovative Ventral Hernia Repair – Use of Onlay Mesh with Antibiotic Beads in Suboptimal Operative Candidates with High-Risk Hernias

Introduction: There are many well described approaches to symptomatic hernia management; however, there remains a significant patient population with limited options for a durable ventral hernia repair with reasonable risk of infection and recurrence. Drawing from orthopedic literature, we changed our approach to this clinical problem and developed a palliative ventral herniorrhaphy pathway. Methods: An IRB approved retrospective review (January 2017-June 2019) of patients’ palliative ventral herniorrhaphy was performed. Results: 43 patients included with female preponderance (58.6%) , mean age 61.5 years. The mean BMI was 38.1kg/m2 (IQR: 25.4-62) and 28 patients (65.1%) had a history of prior wound/mesh infection. Repair within 48 hours was performed in 14 patients. Overall polypropylene prosthetic was implanted in 26 patients, and bioprosthetic/absorbable mesh was used in the remaining; , the mean surface area of implanted mesh was 561 cm2. The most common wound complications identified were skin separation (30.2%) and seroma formation (48.8%). Hernia recurrence occurred in 4 (9.3%) patients with mean followup 24.1 months (9-37). Three patients had central lightweight mesh rupture and 1 had recurrence (bioprosthetic mesh); all were subsequently repaired. Conclusion: Despite a small volume of patients, our palliative ventral hernia repair pathway offers durable repair with an acceptable risk of recurrence and mesh infection in patients who would otherwise be considered non-operative. Local surgical site complications were frequent but did not appear to affect the risk of recurrence or long-term complications.