Ventral Hernia Mesh Repair

Giant omphalocele are defects larger than 10 centimeters encompassing the liver within the defect with a total loss of abdominal cavity domain. Babies born with giant omphalocele are seldom closed primarily during the neonatal due to the development of abdominal compartment syndrome, compression of the inferior vena cava  and suprahepatic veins leading to multisystemic organ failure and death. The defect is covered with some bacteriostatic ointment and the amnion left to granulate creating neoskin as simple cover. Once the defect is covered with the growing skin the hernia is closed either using a prosthetic mesh, component separation or primarily. Primary repair has a 25-52% recurrence rate and is used for small < 5 cm defect. The component separation technique (CST) enlarges the abdominal wall surface by translation of the muscular layer without compromising the blood supply and innervation of the muscles. A longitudinal cut is made in the external aponeurotic fascia lateral to the rectum encompassing closure in the midline. This can be used when closing hernias between 5 and 10 cm in diameter. CST technique has a 33% of wound complications and 30% re-herniation rate. Transection of the perforating branches of the epigastric artery interfere with the blood supply of the skin of the ventral abdominal wall who will need collaterals from the intercostal artery and pudendal artery to survive. Prosthetic material can be synthetic or biologic. Prolene is a cheap synthetic mesh that creates adhesion, erosions and fistula. Biologic mesh are biodegradable unless process like cross-linking the collagen fibers take place. This extracellular material derived from human or other mammalian animal. Broad range of size helps repair larger hernia defects. Biologic mesh minimized adhesions between the mesh and viscera and incites fibrous tissue to grow and create a tough fascia with secure fixation of the mesh to the abdominal fascia. Biologic mesh are preferred to be placed underneath the peritoneal fascia (sub-lay or underlay). Biologic mesh should be biocompatible, non-toxic and nonimmunogenic. Neither antibiotic coverage nor subcutaneous drainage has an effect in the incidence of wound-related complications when placing this mesh.  

References:
1- Ladd AP, Rescorla FJ, Eppley BL: Novel Use of Acellular Dermal Matrix in the formtion of a Bioprosthetic Silo for Giant Omphalocele Coverage. J Pediatr Surg. 39(8): 1291-93, 2004
2- Pacilli M, Spitz L. Kiely EM, Curry J, Pierro A: Staged repair of giant omphalocele in the neonatal period. J Pediatr Surg. 40: 785-788, 2005
3-van Eijck FC, de Blaauw I, Bleichrodt RP, Rieu PN, van der Staak FH, Wijnen MH, Wijnen RM: Closure of giant omphaloceles by the abdominal wall component separation technique in infants. J Pediatr Surg. 43(1):246-50, 2008
4- Eltayeb AA, Ibrahim IA, Mohamed MB: The use of PROCEED mesh in ventral hernias: a pilot study on 22 cases. Afr J Paediatr Surg. 10(3):217-21, 2013
5- Lambropoulos V, Mylona E, Mouravas V, Tsakalidis C, Spyridakis I,  Mitsiakos G, Karagianni P: Repair of Postoperative Abdominal Hernia in a Child with Congenital Omphalocele Using Porcine Dermal Matrix. Case Rep Med. 2016;2016:1828751. doi: 10.1155/2016/1828751. Epub 2016 Mar 24.
6- Risby K, Jakobsen MS, Qvist N: Congenital Abdominal Wall Defects: Staged closure by Dual Mesh. J Neonatal Surg. 5(1):2, 2016



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