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Practice patterns in complex ventral hernia repair and place of biological grafts: A national survey among French digestive academic surgeons - 01/01/14

Doi : 10.1016/j.jviscsurg.2013.12.001 
C. Mariette a, , P. Wind b, R. Micelli Lupinacci c, C. Tresallet c, M. Adham d, C. Arvieux e, S. Benoist f, S. Berdah g, A. Berger h, N. Briez a, C. Brigand i, R. Caiazzo j, N. Carrere k, C. Casa l, D. Collet m, S. Deguelte n, B. Dousset o, V. Dubuisson p, O. Glehen q, J.-C. Gineste r, A. Hamy l, F. Lacaine s, C. Laurent r, P.-A. Lehur t, J.-Y. Mabrut u, P. Mathieu v, M. Mathonnet w, B. Meunier x, F. Michot y, M. Ouaissi z, J.-P. Palot n, Y. Parc aa, F. Pattou j, F. Paye aa, D. Pezet ab, G. Piessen a, M. Pocard ac, N. Regenet t, J.-M. Regimbeau ad, C. Sabbagh ad, P. Zerbib ae, J.-M. Toussaint af
a Department of digestive and oncological surgery, Claude-Huriez University Hospital, place de Verdun, 59037 Lille cedex, France 
b Department of digestive surgery, University Hospital of Avicennes, Avicennes, France 
c Department of digestive surgery, University Hospital Pitié-Salpétrière, Paris, France 
d Department of digestive surgery, University Hospital E.-Herriot, Lyon, France 
e Department of digestive surgery, University Hospital of Grenoble, Grenoble, France 
f Department of digestive surgery, University Hospital of Kremlin-Bicêtre, Le Kremlin-Bicêtre, France 
g Department of digestive surgery, Nord University Hospital, Marseille, France 
h Department of digestive surgery, Georges-Pompidou European University Hospital, Paris, France 
i Department of digestive surgery, University Hospital of Strasbourg, Strasbourg, France 
j Department of visceral and endocrine surgery, University Hospital of Lille, Lille, France 
k Department of digestive surgery, University Hospital of Toulouse, Toulouse, France 
l Department of digestive surgery, University Hospital of Angers, Angers, France 
m Department of digestive surgery, Haut-Leveque University Hospital, Bordeaux, France 
n Department of digestive surgery, University Hospital of Reims, Reims, France 
o Department of digestive surgery, Cochin University Hospital, Paris, France 
p Department of digestive surgery, Pellegrin University Hospital, Bordeaux, France 
q Department of digestive surgery, Lyon-Sud University Hospital, Lyon, France 
r Department of digestive surgery, Saint-André University Hospital, Bordeaux, France 
s Department of digestive surgery, Tenon University Hospital, Paris, France 
t Department of digestive surgery, University Hospital of Nantes, Nantes, France 
u Department of digestive surgery, Croix-Rousse University Hospital, Lyon, France 
v Department of digestive surgery, University Hospital of Besançon, Besançon, France 
w Department of digestive surgery, University Hospital of Limoges, Limoges, France 
x Department of digestive surgery, University Hospital of Rennes, Rennes, France 
y Department of digestive surgery, University Hospital of Rouen, Rouen, France 
z Department of digestive surgery, Timone University Hospital, Marseille, France 
aa Department of digestive surgery, Saint-Antoine University Hospital, Paris, France 
ab Department of digestive surgery, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France 
ac Department of digestive surgery, Lariboisière University Hospital, Paris, France 
ad Department of digestive surgery, Amiens University Hospital, Amiens, France 
ae Department of general surgery and transplantation, University Hospital of Lille, Lille, France 
af Hull Associates, Medtech consulting, 100 Ledgewood Place, Suite 204, Rockland, Massachusetts 02370, USA 

Corresponding author. Tel.: +33 3 20 44 44 07; fax: +33 3 20 44 43 85.

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Summary

Background

Despite the prevalence of complex ventral hernias, there is little agreement on the most appropriate technique or prosthetic to repair these defects, especially in contaminated fields. Our objective was to determine French surgical practice patterns among academic surgeons in complex ventral hernia repair (CVHR) with regard to indications, most appropriate techniques, choice of prosthesis, and experience with complications.

Methods

A survey consisting of 21 questions and 6 case-scenarios was e-mailed to French practicing academic surgeons performing CVHR, representing all French University Hospitals.

Results

Forty over 54 surgeons (74%) responded to the survey, representing 29 French University Hospitals. Regarding the techniques used for CVHR, primary closure without reinforcement was provided in 31.6% of cases, primary closure using the component separation technique without mesh use in 43.7% of cases, mesh positioned as a bridge in 16.5% of cases, size reduction of the defect by using aponeurotomy incisions without mesh use in 8.2% of cases. Among the 40 respondents, 36 had experience with biologic mesh. There was a strong consensus among surveyed surgeons for not using synthetic mesh in contaminated or dirty fields (100%), but for using it in clean settings (100%). There was also a strong consensus between respondents for using biologic mesh in contaminated (82.5%) or infected (77.5%) fields and for not using it in clean setting (95%). In clean-contaminated surgery, there was no consensus for defining the optimal therapeutic strategy in CVHR. Infection was the most common complication reported after biologic mesh used (58%). The most commonly reported influences for the use of biologic grafts included literature, conferences and discussion with colleagues (85.0%), personal experience (45.0%) and cost (40.0%).

Conclusions

Despite a lack of level I evidence, biologic meshes are being used by 90% of surveyed surgeons for CVHR. Importantly, there was a strong consensus for using them in contaminated or infected fields and for not using them in clean setting. To better guide surgeons, prospective, randomized trials should be undertaken to evaluate the short- and long-term outcomes associated with these materials in various surgical wound classifications.

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Keywords : Ventral hernia repair, Contaminated field, Abdominal wall reconstruction, Prosthetic, Biologic mesh, Survey


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