Page 62 - Read Online

Page 8 of 9 Alimi et al. Plast Aesthet Res 2020;7:5 I http://dx.doi.org/10.20517/2347-9264.2019.39

Table 7. Review of outcomes by mesh plane location with the use of biologic mesh [15]
Biologic mesh Onlay Inlay Sublay (Retromuscular) Sublay (Intraperitoneal/Preperitoneal) P value
Infection 21.3% 23.3% 18.1% 19.2% 0.814
Seroma/Hematoma 32.3% 10.8% 11.2% 8.0% < 0.001
Mesh removal 0.0% 0.0% 1.6% 0.5% 0.359
Recurrence 28.6% 29.1% 11.6% 11.2% 0.016
Overall complication 57.3% 54.2% 40.9% 40.9% 0.197

CONCLUSION
Half a million patients undergo ventral hernia repair annually in the United States as a result of incisional
hernias, failed repairs, de novo abdominal wall defects, and abdominal catastrophes. Although the standard
approach of hernia repair has been well studied, the ideal anatomic location of mesh placement is still
highly debated. Sosin et al.’s systematic review of mesh placement found that anatomic location can
[15]
change outcomes in hernia recurrence. Analysis of 51 articles showed that, of the four mesh techniques,
namely onlay, interposition, sublay-retromuscular, and sublay-preperitoneal/sublay-peritoneal, the sublay-
retromuscular approach is associated with the lowest recurrence rate, whereas the interposition technique
is associated with the highest recurrence rate. There was no statistical difference in other complication
rates among the four groups, which included postoperative infection, hematoma/seroma formation,
mesh explantation, and mortality. Overwhelmingly, the inlay placement of mesh is the least favored and
should be avoided if possible. In the minimally invasive approach, both robotically and laparoscopically,
the sublay-preperitoneal/sublay-intraperitoneal repair has proven very useful with similar perioperative
complications and recurrence rates. In regards to mesh selection, in accordance with the recommendations
of the VHWG, we recommend that all ventral hernias be reinforced with mesh regardless of whether the
[22]
midline fascia can be reapproximated . While strong recommendations for the use of synthetic versus
biologic mesh are unclear in patients with VHWG Grades 2 and 3, biologic mesh’s benefit is clear in grossly
contaminated wounds and synthetic mesh is recommended in VHWG Grade 1 patients.

DECLARATIONS
Authors’ contributions
Conceived the concept of the review and are the primary authors of the manuscript: Alimi Y, Bhanot P
Performed significant writing and review of the final manuscript: Merle C
Provided feedback, essential data gathering and review of the manuscript: Sosin M
Provided principal figures in the article: Mahan M
All authors read and approved the final manuscript.

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared no conflicts of interest. Dr. Parag Bhanot is a consultant to Allergan.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.