Clinical Study Of Repairing Large Abdominal Wall Defect With Multi-layer Mesh Bridging Technique

Objective With the rapid development of medical technology,the complications of abdominal wall defect in surgical patients are gradually increasing.The integrity of abdominal wall is vital for human physiological to function properly.When abdominal wall defect occurs,it can easily lead to varieties of systemic disorders.At present,the only cure for abdominal wall defect is through surgery.The use of mesh had provided important help in the repair of abdominal wall defect.However,the possible complications after mesh repair such as infection,rejection and recurrence are issues that requires close clinical attention.The purpose of this study was to investigate the clinical efficacy of double-layer mesh(synthetic+biological)and“sandwich”mesh(synthetic+biological+omentum flaps)bridging technique in the repair of large abdominal wall defect patients to provide a reference for the selection of surgical methods in clinical practice.Methods The clinical data of patients with large abdominal wall defect after extensive resection of abdominal neoplasms or patients with acquired large abdominal wall defect who underwent multi-layer mesh bridging technique in Hernia and Abdominal Wall Disease Center of Shanghai Ninth People’s Hospital affiliated to the Shanghai Jiao Tong University School of Medicine between November 2015 to February 2019 were enrolled.Patients were divided into double-layer group(synthetic+biological)and“sandwich”group(synthetic+biological+omentum flaps)according to different surgical methods.The intraoperative,postoperative complications and recurrence rate were compared and analyzed.Results All 23 patients underwent the operation successfully without perioperative death and serious complications,including 12 cases of double-layer group and 11 cases of“sandwich”group.The mean abdominal wall defect area was(211.50±91.01)cm~2 in double-layer group,(359.82±203.96)cm~2 in“sandwich”group,there were significant difference(P=0.044);mean operation time was(6.92±2.19)hours in double-layer group and(5.18±1.17)hours in“sandwich”group,there were no significant difference(P=0.154).There were 6 cases of seroma in double-layer group and 1 case in“sandwich”group with a significant difference(P=0.033).In double-layer group there were 1 case of infection,3 cases of subcutaneous effusion,whereas in the“sandwich”group there were 1 case of hematoma,1 case of subcutaneous effusion and 1 case of incomplete intestinal obstruction.There was significant difference in total short-term complication rate between the two group(P=0.021).The average follow-up time of double-layer group was(10.33±6.47)months and“sandwich”group was(8.09±3.51)months.No complications occurred such as abdominal wall defect recurrence、bulging or chronic pain in all patients.Conclusions The“sandwich”mesh bridging technique based on omentum flap can effectively reduce postoperative complication rate,it is a new,safe and effective alternative repair method for large abdominal wall defect,but further long-term follow-up and more cases are needed to assess the reliability of this technique.