Early outcomes of contaminated midline incisional hernia repair with mesh suture.

Abstract

Purpose: Mesh suture is a novel reinforcement construct designed to provide enhanced mechanical support during midline fascial closure in comparison to conventional sutures while minimizing tissue dissection and foreign body burden in comparison to use of a planar mesh. Its use in contaminated fields remains understudied. This study evaluates the early clinical outcomes following mesh suture closure in clean-contaminated and contaminated incisional hernia repairs.

Methods: A retrospective review was conducted of patients undergoing incisional hernia repair with mesh suture closure between January 2023 and July 2024 across an academic health system. Eligible patients had clean-contaminated or contaminated wounds and underwent mesh suture implantation without planar mesh. Data included demographics, operative details, surgical site infections (SSI), surgical site occurrences (SSO), reoperations, readmissions, and hernia recurrence. Hernia recurrence-free survival was estimated using Kaplan-Meier analysis. Major complications were defined as surgical complication or reoperation within 90 days.

Results: Fifty-one patients were included, with repairs performed by 22 surgeons. Most patients (62.7%) had clean-contaminated wounds. Anterior component separation was performed in 25.5% of cases. The 90-day SSI rate was 15.7%, with five patients requiring procedural intervention. The 90-day SSO rate was 23.5% and included one enterocutaneous fistula that resolved without surgical intervention. Readmission occurred in 27.4% of patients, and 9.8% underwent reoperation. Four hernia recurrences were observed (8.2%), with a 12-month recurrence-free survival of 91% and a mean recurrence-free survival of 17.3 months (95% CI: 16.5-18.1). Presence of a stoma was significantly associated with major complications (p = 0.041).

Conclusion: Mesh suture closure was technically feasible across diverse surgical settings and demonstrated encouraging SSI and SSO rates as compared to conventional suture only and planar mesh-based repairs as reported in the literature. These findings support further investigation in prospective, comparative studies to assess long-term durability and comparative effectiveness.