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Biological mesh is a safe and effective method of abdominal wall reconstruction in cytoreductive surgery for peritoneal malignancy

BACKGROUND: Patients with peritoneal malignancy often have multiple laparotomies before referral for cytoreductive surgery (CRS). Some have substantial abdominal wall herniation and tumour infiltration of abdominal incisions. CRS involves complete macroscopic tumour removal and hyperthermic intraper...

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Autores principales: Tzivanakis, A., Dayal, S. P., Arnold, S. J., Mohamed, F., Cecil, T. D., Venkatasubramaniam, A. K., Moran, B. J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley & Sons, Ltd 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254008/
https://www.ncbi.nlm.nih.gov/pubmed/30511047
http://dx.doi.org/10.1002/bjs5.93
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author Tzivanakis, A.
Dayal, S. P.
Arnold, S. J.
Mohamed, F.
Cecil, T. D.
Venkatasubramaniam, A. K.
Moran, B. J.
author_facet Tzivanakis, A.
Dayal, S. P.
Arnold, S. J.
Mohamed, F.
Cecil, T. D.
Venkatasubramaniam, A. K.
Moran, B. J.
author_sort Tzivanakis, A.
collection PubMed
description BACKGROUND: Patients with peritoneal malignancy often have multiple laparotomies before referral for cytoreductive surgery (CRS). Some have substantial abdominal wall herniation and tumour infiltration of abdominal incisions. CRS involves complete macroscopic tumour removal and hyperthermic intraperitoneal chemotherapy (HIPEC). Abdominal wall reconstruction is problematic in these patients. The aim of this study was to establish immediate and long‐term outcomes of abdominal wall reconstruction with biological mesh in a single centre. METHODS: A dedicated peritoneal malignancy database was searched for all patients who had biological mesh abdominal wall reconstruction between 2004 and 2015. Short‐ and long‐term outcomes were reviewed. All patients had annual abdominal CT as routine peritoneal malignancy follow‐up. RESULTS: Some 33 patients (22 women) with a mean age of 53·4 (range 19–82) years underwent abdominal wall reconstruction with biological mesh. The majority (23) had CRS for pseudomyxoma (19 low grade), six for colorectal peritoneal metastasis and four for appendiceal adenocarcinoma; 18 had undergone CRS and HIPEC previously. Twenty‐five of the 33 patients had abdominal wall tumour involvement and eight had concurrent hernias. The mean duration of surgery was 486 (range 120–795) min and the mean mesh size used was 345 (50–654) cm(2). Ten patients developed wound infections and four had a seroma. Two developed early enterocutaneous fistulas. Mean follow‐up was 48 months. Five patients developed an incisional hernia. Four died from progressive malignancy. A further 15 patients had disease recurrence, but only one had isolated abdominal wall recurrence. CONCLUSION: Biological mesh was safe and effective for abdominal wall reconstruction in peritoneal malignancy. Postoperative wound infections were frequent but nevertheless incisional hernia rates were low with no instances of mesh‐related bowel erosion or fistulation.
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spelling pubmed-62540082018-12-03 Biological mesh is a safe and effective method of abdominal wall reconstruction in cytoreductive surgery for peritoneal malignancy Tzivanakis, A. Dayal, S. P. Arnold, S. J. Mohamed, F. Cecil, T. D. Venkatasubramaniam, A. K. Moran, B. J. BJS Open Original Articles BACKGROUND: Patients with peritoneal malignancy often have multiple laparotomies before referral for cytoreductive surgery (CRS). Some have substantial abdominal wall herniation and tumour infiltration of abdominal incisions. CRS involves complete macroscopic tumour removal and hyperthermic intraperitoneal chemotherapy (HIPEC). Abdominal wall reconstruction is problematic in these patients. The aim of this study was to establish immediate and long‐term outcomes of abdominal wall reconstruction with biological mesh in a single centre. METHODS: A dedicated peritoneal malignancy database was searched for all patients who had biological mesh abdominal wall reconstruction between 2004 and 2015. Short‐ and long‐term outcomes were reviewed. All patients had annual abdominal CT as routine peritoneal malignancy follow‐up. RESULTS: Some 33 patients (22 women) with a mean age of 53·4 (range 19–82) years underwent abdominal wall reconstruction with biological mesh. The majority (23) had CRS for pseudomyxoma (19 low grade), six for colorectal peritoneal metastasis and four for appendiceal adenocarcinoma; 18 had undergone CRS and HIPEC previously. Twenty‐five of the 33 patients had abdominal wall tumour involvement and eight had concurrent hernias. The mean duration of surgery was 486 (range 120–795) min and the mean mesh size used was 345 (50–654) cm(2). Ten patients developed wound infections and four had a seroma. Two developed early enterocutaneous fistulas. Mean follow‐up was 48 months. Five patients developed an incisional hernia. Four died from progressive malignancy. A further 15 patients had disease recurrence, but only one had isolated abdominal wall recurrence. CONCLUSION: Biological mesh was safe and effective for abdominal wall reconstruction in peritoneal malignancy. Postoperative wound infections were frequent but nevertheless incisional hernia rates were low with no instances of mesh‐related bowel erosion or fistulation. John Wiley & Sons, Ltd 2018-08-02 /pmc/articles/PMC6254008/ /pubmed/30511047 http://dx.doi.org/10.1002/bjs5.93 Text en © 2018 The Authors. BJS Open published by John Wiley & Sons Ltd on behalf of BJS Society Ltd This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Tzivanakis, A.
Dayal, S. P.
Arnold, S. J.
Mohamed, F.
Cecil, T. D.
Venkatasubramaniam, A. K.
Moran, B. J.
Biological mesh is a safe and effective method of abdominal wall reconstruction in cytoreductive surgery for peritoneal malignancy
title Biological mesh is a safe and effective method of abdominal wall reconstruction in cytoreductive surgery for peritoneal malignancy
title_full Biological mesh is a safe and effective method of abdominal wall reconstruction in cytoreductive surgery for peritoneal malignancy
title_fullStr Biological mesh is a safe and effective method of abdominal wall reconstruction in cytoreductive surgery for peritoneal malignancy
title_full_unstemmed Biological mesh is a safe and effective method of abdominal wall reconstruction in cytoreductive surgery for peritoneal malignancy
title_short Biological mesh is a safe and effective method of abdominal wall reconstruction in cytoreductive surgery for peritoneal malignancy
title_sort biological mesh is a safe and effective method of abdominal wall reconstruction in cytoreductive surgery for peritoneal malignancy
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254008/
https://www.ncbi.nlm.nih.gov/pubmed/30511047
http://dx.doi.org/10.1002/bjs5.93
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