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Lightweight vs Midweight Polypropylene Mesh in 948 Open Ventral Hernia Repairs (OVHR)
Vol. 221, No. 4S1, October 2015
Scientific Forum Abstracts
overall infections in patients with considerably elevated HbA1c (8.0% HbA1c; OR 1.37; 95% CI, 0.69-2.70; p¼0.37). CONCLUSIONS: Elevated preoperative HbA1c is not significantly associated with postoperative infections. Lightweight vs Midweight Polypropylene Mesh in 948 Open Ventral Hernia Repairs (OVHR) Laurel J Blair, MD, Ciara Huntington, MD, Tiffany C Cox, MD, Tanushree Prasad, Amy E Lincourt, PhD, MBA, Vedra A Augenstein, MD, FACS, B Todd Heniford, MD, FACS Carolinas Medical Center, Charlotte, NC INTRODUCTION: In 2005, lightweight mesh (LWM) was introduced with the promise of improved quality of life (QOL) and equal recurrence rates. Little information proving or denying either has been put forth. Our aim was to compare the long-term outcomes of LWM vs mid-weight mesh (MWM) in open ventral hernia repair (OVHR). METHODS: Prospective data were collected from 2000 to 2014 for all elective OVHR using synthetic LWM or MWM. Emergent, contaminated, and non-LWM or MWM operations were excluded. Carolinas Comfort Scale (QOL) was recorded at 1, 6, and 12 months. Statistical evaluation included Pearson’s chi-square, Fisher’s exact tests, and Wilcoxon 2-sample tests. RESULTS: There were 948 OVHRs, 400 LWM, and 548 MWM. The MWM patients tended to be more complex than LWM patients, with longer operative times, larger defects requiring larger meshes and more component separations, more frequent panniculectomy, and longer inpatient stay (Table, p<0.0001). With 33.6 months average follow-up, despite the case complexity, MWM had fewer recurrences (0.55% vs 5.0%, p<0.0001). In obese patients, LWM had greater recurrence than MWM (5.9% vs 0.9%, p¼0.0015). However, even in nonobese patients, LWM patients continued to have higher recurrence rates (3.1% vs 0.0%, p¼0.01). There was no difference in rates of mesh infection or other postoperative complications (p>0.05)(Table). QOL scores were no different at 1, 6, or 12 months (p>0.05). Table. Patient Characteristics and Operative Details in Elective Open Ventral Hernia Repair, Lightweight vs Midweight Mesh Operative characteristics
Lightweight mesh
Midweight mesh
p Value
Operative time, min Defect size, cm2 Mesh size, cm2 Component separation, % Panniculectomy, % Length of stay days Seroma, % Hematoma, % Wound infection, % Mesh infection, %
154 92 91 135 584 476 13.0 19.6 4.8 6.6 5.0 0.75 4.0 0.3
182 84 201 228 772 438 35.8 29.4 6.0 4.6 7.7 0.36 6.4 1.5
<0.0001* <0.0001* <0.0001* <0.0001* 0.0005* <0.0001* 0.10 0.41 0.11 0.06
*p<0.05 considered significant.
S73
CONCLUSIONS: Lightweight mesh, commonly favored in OVHR based on anecdotal reports of improved postoperative QOL, has equivalent QOL in long-term follow-up and an increased long-term failure rate compared with OVHR with MWM. Despite increased complexity in the MWM group, LWM demonstrates no clinical or QOL advantages and therefore should not be used for OVHR. Liposomal Bupivicaine Reduces Narcotic Use and Time to Flatus in Patients Undergoing Laparotomy Atuhani S Burnett, MD, PhD, Brian Faley, PharmD., Donald A McCain, MD, PhD, FACS, Themba L Nyirenda, PhD, Zubin M Bamboat, MD Hackensack University Medical Center, Hackensack, NJ INTRODUCTION: Narcotic use after laparotomy can prolong ileus, length of stay, and increase complications and hospital costs. Development of a sustained release formulation of bupivacaine (Exparel, Pacira), is a novel option for pain control. Addition of Exparel to multimodal therapy (MMT) to optimize postoperative pain has never been studied. METHODS: Data were collected prospectively on 61 consecutive patients undergoing laparotomy for a variety of malignancies. All patients were treated with MMT consisting of IV acetominophen, Toradol (Roche), and morphine or Dilaudid (Purdue Pharma) patient-controlled analgesia (PCA). Thirty-one patients were additionally treated with 40 mL of Exparel infiltrated during fascial closure (Table). Endpoints were narcotic use, time to flatus, length of stay, and complications. RESULTS: Both groups had similar demographics, administration of acetominophen, Toradol, and complication rates. Average PCA use for the first 72 hours was 78 mg of morphine for the Exparel group and 112 mg in the control group (p¼0.04). When divided into 24-hour increments, immediate postoperative (0-24 hours) PCA use was similar between groups. However, PCA use for the Exparel group was decreased by 46% during the 24-48 hour period (p¼0.038), and again by 55% during the 48-72 hour period (p¼0.019). Time to flatus was decreased to 3.0 days in the Exparel group compared with 4.0 days in control group (p¼0.005). There was a trend toward shorter stay in the Exparel group (p¼0.83). Table. Average Postoperative Morphine Use Time period, h
0-24 24-48 48-72 0-72
MMT, mg (n¼30)
MMT + Exparel, mg (n¼31)
p Value
49.4 41.6 22.7 112
44.9 22.5 10.2 78
0.32 0.038 0.019 0.04
MMT, multimodal therapy.
CONCLUSIONS: Exparel use decreases postoperative narcotic use, time to flatus, and may reduce length of stay. Prospective randomized trials are needed to verify whether Exparel should be considered a standard component of MMT to minimize pain after laparotomy.
Scientific Forum Abstracts
overall infections in patients with considerably elevated HbA1c (8.0% HbA1c; OR 1.37; 95% CI, 0.69-2.70; p¼0.37). CONCLUSIONS: Elevated preoperative HbA1c is not significantly associated with postoperative infections. Lightweight vs Midweight Polypropylene Mesh in 948 Open Ventral Hernia Repairs (OVHR) Laurel J Blair, MD, Ciara Huntington, MD, Tiffany C Cox, MD, Tanushree Prasad, Amy E Lincourt, PhD, MBA, Vedra A Augenstein, MD, FACS, B Todd Heniford, MD, FACS Carolinas Medical Center, Charlotte, NC INTRODUCTION: In 2005, lightweight mesh (LWM) was introduced with the promise of improved quality of life (QOL) and equal recurrence rates. Little information proving or denying either has been put forth. Our aim was to compare the long-term outcomes of LWM vs mid-weight mesh (MWM) in open ventral hernia repair (OVHR). METHODS: Prospective data were collected from 2000 to 2014 for all elective OVHR using synthetic LWM or MWM. Emergent, contaminated, and non-LWM or MWM operations were excluded. Carolinas Comfort Scale (QOL) was recorded at 1, 6, and 12 months. Statistical evaluation included Pearson’s chi-square, Fisher’s exact tests, and Wilcoxon 2-sample tests. RESULTS: There were 948 OVHRs, 400 LWM, and 548 MWM. The MWM patients tended to be more complex than LWM patients, with longer operative times, larger defects requiring larger meshes and more component separations, more frequent panniculectomy, and longer inpatient stay (Table, p<0.0001). With 33.6 months average follow-up, despite the case complexity, MWM had fewer recurrences (0.55% vs 5.0%, p<0.0001). In obese patients, LWM had greater recurrence than MWM (5.9% vs 0.9%, p¼0.0015). However, even in nonobese patients, LWM patients continued to have higher recurrence rates (3.1% vs 0.0%, p¼0.01). There was no difference in rates of mesh infection or other postoperative complications (p>0.05)(Table). QOL scores were no different at 1, 6, or 12 months (p>0.05). Table. Patient Characteristics and Operative Details in Elective Open Ventral Hernia Repair, Lightweight vs Midweight Mesh Operative characteristics
Lightweight mesh
Midweight mesh
p Value
Operative time, min Defect size, cm2 Mesh size, cm2 Component separation, % Panniculectomy, % Length of stay days Seroma, % Hematoma, % Wound infection, % Mesh infection, %
154 92 91 135 584 476 13.0 19.6 4.8 6.6 5.0 0.75 4.0 0.3
182 84 201 228 772 438 35.8 29.4 6.0 4.6 7.7 0.36 6.4 1.5
<0.0001* <0.0001* <0.0001* <0.0001* 0.0005* <0.0001* 0.10 0.41 0.11 0.06
*p<0.05 considered significant.
S73
CONCLUSIONS: Lightweight mesh, commonly favored in OVHR based on anecdotal reports of improved postoperative QOL, has equivalent QOL in long-term follow-up and an increased long-term failure rate compared with OVHR with MWM. Despite increased complexity in the MWM group, LWM demonstrates no clinical or QOL advantages and therefore should not be used for OVHR. Liposomal Bupivicaine Reduces Narcotic Use and Time to Flatus in Patients Undergoing Laparotomy Atuhani S Burnett, MD, PhD, Brian Faley, PharmD., Donald A McCain, MD, PhD, FACS, Themba L Nyirenda, PhD, Zubin M Bamboat, MD Hackensack University Medical Center, Hackensack, NJ INTRODUCTION: Narcotic use after laparotomy can prolong ileus, length of stay, and increase complications and hospital costs. Development of a sustained release formulation of bupivacaine (Exparel, Pacira), is a novel option for pain control. Addition of Exparel to multimodal therapy (MMT) to optimize postoperative pain has never been studied. METHODS: Data were collected prospectively on 61 consecutive patients undergoing laparotomy for a variety of malignancies. All patients were treated with MMT consisting of IV acetominophen, Toradol (Roche), and morphine or Dilaudid (Purdue Pharma) patient-controlled analgesia (PCA). Thirty-one patients were additionally treated with 40 mL of Exparel infiltrated during fascial closure (Table). Endpoints were narcotic use, time to flatus, length of stay, and complications. RESULTS: Both groups had similar demographics, administration of acetominophen, Toradol, and complication rates. Average PCA use for the first 72 hours was 78 mg of morphine for the Exparel group and 112 mg in the control group (p¼0.04). When divided into 24-hour increments, immediate postoperative (0-24 hours) PCA use was similar between groups. However, PCA use for the Exparel group was decreased by 46% during the 24-48 hour period (p¼0.038), and again by 55% during the 48-72 hour period (p¼0.019). Time to flatus was decreased to 3.0 days in the Exparel group compared with 4.0 days in control group (p¼0.005). There was a trend toward shorter stay in the Exparel group (p¼0.83). Table. Average Postoperative Morphine Use Time period, h
0-24 24-48 48-72 0-72
MMT, mg (n¼30)
MMT + Exparel, mg (n¼31)
p Value
49.4 41.6 22.7 112
44.9 22.5 10.2 78
0.32 0.038 0.019 0.04
MMT, multimodal therapy.
CONCLUSIONS: Exparel use decreases postoperative narcotic use, time to flatus, and may reduce length of stay. Prospective randomized trials are needed to verify whether Exparel should be considered a standard component of MMT to minimize pain after laparotomy.