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PWE-230 The exaggerated inflammatory response to large incisional hernia and enterocutaneous fistula repair with biological mesh
  1. J Clarke1,
  2. H Thomson2,
  3. A Windsor2,
  4. J McCullough2
  1. 1Department of Surgery and Cancer, Imperial College London
  2. 2University College London Hospitals NHS Foundation Trust, London, UK

Abstract

Introduction Biological meshes are increasingly used in the repair of complex, large incisional hernias, particularly in the context of a contaminated surgical field. In our centre it was noted that patients displayed an exaggerated and prolonged inflammatory response on post-operative blood results in comparison to other similar surgical procedures. This study aims to investigate the post-operative inflammatory response in patients undergoing placement of large biological meshes for the repair of large incisional hernias or enterocutaneous fistulae.

Method Post-operative white blood cell count (WCC) and complement reactive protein (CRP) levels were recorded on the first five post-operative days for a consecutive cohort of patients following repair of large ventral or incisional hernias with or without repair of enterocutaneous fistulae. The mesh size and the presence of component separation was also recorded. Post-operative WCC and CRP data was collected for a size-matched contemporaneous, consecutive control group of patients undergoing open colorectal resections for a diagnosis of colorectal cancer. Post-operative inflammatory responses were compared.

Results 41 patients underwent a large ventral hernia repair using biologic mesh, of which 16 (39.0%) underwent simultaneous repair of an enterocutaneous fistula. 27 (65.9%) underwent component separation. Post-operative CRP was significantly higher in patients in the hernia group on the third (188 vs. 133) and fourth (188 vs. 117) post-operative days (p < 0.01). There was no significant difference in WCC on either day. The CRP response was not significantly different between groups by the fifth post-operative day. Repair of enterocutaneous fistulae was associated with significantly increased CRP levels on the third and fourth post-operative day when compared to hernia repair alone. There was a positive correlation between mesh area (mean area = 183cm2) and CRP level on the third post-operative day (Pearson’s r = 0.42).

Conclusion Patients undergoing large ventral hernia repairs using biological mesh display an exaggerated and prolonged inflammatory response in comparison to open colorectal cancer resections. The inflammatory response is no different between groups by the fifth post-operative day. This data suggests that an exaggerated inflammatory response should be expected in such procedures and that normalisation of inflammatory markers ought to be expected by the fifth post-operative day.

Disclosure of interest None Declared.

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