Outcomes after ventral mesh removal: a multicentric cohort study

Abstract Purpose In case of infection, recurrence, chronic pain or acute bowel obstruction, removal of a ventral mesh might be necessary. While infrequent, ventral mesh removal can be associated with important postoperative morbidity. The aim of this study was to assess if postoperative major complications occurred more frequently after removal of an intraperitoneal mesh compared to a retromuscular mesh. Methods A retrospective cohort study was performed. Patients from 3 centers in France were included. Patients were included if they underwent removal of a ventral mesh for any reason and if older than 18. Patients with intraperitoneal and retromuscular meshes were compared. Overall and major (≥grade 3a) complications were defined according to the Clavien-Dindo classification. The primary endpoint was the rate of major complications. Results A total of 101 patients were included (50 women, 50%; median age 63, IQR 53–72; median body mass index 29, IQR 27–32; 20 active smokers, 20%; 35 diabetic patients, 35%). Intraperitoneal mesh was present in 74 patients (73%), retromuscular mesh in 22 patients (22%), and subcutaneous mesh in 5 patients (5%). Postoperative complications occurred in 40 patients in the intraperitoneal group (54%) and in 12 patients in the retromuscular group (55%, p  = 0.967). Major complication rate was higher in the intraperitoneal group compared to the retromuscular group (18/74 = 24% vs. 1/22 = 5%, p  = 0.041). On multivariable analysis, age, smoking, and intraperitoneal mesh removal were found as independent predictors of major complication. Conclusion In this multicentric cohort of patients, removal of intraperitoneal mesh compared to removal of retromuscular mesh was associated with a higher risk of major postoperative morbidity. Use of intraperitoneal mesh for ventral hernia should therefore be cautiously and restrictively considered.