Current Literature

Study Suggests Biologic Mesh Placement and Small Bites Offer No Advantage in Hernia Prevention

Coelho R, Dhanani NH, Lyons NB, et al. Hernia Prevention Using Biologic Mesh and/or Small Bites: A Multispecialty 2x2, Factorial Randomized, Controlled Trial. J Am Coll Surg. 2023, In Press.

Although available data support the potential value of placing biologic mesh and using small fascial suture bites to reduce the risk of midline ventral incisional hernia in high-risk patients with obesity or smoking history, concerns over risks of biologic mesh placement have limited the use of these techniques by practicing surgeons.

This single institution, randomized, controlled trial sought to compare outcomes of patients who had biologic mesh placed and/or small suture bites used with patients who did not have mesh placement and had large fascial bites used for fascial closure. Data were obtained at 1 year following the index procedure. A total of 107 patients were randomized, with 52 having mesh placed and 55 having small bites. Overweight and obesity were documented in 85% of patients and 16% were smokers. Elective colorectal cases were the most common procedures; complex cases (fistula, trauma, volvulus) accounted for less than 10% of included patients.

The primary outcomes of interest were deep or organ space infection, occurrence of incisional hernia, reoperation, or death. The data analysis showed that the occurrence of endpoint events was similar in all the comparison groups. The authors concluded that biologic mesh placement and small bites offered no advantage.

Editorial

Torres CM, Mohamed A. Is the Biologic Clock for Biologic Mesh in Abdominal Surgery Nearing Its End? J Am Coll Surg. 2023, In Press.

In the editorial by Crisanto M. Torres, MD, MPH, and Abdimajid Mohamed, MD, that accompanied the article, the editorialists noted that these findings are important but need to be interpreted cautiously because the included procedures were mostly colorectal surgeries and there were few emergent, urgent, or trauma patients. Despite these limitations, there appears to be no indication for routine placement of biologic mesh; additional studies evaluating mesh placement and small bite closure were recommended.

Bariatric Surgery May Reduce Residual Risk of Breast Cancer

Doumouras AG, Lovrics O, Paterson JM, et al. Residual Risk of Breast Cancer after Bariatric Surgery. JAMA Surg. 2023. doi: 10.1001/jamasurg.2023.0530 [published Online First: 20230412]

Because obesity raises the risk of breast cancer, this study used retrospective cohort data (n = 69,260) to determine whether risk was changed in patients who underwent bariatric surgery for management of morbid obesity (BMI >35 with comorbid conditions or BMI >40 without comorbid conditions). Multiple provincial databases in Ontario, Canada, were used to gather and compare patients who underwent bariatric surgery with patients who did not; follow-up data were obtained at 1, 2, and 5 years postoperatively.

The data analysis showed that the risk of breast cancer in patients who underwent bariatric surgery was reduced to a level equal to patients with a BMI of 25 who did not undergo bariatric surgery. The authors concluded that there is significant benefit of bariatric surgery in obese patients at risk for breast cancer.

Editorial

Pilewskie ML, Dimick JB. Bariatric Surgery for Breast Cancer Risk Reduction-Benefit May Not Be One Size Fits All. JAMA Surg. 2023. doi: 10.1001/jamasurg.2023.0534 [published Online First: 20230412]

In the editorial by Milissa L. Pilewskie, MD, and Justin B. Dimick, MD, MPH, that accompanied the article, it was noted that many patients do not reach a normal BMI after bariatric surgery and data confirming the amount of weight loss and its relationship to breast cancer risk reduction are not reported in the article. They also noted that breast cancer risk is influenced by genetic predisposition, family history, presence of a high-risk lesion, and chest wall radiation. These factors need to be considered when counselling patients concerning the potential for cancer risk reduction following bariatric surgery.