Long-Term Follow-Up of Patients Undergoing CAWR Should be Mandatory: A Call for Action

The study published in this issue of our journal by Hassan et al. [1] reports on a much-awaited results of long-term outcomes in patients undergoing complex abdominal wall reconstruction for abdominal wall defects. The authors are to be congratulated on this monumental task in performing a longitudinal study of all consecutive AWR patients who had reconstruction using biologic mesh for primary ventral hernias repair or following oncologic resection at MD Anderson Cancer Center from 2005 to 2019. Of 720 patients who underwent AWR with biologic mesh (porcine or bovine acellular dermal matrix), 109 patients were able to be followed for at least 6 years that protocol called for. Moreover, only patients who underwent midline AWR using PCS and sublay mesh placement were studied. While one may question the fact that only 20% of patients were followed for an average of 8 years, given the nature of the study population undergoing oncologic resections (this data is missing), age of patients and patient’s referral pattern to the MD Anderson hospital, still makes this study very important in the field that we did not have long-term outcomes. At a mean follow up of 96 months, only 17.4% of patients had hernia recurrence while about one-fourth developed wound infections, although almost 45% of patients were at high risk for wound infection. These results demonstrate clearly that acellular dermal matrix provides long-term durability in hernia management, while at the same time protects from the infections (as demonstrated by the fact that no mesh was infected and only one mesh was removed) although 37 patients (33.9%) had clean-contaminated defects, 8 patients (7.3%) had contaminated defects, and 3 patients (2.8%) had infected defects. At the same time, this study underscores the fact that almost half of the patients have significant perioperative complications. This is in line with previous reports. Interestingly these authors on their first study [2] of 725 patients published in JACS in 2021 reported that 322 (44.4%) patients had clean-contaminated defects, and 101 patients (13.9%) had contaminated/dirty-infected defects. This cohort of patients had similar recurrence of hernia rate of 20.8%, SSO rate of 54.5%, and SSI rate of 23.8%. The authors concluded that contaminated/dirty-infected defects were independent predictors of SSOs but not hernia recurrence. …