Early results on the use of biomaterials as adjuvant to abdominal wall closure following cytoreduction and hyperthermic intraperitoneal chemotherapy.docVIP

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Early results on the use of biomaterials as adjuvant to abdominal wall closure following cytoreduction and hyperthermic intraperitoneal chemotherapy.doc

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Early results on the use of biomaterials as adjuvant to abdominal wall closure following cytoreduction and hyperthermic intraperitoneal chemotherapy

Boutrosetal.WorldJournalofSurgicalOncology2010,8:72 /content/8/1/72 WORLD JOURNAL OF SURGICAL ONCOLOGY TECHNICAL INNOVATIONS OpenAccess Earlyresultsontheuseofbiomaterialsas adjuvanttoabdominalwallclosurefollowing cytoreductionandhyperthermicintraperitoneal chemotherapy CherifBoutros,PonandaiSomasundar,NJosephEspat* Abstract Background:Hyperthermicchemotherapyappliesthermalenergytobothabdominalwallaswellastheintra- abdominalviscera.Thecombinationofthehyperthemia,chemotherapyandcytoreductivesurgery(CRS)is associatedwithadefinedriskofabdominalwallandintestinalmorbidityreportedtobeashighas15%, respectivelytodate,nostudieshaveevaluatedtheuseofbiomaterialmeshasadjuvanttoabdominalwallclosure inthisgroupofpatients.Inthepresentreport,wehypothesizedthatpostHIPECclosurewithabiomaterialcan reduceabdominalwallmorbidityafterCRSandhyperthermicintraperitonealchemotherapy. Materialsandmethods:AllpatientstreatedwithHIPECinatertiarycarecenterover12months(2008-2009) periodwereincluded.EightpatientsreceivedcytoreductivesurgeryfollowedbyHIPECfor90minutesusing MitomycinC(15mgq45minutes×2).AbdominalwallclosurewasperformedusingSurgisis(CookBiotech.) meshinanunderlaypositionwith3cmfascialoverlap-closure.Operativetime,hospitallengthofstay(LOS)aswell aspostoperativeoutcomewithspecialattentiontoabdominalwallandbowelmorbiditywereassessed. Results:Eightpatients,meanage59.7ys(36-80)weretreatedaccordingtotheaboveprotocol.Theprimary pathologywasappendicealmucinousadenocarcinoma(n=3)colorectalcancer(n=3),andovariancancer(n= 2).Fourpatients(50%)presentedinitiallywithabdominalwallmorbidityincludingincisionalventralhernia(n=3) andexcessiveabdominalwallmetastaticimplants(n=1).Themeanperitonealcancerindex(PCI)was8.75.Twenty eightCRSwereperformed(3.5CRS/patient).Themeanoperatingtimewas6hours.Sevenpatientshadno abdominalwallorbowelmorbidity,themeanLOSforthesepatientswas8days.Duringthefollowupperiod (mean6.3months),onepatientrequiredexploratorylaparotomy2weeksaftersurgeryandsubsequently developedanincisio