SRS143 - Improved outcomes in the management of high-risk incisional hernias utilising biological mesh and soft-tissue reconstruction: a ten-year follow-up

Abstract Introduction High-risk incisional hernias present significant challenges in abdominal wall reconstruction (AWR), often compounded by comorbidities and prior surgery. Optimised surgical techniques and multidisciplinary management are essential to improving outcomes in this patient group. Aims This study evaluated peri-operative and long-term outcomes, including surgical site occurrences (SSOs), recurrence rates, and mortality, following AWR with biological mesh and soft-tissue reconstruction in high-risk patients over a ten-year period at a single NHS centre employing a dual-speciality approach (plastic and general surgery). Methods A retrospective cohort analysis was undertaken at the Royal Free Hospital NHS Foundation Trust, including patients undergoing AWR with biological mesh between January 2014 and January 2025. Inclusion criteria targeted high-risk cases (VHWG scores 2–4) with multidisciplinary preoperative optimisation and structured postoperative care. Data collected included demographics, operative details, perioperative outcomes, and long-term results. Statistical analyses comprised multivariate linear and logistic regression to identify independent risk factors for complications and recurrence. Results A total of 79 patients met the inclusion criteria, with hypertension (50.6%) and diabetes (31.6%) prominent. SSO rates were low (seroma 10.1%, haematoma 8.9%, surgical-site infection 5.1%), with recurrence observed in 6.3% at a median follow-up of 17 months. Procedure-related mortality was 2.5%. Independent predictors of adverse outcomes included ASA grade, stoma presence, emergency presentation, and small bowel repair. Conclusions A structured, multidisciplinary approach, including patient selection, preoperative optimisation and biological mesh repair with soft-tissue reconstruction, provides improved outcomes for high-risk incisional hernia patients. Expansion of multicentre collaboration is warranted to strengthen evidence and refine protocols.