Midwest Surgical Association
Single institutional experience using biological mesh for abdominal wall reconstruction

https://doi.org/10.1016/j.amjsurg.2013.09.020Get rights and content

Abstract

Background

Complex ventral hernias remain a challenge. We present a study evaluating outcomes of complex ventral hernia repair using human-derived acellular dermal matrix (AlloDerm) and porcine-derived acellular dermal sheet (Permacol).

Methods

A retrospective review of 251 patients undergoing complex hernia repair was performed. Primary outcome was hernia recurrence; and secondary outcomes included early and late complications and mortality.

Results

Recurrence for Permacol versus AlloDerm was 32% versus 47% (P = .02). There was a difference in early complications (48% vs 30%, P = .007) and also late complications (30% vs 21%, P = .16) of Permacol versus AlloDerm. Overall survival was 85% for the Permacol group versus 78% for the AlloDerm group (P = .23). Recurrence for Permacol versus AlloDerm for underlay technique was 19% versus 22% and that for bridging technique was 44% versus 57%.

Conclusion

There exists a high complication rate from both Permacol and AlloDerm in complex ventral hernia repair especially when used as a fascial bridge.

Section snippets

Methods

The study was carried out following guidelines set by our Institutional Review Board. A retrospective study design was used to evaluate outcomes of patients having received PAD or ADM biologic mesh as part of a ventral abdominal wall hernia repair. All parastomal, inguinal, and laparoscopic hernia repairs were excluded. Records of all pieces of ADM dispensed by our blood bank and of all pieces of PAD dispensed by our operating room facilities were queried. The decision to use PAD or ADM was

Results

A total of 251 patients underwent complex ventral hernia repair between January 2007 and June 2011 at our institution, a tertiary care hospital. Patients were divided into 2 groups, repair with PAD (124) or ADM (127). In the PAD group, the average age was 61.9 ± 13.7 years, while the average age in the ADM group was 61.3 ± 14.6 years (P = .76). There were 52% men in the PAD group and 43% men in the ADM (P = .15) group. The average body mass index (BMI) between the 2 groups was 30.7 ± 7.6 versus

Comments

Abdominal wall reconstruction in the presence of contamination and infection still persists as a challenge to the general surgeon. The use of prosthetic mesh is still somewhat contraindicated in abdominal wall reconstruction in the setting of enterocutaneous fistula, wound infections, clean contaminated and contaminated dirty surgical fields, although recent literature may debate the use of prosthetics in contaminated fields.6, 7 According to a recent retrospective analysis by Souza and

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All authors have no conflict of interest, there has been no support from industry, no grants, no sponsors.

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