Repair of High-Risk Incisional Hernias and Traumatic Abdominal Wall Defects with Porcine Mesh

Abstract

Complex ventral hernias represent a significant challenge to surgeons. We hypothesized that a wide underlay technique in combination with a novel biologic mesh would result in repair with a low recurrence rate. Medical records of patients undergoing ventral herniorrhaphy with Xen-Matrix biologic mesh were evaluated. All patients were evaluated for hernia recurrence both immediately and after 2 to 3 years. There were 57 patients included in the study. The overall recurrence rate was 7.2 per cent; however, all recurrences were early and were likely technical failures. The average duration of follow-up was 30.6 months with no further recurrences after the early technical failures. The average number of previous recurrences was 1.5. Fascial closure was obtained over the mesh in 84 per cent of patients, with component separation being necessary in 36 per cent of patients. Lack of fascial reapproximation over the mesh was associated with early recurrence (0 vs 55%, P < 0.0001). Complex ventral hernias can be repaired with a low recurrence rate. Our technique in combination with the XenMatrix biologic mesh provides for durable repair. Whenever possible, the fascia should be closed above the underlay mesh, because this technique provides a more durable repair than using the mesh as a “fascial bridge.”

Systematic review of the stage of innovation of biological mesh for complex or contaminated abdominal wall closure

“…All were IDEAL stage 2a (cohort studies). Evidence was of very low quality in three studies , , low quality in three , , and moderate quality in two . The evidence in one study of abdominal wall reconstruction with porcine acellular dermal matrix (Permacol™) was of moderate quality owing to reporting of long‐term outcomes of at least 5 years.…”

“…The eight studies involved a mixture of procedures, with degree of contamination ranging from clean‐contaminated to dirty. Mesh placement was intraperitoneal in six studies, extraperitoneal in one study, and a combination in one study. All were IDEAL stage 2a (cohort studies).…”

Use of a Non-Crosslinked Porcine Dermal Matrix in Repair of the Achilles and Other Tendons of the Foot

“…Because of its design, including the absence of crosslinking, the matrix rapidly incorporates with neovascularization and cellular infiltration within 2 weeks. 20 A proprietary water based manufacturing process is used with Proformix to remove the undesirable cellular components while leaving an open intact collagen matrix that encourages tissue ingrowth, revascularization, and remodeling.…”

“…19 Other clinical applications followed including repair of the abdominal wall and ventral hernia. 20,21 More recently, they have been introduced for tendon repair in podiatry and orthopedics, usually to support the Achilles tendon or rotator cuff repair. 22 Some of these materials have displayed unfavorable properties after implantation and the search for a wholly satisfactory material has not been easy.…”

Clinical Application of a Silk Fibroin Protein Biologic Scaffold for Abdominal Wall Fascial Reinforcement

“…Despite the relatively short follow-up times, these rates compare favorably to those in other nationally published series, which range from 7% to 80%. 5 , 47 Technical aspects of abdominal wall repair, such as complete fascial closure, perforator-preserving dissection, and obliteration of dead space, contributed to good outcomes and may have superseded the effects of the SBS device. 48 …”