Ventral hernia repair with lateral component separation and onlay Biodesign graft

Abstract

Background Ventral hernia is common, complicating up to 20 % of laparotomies. Plication of the rectus sheath with lateral component separation (LCS) provides a durable repair with acceptable functional outcomes. Additional support to the anterior abdominal wall may be provided by synthetic or biological mesh. Biological grafts invoke local tissue remodeling and result in strong fibrocollagenous tissue able to support the dynamic stressor of the anterior abdominal wall. Biodesign graft is a new graft derived from porcine smallintestine submucosa. We aim to review the use of Biodesign mesh for repair of ventral hernia with LCS. Methods Patients underwent ventral hernia repair completed with plication of the rectus sheath, LCS, and use of an onlay Biodesign graft. Data was collected retrospectively. Key outcome measures included post-operative complications and recurrence. Results Twelve patients were included for analysis. Mean age was 51.2 years, with 50 % males and a median weight of 87 kg (65-111 kg). Median operative time was 210 min (147 to 278 min) and median length of stay was 4 days. At a mean follow-up of 14.0 months, 8/12 (66 %) developed seroma, 1/12 (8 %) developed abdominal wall abscess, and 1/12 (8 %) suffered flap failure requiring vacuum dressings for closure. No patients were complicated by ventral hernia recurrence. Conclusions Our results describe an early Australian experience of onlay Biodesign graft in the context of rectus sheath plication with LCS. We report acceptable rates of postoperative complications and recurrence. Level of evidence: IV, therapeutic study.

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

“…Of the 23 studies using biological mesh for reinforcement, all reported only elective patients undergoing repair of incisional hernia. The degree of contamination in all studies was clean‐contaminated.…”

“…The degree of contamination in all studies was clean‐contaminated. Mesh placement was reported as intraperitoneal in five studies , , , extraperitoneal in seven , , , and a combination in ten studies , , , , . One study did not report the location of mesh placement.…”

“…All 23 studies were IDEAL stage 2a (cohort studies). Seven , , were of very low quality, 14 , of low quality, and two of moderate quality. None reported standardization of technique or location of biological mesh placement; the choice of mesh type was based on the preference of operating surgeon.…”

“…The degree of contamination in all studies was clean-contaminated. Mesh placement was reported as intraperitoneal in five studies 34,35,42,44,46 , extraperitoneal in seven 30,32,33,37,40,48,50 and a combination in ten studies 29,31,36,38,39,41,43,45,47,49 . One study 28 26 2015 Greece Prophylaxis Bovine pericardium 36 Maggiori et al 24 2015 France Prophylaxis Strattice™ 17 Ueno et al 29 2004 USA Reinforcement Surgisis ® 16 Limpert et al 37 2009 USA Reinforcement Bovine pericardium 22 Hsu et al 35 2009 USA Reinforcement Permacol™ 16 Chavarriaga et al 32 2010 USA Reinforcement Permacol™ 7 Cox et al 48 2010 USA Reinforcement Surgisis ® 10 Shah et al 45 2011 elective and emergency operations.…”