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01-02-2021 | Incisional Hernia

Implantation of biologic mesh in ventral hernia repair—does it make sense?

Authors: Abdelkader Taibi, Sophiane Derbal, Sylvaine Durand Fontanier, Niki Christou, Fabien Fredon, Stephane Bouvier, Anne Fabre, Thibaud Rivaille, Denis Valleix, Muriel Mathonnet

Published in: Surgical Endoscopy | Issue 2/2021

Abstract

Background

Biological acellular porcine dermis mesh, such as Permacol™, has been used since 2009 to treat abdominal incisional hernias in a septic context. This study investigated the risk factors for incisional hernia recurrence after biological mesh augmentation.

Results

Over a period of 6 years from February 2009 to February 2015, 68 patients underwent surgery. The mesh was placed intraperitoneally with closure of the anterior fascia in 27 cases (39.7%). The biological mesh was placed in the retromuscular pre-fascial plane in 1 case (1.5%) and pre-aponeurotic plane in 1 case (1.5%). Closure of the anterior fascia was not achieved in 39 cases, including 20 cases in which the mesh was placed intraperitoneally (intraperitoneal bridging group, 29.4%) and 19 cases in which the mesh was placed between the edges of the fascia (inlay bridging group, 27.9%). There were 37 cases of postoperative surgical site infections (54.4%), and Clavien–Dindo morbidity staging indicated stage I–II and III–IV complications in 19.1% and 44.1% of the cases, respectively. The recurrence rate was 61.8%, and the mortality rate was 0%. The rate of recurrence was significantly lower in the «fascia approximated» group (37%), p = 0.001). Univariate analyses of risk factors for procedural failure indicated an increased risk of recurrence in cases of postoperative surgical site infections, complications of Clavien–Dindo grade III or higher, an absent fascial closure in front of the mesh (OR = 8.69), an operating time longer than 180 min, and a VHWG score higher than 2. After logistic regression, the risk factors for recurrence were postoperative infections (OR = 6.2), placement of bridged biological mesh (OR = 22.3), and postoperative morbidity grade III or higher (OR = 16.7).

Conclusions

Patients with postoperative surgical site infections are at an increased risk for recurrence, and bridged mesh placements lack efficacy. Overall, this study challenges the purported advantage of biologics in treating incisional hernia repairs.

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Title: Implantation of biologic mesh in ventral hernia repair—does it make sense?
Authors: Abdelkader Taibi
Sophiane Derbal
Sylvaine Durand Fontanier
Niki Christou
Fabien Fredon
Stephane Bouvier
Anne Fabre
Thibaud Rivaille
Denis Valleix
Muriel Mathonnet
Publication date: 01-02-2021
Publisher: Springer US
Keyword: Incisional Hernia
Published in: Surgical Endoscopy / Issue 2/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-07435-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Implantation of biologic mesh in ventral hernia repair—does it make sense?

Abstract

Background

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Results

Conclusions

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