World Journal of Surgery

, Volume 43, Issue 3, pp 791–797 | Cite as

Indications and Outcomes of a Cross-Linked Porcine Dermal Collagen Mesh (Permacol) for Complex Abdominal Wall Reconstruction: A Multicenter Audit

  • Alexandre Doussot
  • Fawaz Abo-Alhassan
  • Sofiane Derbal
  • Isabelle Fournel
  • Faustin Kasereka-Kisenge
  • Tatiana Codjia
  • Haitham Khalil
  • Vincent Dubuisson
  • Haythem Najah
  • Alexis Laurent
  • Benoît Romain
  • Christophe Barrat
  • Christophe Trésallet
  • Muriel Mathonnet
  • Pablo Ortega-DeballonEmail author
Original Scientific Report



To reduce the occurrence of complications in the setting of high-risk patients with contaminated operative field, a wide range of biologic meshes has been developed. Yet, few series have reported outcomes after abdominal wall repair (AWR) using such meshes. Permacol is an acellular porcine dermal collagen matrix with a cross-linked pattern. This study reports short- and long-term outcomes after AWR for incisional hernia using Permacol.

Materials and methods

All consecutive patients undergoing single-stage open AWR using Permacol mesh at eight university hospitals were included. Mortality, complication and hernia recurrence rates were assessed. Independent risk factors for complications and hernia recurrence were identified with logistic regression and Fine and Gray analysis, respectively.


Overall, 250 patients underwent single-stage AWR with Permacol. Nearly 80% had a VHWG grade 3 or 4 defect. In-hospital mortality and complication rates were 4.8% (n = 12) and 61.6% (n = 154), respectively. Reintervention for complications was required for 74 patients (29.6%). Mesh explantation rate was 4% (n = 10). Independent risk factors for complications were smoking, defect size and VHWG grade. After a mean follow-up time of 16.8 months (± 18.1 months), 63 (25.2%) experienced hernia recurrence. One-, 2- and 3-year RFS were 90%, 74% and 57%, respectively. Previous AWR, mesh location and the need for reintervention were independent predictors of hernia recurrence.


Single-stage AWR is feasible using Permacol. Mortality and complication rates are high due to patients’ comorbidities and the degree of contamination of the operative field. Given the observed recurrence rate, the benefit of biologics remains to be ascertained.



The authors thank Cyril Boisson (EPICAD INSERM UMR 1231, University of Bourgogne Franche-Comté, Dijon, France; LipSTIC LabEx, Fondation de Cooperation Scientifique Bourgogne Franche-Comte, Dijon) for his assistance with statistical analysis.

Compliance with ethical standards

Conflict of interest

P. Ortega-Deballon has received grants from Covidien/Medtronic, Bard and LifeCell/Acelity. The other authors have no disclosures.


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Alexandre Doussot
    • 1
  • Fawaz Abo-Alhassan
    • 1
  • Sofiane Derbal
    • 2
  • Isabelle Fournel
    • 3
  • Faustin Kasereka-Kisenge
    • 4
  • Tatiana Codjia
    • 5
  • Haitham Khalil
    • 5
  • Vincent Dubuisson
    • 6
  • Haythem Najah
    • 4
  • Alexis Laurent
    • 7
  • Benoît Romain
    • 8
  • Christophe Barrat
    • 9
  • Christophe Trésallet
    • 4
  • Muriel Mathonnet
    • 2
  • Pablo Ortega-Deballon
    • 1
    Email author
  1. 1.Department of Digestive SurgeryUniversity Hospital of DijonDijonFrance
  2. 2.Department of Digestive SurgeryUniversity Hospital of LimogesLimogesFrance
  3. 3.INSERM, CIC1432, Clinical Epidemiology UnitDijonFrance
  4. 4.Department of Digestive SurgeryPitié-Salpétrière HospitalParisFrance
  5. 5.Department of Digestive SurgeryUniversity Hospital of RouenRouenFrance
  6. 6.Department of Digestive SurgeryUniversity Hospital of BordeauxBordeauxFrance
  7. 7.Department of Digestive SurgeryHenri Mondor HospitalCréteilFrance
  8. 8.Department of Digestive SurgeryUniversity Hospital of StrasbourgStrasbourgFrance
  9. 9.Department of Digestive SurgeryJean Verdier HospitalBondyFrance

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