Hernia

, Volume 12, Issue 3, pp 247–250 | Cite as

Results of AlloDerm use in abdominal hernia repair

Original Article

Abstract

Background

AlloDerm (decellularized human cadaveric dermis) is increasingly being used for tissue reconstruction and hernia repairs. This article presents the results of AlloDerm use in treating abdominal wall hernias by analyzing all patients who underwent repair with AlloDerm at our institution.

Methods

A series of 70 consecutive patients starting in October 2003 with abdominal wall hernia repair using AlloDerm was studied. This study began as a retrospective chart review, which included subsequent postoperative follow-up. SPSS version 11.5 was used for statistical analysis, and parametric tests were conducted. Various technical variables (type of AlloDerm placement, mesh-suture technique, suture type) and nontechnical variables (steroids use, obesity, smoking status, diabetes, prior surgeries, number of comorbidities) were evaluated.

Results

Of 70 study patients, 31 were men and 39 were women, with a mean age of 58 (range 25–88) years. Fifty-six patients (80%) had no complications, whereas 14 (20%) suffered one or more complications. Of those patients with complications, there was one rejection, two infections, and 14 hernia recurrences. The overall complication rate was 24%. Of patients with hernia recurrences, one had the initial repair with AlloDerm implant of <1.8-mm thickness (thick) and 13 patients had their initial repair with AlloDerm implant of >1.8-mm thickness (ultrathick). The 14 patients with recurrences include three who had a prior AlloDerm repair with ultrathick implant. Two of these three patients reported abdominal wall protrusion, and one had a recurrence between two pieces of AlloDerm used in the initial repair. Of these 14 patients, nine had subsequent repair of their recurrence with synthetic mesh, and four had subsequent repair with AlloDerm with satisfactory outcomes; one patient was yet to have a repair at the time of this paper. Recurrence rates with ultrathick and thick AlloDerm were 23% and 6%, respectively. None of the patients who were on steroid therapy had complications. Mesh-suture technique had no effect on recurrence. Type of placement was positively correlated with infection (Pearson’s R 0.575, p 0.05), showing that onlay mesh is better than underlay/interpositional mesh in having a lower infection rate. Diabetes was associated with mesh infection (Pearson’s R 0.548, p 0.05), and redo hernia repair was associated with longer length of hospital stay (LOS). The average number of comorbidities was five for the series. LOS positively correlated with presence of comorbidities.

Conclusions

Early results in repair of abdominal hernia with AlloDerm appear to have a complication rate of 24%. Recurrence is the most common complication. Thinner AlloDerm use has better outcomes with less recurrence. Careful analysis regarding the technical aspects and presence of comorbidities may be explored to improve the present outcomes to prevent recurrences.

Keywords

AlloDerm Abdominal hernia Complications Repair Ventral hernia 

References

  1. 1.
    Retrieved from the world wide web, 6 June, 2006. http://www.lifecell.com/products/95/
  2. 2.
    Buinewicz B, Rosen B (2004) Acellular cadaveric dermis (AlloDerm): a new alternative for abdominal hernia repair. Ann Plast Surg 52(2):188–194PubMedCrossRefGoogle Scholar
  3. 3.
    Choe JM, Kothanpadani R, James L, Bowling D (2001) Autologous, cadaveric and synthetic materials used in sling surgery: comparative biomechanical analysis. Urology 58(3):482–486PubMedCrossRefGoogle Scholar
  4. 4.
    Menon NG, Rodriguez ED, Byrnes CK, Girotto JA, Goldberg NH, Silverman RP (2003) Revascularization of human acellular dermis in full-thickness abdominal wall reconstruction in the rabbit model. Ann Plast Surg 50:523–527PubMedCrossRefGoogle Scholar
  5. 5.
    Silverman RP, Li EN, Holton LH III, Sawan KT, Goldberg NH (2004) Ventral hernia repair using allogenic acellular dermal matrix in a swine model. Hernia 8(4):336–342PubMedCrossRefGoogle Scholar
  6. 6.
    Holton III LH, Kim D, Silverman RP, Rodriguez ED, Singh N, Goldberg NH (2005) Human acellular dermal matrix for repair of abdominal wall defects: review of clinical experience and experimental data. J Long Term Eff Med Implants 15(5):547–558PubMedCrossRefGoogle Scholar
  7. 7.
    Butler CE, Langstein HN, Kronowitz SJ (2005) Pelvic, abdominal, and chest wall reconstruction with AlloDerm in patients at increased risk for mesh-related complications. Plast Reconstr Surg 116:1263–1275 (discussion 1276–1277)Google Scholar
  8. 8.
    Butler CE, Prieto VG (2004) Reduction of adhesions with composite AlloDerm/polypropylene mesh implants for abdominal wall reconstruction. Plast Reconstr Surg 114(2):464–473PubMedCrossRefGoogle Scholar
  9. 9.
    Buinewicz B, Colony LH, Smith RJ (2003) The use of human acellular tissue matrix in abdominal wall reconstruction. A clinical perspective. LifeCell Clinical Monograph SeriesGoogle Scholar
  10. 10.
    Kaleya RN, Thomas R (2005) Use of a global economic model to analyze the cost-benefit of AlloDerm in ventral hernia repair. LifeCell Clinical Monograph SeriesGoogle Scholar
  11. 11.
    Burger JWA, Luijendijk RW, Hop WCJ, Halm JA, Verdaasdonk GG, Jeekel J (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240:578–585PubMedGoogle Scholar
  12. 12.
    Chevrel JP, Bendavid R, Abrahamson J, Arregui M, Flament JB, Phillips EH (2001) Treatment of incisional hernias by an overlapping herniorrhaphy and onlay prosthetic implant. In: Abdominal wall hernias. Principles and management, vol 1. Springer, New York, pp 500–503Google Scholar
  13. 13.
    Flament JB, Palot JP, Fitzgibbons R Jr, Greenburg AG (2002) Proshetic repair and massive abdominal ventral hernias. In: Nuhys & Condon’s hernia, vol 5. Lippincott Williams & Wilkins, Philadelphia, pp 341–365Google Scholar
  14. 14.
    Afifi, Raafat Y (2005) A prospective study between two different techniques for the repair of a large recurrent ventral hernia: a double mesh intraperitoneal repair versus onlay mesh repair. Hernia 9:310–315PubMedCrossRefGoogle Scholar
  15. 15.
    Cassar K, Munro A (2002) Surgical treatment of incisional hernia. Br J Surg 89(5):534–545PubMedCrossRefGoogle Scholar
  16. 16.
    Klinge U, Klosterhalfen B, Muller M, Schumpelick V (1999) Foreign body reaction to meshes used for the repair of abdominal wall hernias. Eur J Surg 165(7):665–673PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • S. Misra
    • 1
  • P. K. Raj
    • 1
  • S. M. Tarr
    • 1
  • R. C. Treat
    • 1
  1. 1.Department of SurgeryFairview Hospital, Cleveland Clinic Health SystemClevelandUSA

Personalised recommendations