, 13:103 | Cite as

New “biological” meshes: the need for a register. The EHS Registry for Biological Prostheses

Call for participating European surgeons
  • L. Ansaloni
  • F. Catena
  • F. Coccolini
  • P. Negro
  • G. Campanelli
  • M. Miserez
Letter to the Editor


Non-absorbable prosthetic materials in hernia surgery can cause relatively rare complications, which include chronic pain, a feeling of stiffness with reduced compliance of the abdominal wall, prosthetic erosion/fistulisation and an increased risk of persistent deep infection. Recently, to avoid these problems, new “biological” prosthetic materials have been developed and proposed for clinical use. These materials are all essentially composed of an extracellular matrix stripped of its cellular components, and differ substantially only in their source (porcine small intestine submucosa, porcine dermis or cadaveric human dermis). Because of the numerous variables involved, it is very difficult to conduct a randomised controlled trial. Therefore, the European Hernia Society (EHS) has decided to start the EHS Registry for Biological Prostheses (ERBP). This is a prospective registry in Europe on the use of collagen meshes in (potentially) contaminated circumstances or clean surgical fields. The registry intends to collect some preoperative data on the patient and indication, intraoperative data and outcome data.


Biological prostheses Hernia Contaminated fields 


  1. 1.
    Lichtenstein IL, Shulman AG, Amid PK, Montllor MM (1989) The tension-free hernioplasty. Am J Surg 157:188–193PubMedCrossRefGoogle Scholar
  2. 2.
    Luijendijk RW, Hop WC, van den Tol MP, de Lange DC, Braaksma MM, IJzermans JN, Boelhouwer RU, de Vries BC, Salu MK, Wereldsma JC, Bruijninckx CM, Jeekel J (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343(6):392–398PubMedCrossRefGoogle Scholar
  3. 3.
    Heise CP, Starling JR (1998) Mesh inguinodynia: a new clinical syndrome after inguinal herniorrhaphy? J Am Coll Surg 187:514–518PubMedCrossRefGoogle Scholar
  4. 4.
    Taylor SG, O’Dwyer PJ (1999) Chronic groin sepsis following tension-free inguinal hernioplasty. Br J Surg 86:562–565PubMedCrossRefGoogle Scholar
  5. 5.
    Bay-Nielsen M, Kehlet H, Strand L, Malmstrøm J, Andersen FH, Wara P, Juul P, Callesen T; Danish Hernia Database Collaboration (2001) Quality assessment of 26,304 herniorrhaphies in Denmark: a prospective nationwide study. Lancet 358:1124–1128PubMedCrossRefGoogle Scholar
  6. 6.
    Condon RE (2001) Groin pain after hernia repair. Ann Surg 233:8PubMedCrossRefGoogle Scholar
  7. 7.
    Falagas ME, Kasiakou SK (2005) Mesh-related infections after hernia repair surgery. Clin Microbiol Infect 11:3–8PubMedCrossRefGoogle Scholar
  8. 8.
    Dayton MT, Buchele BA, Shirazi SS, Hunt LB (1986) Use of an absorbable mesh to repair contaminated abdominal-wall defects. Arch Surg 121:954–960PubMedGoogle Scholar
  9. 9.
    Record RD, Hillegonds D, Simmons C, Tullius R, Rickey FA, Elmore D, Badylak SF (2001) In vivo degradation of 14C-labeled small intestinal submucosa (SIS) when used for urinary bladder repair. Biomaterials 22:2653–2659PubMedCrossRefGoogle Scholar
  10. 10.
    Hodde J (2002) Naturally occurring scaffolds for soft tissue repair and regeneration. Tissue Eng 8:295–308PubMedCrossRefGoogle Scholar
  11. 11.
    Sipe JD (2002) Tissue engineering and reparative medicine. Ann N Y Acad Sci 961:1–9PubMedCrossRefGoogle Scholar
  12. 12.
    Vacanti JP, Langer R (1999) Tissue engineering: the design and fabrication of living replacement devices for surgical reconstruction and transplantation. Lancet 354(Suppl 1):SI32–SI34PubMedGoogle Scholar
  13. 13.
    Langer R, Vacanti JP (1993) Tissue engineering. Science 260:920–926PubMedCrossRefGoogle Scholar
  14. 14.
    Hiles M, Hodde J (2006) Tissue engineering a clinically useful extracellular matrix biomaterial. Int Urogynecol J Pelvic Floor Dysfunct J 17:S39–S43PubMedCrossRefGoogle Scholar
  15. 15.
    Hodde J (2006) Extracellular matrix as a bioactive material for soft tissue reconstruction. ANZ J Surg 76(12):1096–1100PubMedCrossRefGoogle Scholar
  16. 16.
    Parker DM, Armstrong PJ, Frizzi JD, North JH Jr (2006) Porcine dermal collagen (Permacol) for abdominal wall reconstruction. Curr Surg 63:255–258PubMedCrossRefGoogle Scholar
  17. 17.
    Ma SZ, Li XH, Hu J (2006) Acellular extracellular matrix for inguinal hernia repair. Hernia 10:229–231PubMedCrossRefGoogle Scholar
  18. 18.
    Buinewicz B, Rosen B (2004) Acellular cadaveric dermis (AlloDerm): a new alternative for abdominal hernia repair. Ann Plast Surg 52:188–194PubMedCrossRefGoogle Scholar
  19. 19.
    Espinosa-de-los-Monteros A, de la Torre JI, Marrero I, Andrades P, Davis MR, Vásconez LO (2007) Utilization of human cadaveric acellular dermis for abdominal hernia reconstruction. Ann Plast Surg 58(3):264–267PubMedCrossRefGoogle Scholar
  20. 20.
    Lipman J, Medalie D, Rosen MJ (2008) Staged repair of massive incisional hernias with loss of abdominal domain: a novel approach. Am J Surg 195(1):84–88PubMedCrossRefGoogle Scholar
  21. 21.
    Ansaloni L, Catena F, D’Alessandro L (2003) Prospective randomized, double-blind, controlled trial comparing Lichtenstein’s repair of inguinal hernia with polypropylene mesh versus Surgisis gold soft tissue graft: preliminary results. Acta Biomed Ateneo Parmense 74(Suppl 2):10–14Google Scholar
  22. 22.
    Edelman DS (2002) Laparoscopic herniorrhaphy with porcine small intestinal submucosa: a preliminary study. JSLS 6:203–205PubMedGoogle Scholar
  23. 23.
    Ansaloni L, Catena F, Gagliardi S, Gazzotti F, D’Alessandro L, Pinna AD (2007) Hernia repair with porcine small-intestinal submucosa. Hernia 11(4):321–326PubMedCrossRefGoogle Scholar
  24. 24.
    Gagliardi S, Ansaloni L, Catena F, Gazzotti F, D’Alessandro L, Pinna AD (2007) Hernioplasty with Surgisis(R) inguinal hernia matrix (IHM)trade mark. Surg Technol Int 16:128–133PubMedGoogle Scholar
  25. 25.
    Napolitano L, Di Bartolomeo N, Aceto L, Waku M, Innocenti P (2004) Use of prosthetic materials in incisional hernias: our clinical experience. G Chir 25(4):141–145PubMedGoogle Scholar
  26. 26.
    Puccio F, Solazzo M, Marciano P (2005) Comparison of three different mesh materials in tension-free inguinal hernia repair: prolene versus Vypro versus surgisis. Int Surg 90(3 Suppl):S21–S23PubMedGoogle Scholar
  27. 27.
    Edelman DS, Selesnick H (2006) “Sports” hernia: treatment with biologic mesh (Surgisis): a preliminary study. Surg Endosc 20(6):971–973PubMedCrossRefGoogle Scholar
  28. 28.
    Edelman DS, Hodde JP (2006) Bioactive prosthetic material for treatment of hernias. Surg Technol Int 15:104–108PubMedGoogle Scholar
  29. 29.
    Fine AP (2006) Laparoscopic repair of inguinal hernia using Surgisis mesh and fibrin sealant. JSLS 10(4):461–465PubMedGoogle Scholar
  30. 30.
    Ansaloni L, Cambrini P, Catena F, Di Saverio S, Gagliardi S, Gazzotti F, Hodde JP, Metzger DW, D’Alessandro L, Pinna AD (2007) Immune response to small intestinal submucosa (surgisis) implant in humans: preliminary observations. J Invest Surg 20(4):237–241PubMedCrossRefGoogle Scholar
  31. 31.
    Saettele TM, Bachman SL, Costello CR, Grant SA, Cleveland DS, Loy TS, Kolder DG, Ramshaw BJ (2007) Use of porcine dermal collagen as a prosthetic mesh in a contaminated field for ventral hernia repair: a case report. Hernia 11(3):279–285PubMedCrossRefGoogle Scholar
  32. 32.
    Smart N, Immanuel A, Mercer-Jones M (2007) Laparoscopic repair of a Littre’s hernia with porcine dermal collagen implant (Permacol). Hernia 11(4):373–376PubMedCrossRefGoogle Scholar
  33. 33.
    Shaikh FM, Giri SK, Durrani S, Waldron D, Grace PA (2007) Experience with porcine acellular dermal collagen implant in one-stage tension-free reconstruction of acute and chronic abdominal wall defects. World J Surg 31(10):1966–1975PubMedCrossRefGoogle Scholar
  34. 34.
    Liyanage SH, Purohit GS, Frye JN, Giordano P (2006) Anterior abdominal wall reconstruction with a Permacol implant. J Plast Reconstr Aesthet Surg 59(5):553–555PubMedCrossRefGoogle Scholar
  35. 35.
    Gupta A, Zahriya K, Mullens PL, Salmassi S, Keshishian A (2006) Ventral herniorrhaphy: experience with two different biosynthetic mesh materials, Surgisis and Alloderm. Hernia 10(5):419–425PubMedCrossRefGoogle Scholar
  36. 36.
    Albo D, Awad SS, Berger DH, Bellows CF (2006) Decellularized human cadaveric dermis provides a safe alternative for primary inguinal hernia repair in contaminated surgical fields. Am J Surg 192(5):e12–e17PubMedCrossRefGoogle Scholar
  37. 37.
    Schuster R, Singh J, Safadi BY, Wren SM (2006) The use of acellular dermal matrix for contaminated abdominal wall defects: wound status predicts success. Am J Surg 192(5):594–597PubMedCrossRefGoogle Scholar
  38. 38.
    Alaedeen DI, Lipman J, Medalie D, Rosen MJ (2007) The single-staged approach to the surgical management of abdominal wall hernias in contaminated fields. Hernia 11(1):41–45PubMedCrossRefGoogle Scholar
  39. 39.
    Kim H, Bruen K, Vargo D (2006) Acellular dermal matrix in the management of high-risk abdominal wall defects. Am J Surg 192(6):705–709PubMedCrossRefGoogle Scholar
  40. 40.
    Diaz JJ Jr, Guy J, Berkes MB, Guillamondegui O, Miller RS (2006) Acellular dermal allograft for ventral hernia repair in the compromised surgical field. Am Surg 72(12):1181–1188PubMedGoogle Scholar
  41. 41.
    Patton JH Jr, Berry S, Kralovich KA (2007) Use of human acellular dermal matrix in complex and contaminated abdominal wall reconstructions. Am J Surg 193(3):360–363PubMedCrossRefGoogle Scholar
  42. 42.
    Bellows CF, Albo D, Berger DH, Awad SS (2007) Abdominal wall repair using human acellular dermis. Am J Surg 194(2):192–198PubMedCrossRefGoogle Scholar
  43. 43.
    Jin J, Rosen MJ, Blatnik J, McGee MF, Williams CP, Marks J, Ponsky J (2007) Use of acellular dermal matrix for complicated ventral hernia repair: does technique affect outcomes? J Am Coll Surg 205(5):654–660 (Epub 2007 September 14)PubMedCrossRefGoogle Scholar
  44. 44.
    Franklin ME Jr, Gonzalez JJ Jr, Michaelson RP, Glass JL, Chock DA (2002) Preliminary experience with new bioactive prosthetic material for repair of hernias in infected fields. Hernia 6:171–174PubMedCrossRefGoogle Scholar
  45. 45.
    Franklin ME Jr, Gonzalez JJ Jr, Glass JL (2004) Use of porcine small intestinal submucosa as a prosthetic device for laparoscopic repair of hernias in contaminated fields: 2-year follow-up. Hernia 8:186–189PubMedGoogle Scholar
  46. 46.
    Helton WS, Fisichella PM, Berger R, Horgan S, Espat NJ, Abcarian H (2005) Short-term outcomes with small intestinal submucosa for ventral abdominal hernia. Arch Surg 140:549–560PubMedCrossRefGoogle Scholar
  47. 47.
    Catena F, Ansaloni L, Leone A, De Cataldis A, Gagliardi S, Gazzotti F, Peruzzi S, Agrusti S, D’Alessandro L, Taffurelli M (2005) Lichtenstein repair of inguinal hernia with Surgisis inguinal hernia matrix soft-tissue graft in immunodepressed patients. Hernia 9:29–31PubMedCrossRefGoogle Scholar
  48. 48.
    Catena F, Ansaloni L, Gazzotti F, Gagliardi S, Di Saverio S, D’Alessandro L, Pinna AD (2007) Use of porcine dermal collagen graft (Permacol) for hernia repair in contaminated fields. Hernia 11(1):57–60PubMedCrossRefGoogle Scholar
  49. 49.
    Helton WS, Fisichella PM, Berger R, Horgan S, Espat NJ, Abcarian H (2005) Short-term outcomes with small intestinal submucosa for ventral abdominal hernia. Arch Surg 140(6):549–562PubMedCrossRefGoogle Scholar
  50. 50.
    Treviño JM, Franklin ME Jr, Berghoff KR, Glass JL, Jaramillo EJ (2006) Preliminary results of a two-layered prosthetic repair for recurrent inguinal and ventral hernias combining open and laparoscopic techniques. Hernia 10(3):253–257PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • L. Ansaloni
    • 1
  • F. Catena
    • 1
  • F. Coccolini
    • 1
  • P. Negro
    • 2
    • 3
  • G. Campanelli
    • 4
  • M. Miserez
    • 5
  1. 1.General, Emergency and Transplant Surgery DepartmentSt. Orsola-Malpighi University HospitalBolognaItaly
  2. 2.Dipartimento di Chirurgia GeneraleSpecialità Chirurgiche e Trapianti d’Organo Paride StefaniniRomeItaly
  3. 3.Dipartimento Emergenza e AccettazioneAzienda Policlinico Umberto IRomeItaly
  4. 4.University of Insubria di VareseVareseItaly
  5. 5.Department of Abdominal SurgeryUniversity Hospital GasthuisbergLeuvenBelgium

Personalised recommendations