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Hernia

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Lessons learned from 227 biological meshes used for the surgical treatment of ventral abdominal defects

  • N. BaldanEmail author
  • G. Munegato
  • A. Di Leo
  • E. Lauro
  • E. Morpurgo
  • S. Pianigiani
  • D. Briscolini
  • R. Ferrara
  • V. Fiscon
  • A. Brolese
  • G. De Manzoni
  • G. Baldazzi
  • D. Snidero
  • S. Merigliano
  • F. Ricci
  • E. Laterza
  • R. Merenda
  • R. Gianesini
  • NEI-Meshing Collaborative
Original Article
  • 83 Downloads

Abstract

Purpose

The advantages of biological meshes for ventral hernia repair are still under debate. Given the high financial cost, the proper indications for biological meshes should be clarified to restrict their use to properly selected patients.

Methods

A retrospective database was instituted to register all cases of abdominal wall defect treated with biological meshes from 1/2010 to 3/2016.

Results

A total of 227 patients (mean age: 64 years) whose ventral abdominal defects were reconstructed with a biological mesh were included in the study. Patients were divided according to the 2010 four-level surgical-site complication risk grading system proposed by the Ventral Hernia Working Group (VHWG): Grade 1 (G1, 12 cases), Grade 2 (G2, 68 cases), Grade 3 (G3, 112 cases), and Grade 4 (G4, 35 cases). The surgical site complication rate was higher in patients with one or more risk factors (33.6% vs 19% in patients with no risk factors) (P = 0.68). Statistically significant risk factors associated with the onset of one or more postoperative surgical site complications included: diabetes, coronary artery disease, immunosuppression, and obesity. Recurrence was more common in patients with surgical site complications and mainly associated with infection (38.9%) and wound necrosis (44.4%), and in cases of inlay positioning of the mesh (36%).

Conclusions

Due to their high costs, biological mesh should not be used in G1 patients. In infected fields (G4), they should only be used if no other surgical solution is feasible. There is a clear need to prospectively evaluate the performance of biological meshes.

Keywords

Biological mesh Ventral hernia Abdominal wall repair 

Notes

Compliance with ethical standards

Conflict of interest

All the authors declare that they have no conflict of interest.

Ethical statement

According to Italian law, approval from a local ethics committee was not required.

Human or animal studies

This article does not contain any studies with animals performed by any of the authors.

Informed consent

According to Italian law, informed consent from included individuals are not required for this type of study.

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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  • N. Baldan
    • 1
    Email author
  • G. Munegato
    • 2
  • A. Di Leo
    • 3
  • E. Lauro
    • 4
  • E. Morpurgo
    • 5
  • S. Pianigiani
    • 6
  • D. Briscolini
    • 1
  • R. Ferrara
    • 7
  • V. Fiscon
    • 8
  • A. Brolese
    • 9
  • G. De Manzoni
    • 3
  • G. Baldazzi
    • 10
  • D. Snidero
    • 11
  • S. Merigliano
    • 1
  • F. Ricci
    • 4
  • E. Laterza
    • 12
  • R. Merenda
    • 13
  • R. Gianesini
    • 14
  • NEI-Meshing Collaborative
  1. 1.Clinica Chirurgica 3Azienda Ospedaliera Università di PadovaPaduaItaly
  2. 2.Ospedale “S. Maria dei Battuti”ConeglianoItaly
  3. 3.Azienda Ospedaliera Universitaria Integrata di VeronaVeronaItaly
  4. 4.Ospedale “S. Maria del Carmine” di RoveretoRoveretoItaly
  5. 5.Ospedale di CamposampieroCamposampieroItaly
  6. 6.Department of Industrial Engineering, Centre for Mechanics of Biological MaterialsUniversità di PadovaPaduaItaly
  7. 7.Ospedale di BolzanoBolzanoItaly
  8. 8.Ospedale di CittadellaCittadellaItaly
  9. 9.Ospedale “Santa Chiara”TrentoItaly
  10. 10.ASST NORD MILANO Presidio Ospedaliero di Sesto San GiovanniSesto San GiovanniItaly
  11. 11.Ospedale di San Daniele del FriuliSan Daniele del FriuliItaly
  12. 12.Ospedale di LegnagoLegnagoItaly
  13. 13.Ospedale “SS. Giovanni e Paolo”VeniceItaly
  14. 14.Ospedale di ValdagnoValdagnoItaly

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