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Bovine versus porcine acellular dermal matrix for abdominal wall herniorrhaphy or bridging

European Journal of Trauma and Emergency Surgery volume 48, pages 1993–2001 (2022)Cite this article

Abstract

Background

The management of complicated ventral hernias (CVH), namely ventral hernias in actively or recently infected/contaminated operative fields, and open abdomens in which the native fascia cannot be primarily reapproximated, pose a surgical challenge. Fetal Bovine and Porcine Acellular Dermal Matrix (BADM and PADM) biologic meshes are being increasingly used in these scenarios. A comparison, however, of clinically relevant outcomes between the two is lacking. With this investigation, we aim to review and compare clinically relevant outcomes in patients that underwent abdominal wall herniorrhaphy with either BADM or PADM at a tertiary urban academic institution over a 5-year period.

Methods

Patients who had a BADM or PADM implanted during CVH over a 5-year period at a tertiary urban academic hospital were identified. Baseline clinical and hernia characteristics, as well as postoperative outcomes were compared after a retrospective chart review. Phone interviews were also conducted to assess for recurrence, followed by in-person visits as indicated. Cox Proportional Hazard regression was fitted to identify risk factors for recurrence.

Results

Of the 140 patients who underwent biologic mesh implantation for CVH, 109 were for ventral hernia repair and 31 for open abdomen bridging. Mean age was 52.7 ± 14.2 and males constituted 57.9% of our sample, while 25.1% had undergone > 5 prior abdominal operations. Thirty percent were active smokers, and another 30% required emergency surgery. Only immunosuppression was a risk factor for recurrence [HR 13.3 (1.04–169.2), p = 0.047] on Cox Proportional Hazard regression, while mesh selection had no effect.

Conclusions

Both BADM and PADM meshes perform well in CVH, with satisfactory recurrence rates, only slightly higher compared to traditional synthetic mesh repairs.

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Funding

This project was supported by Integra LifeSciences.

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Authors and Affiliations

  1. Division of Trauma, Acute Care Surgery and Surgical Critical Care, Boston Medical Center, Boston University School of Medicine, Boston, MA, 02118, USA

    Kathryn Van Orden, Jeffrey Santos, Alexander Ruditsky, Andrea Foster, Tejal S. Brahmbhatt & Peter A. Burke

  2. Womack Army Medical Center, Fort Bragg, NC, 28310, USA

    Landon S. Frost

  3. Department of Surgery, Division of Trauma, Acute Care Surgery and Surgical Critical Care, Duke University Medical Center, Duke University School of Medicine, 40 Duke Medicine Circle, Duke South, #1557A, Durham, NC, 27710, USA

    Brent Stanfield, Joseph Fernandez-Moure, Krista Haines, Suresh Agarwal & George Kasotakis

Authors
  1. Kathryn Van Orden
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  2. Jeffrey Santos
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  3. Brent Stanfield
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  4. Landon S. Frost
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  5. Alexander Ruditsky
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  6. Andrea Foster
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  7. Tejal S. Brahmbhatt
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  8. Peter A. Burke
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  9. Joseph Fernandez-Moure
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  10. Krista Haines
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  11. Suresh Agarwal
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  12. George Kasotakis
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Corresponding author

Correspondence to George Kasotakis.

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This project was sponsored by Integra. None of the authors have any conflicts of interest.

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Van Orden, K., Santos, J., Stanfield, B. et al. Bovine versus porcine acellular dermal matrix for abdominal wall herniorrhaphy or bridging. Eur J Trauma Emerg Surg 48, 1993–2001 (2022). https://doi.org/10.1007/s00068-021-01641-z

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  • DOI: https://doi.org/10.1007/s00068-021-01641-z

Keywords

  • Complicated ventral hernia
  • Open abdomen
  • Ventral hernia repair
  • Hernia recurrence
  • Biologic mesh