Skip to main content

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



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.


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.


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.


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

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4


  1. Lopez-Cano M, Martin-Dominguez LA, Pereira JA, Armengol-Carrasco M, Garcia-Alamino JM. Balancing mesh-related complications and benefits in primary ventral and incisional hernia surgery. A meta-analysis and trial sequential analysis. PLoS ONE. 2018;13:e0197813.

    Article  Google Scholar 

  2. Kaufmann R, Halm JA, Eker HH, Klitsie PJ, Nieuwenhuizen J, van Geldere D, Simons MP, van der Harst E, van’t Riet M, van der Holt B, et al. Mesh versus suture repair of umbilical hernia in adults: a randomised, double-blind, controlled, multicentre trial. Lancet. 2018;391:860–9.

    Article  Google Scholar 

  3. Oma E, Bisgaard T, Jorgensen LN, Jensen KK. Nationwide propensity-score matched study of mesh versus suture repair of primary ventral hernias in women with a subsequent pregnancy. World J Surg. 2019;43:1497–504.

    Article  Google Scholar 

  4. Usher FC, Ochsner J, Tuttle LL Jr. Use of marlex mesh in the repair of incisional hernias. Am Surg. 1958;24:969–74.

    CAS  PubMed  Google Scholar 

  5. Nguyen MT, Berger RL, Hicks SC, Davila JA, Li LT, Kao LS, Liang MK. Comparison of outcomes of synthetic mesh vs suture repair of elective primary ventral herniorrhaphy: a systematic review and meta-analysis. JAMA Surg. 2014;149:415–21.

    Article  Google Scholar 

  6. Shankar DA, Itani KM, O'Brien WJ, Sanchez VM. Factors Associated With Long-term Outcomes of Umbilical Hernia Repair. JAMA Surg 2017.

  7. Collaboration EUHT. Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials. Ann Surg. 2002;235:322–32.

    Article  Google Scholar 

  8. Mathes T, Walgenbach M, Siegel R. Suture versus mesh repair in primary and incisional ventral hernias: a systematic review and meta-analysis. World J Surg. 2016;40:826–35.

    Article  Google Scholar 

  9. Ventral Hernia Working G, Breuing K, Butler CE, Ferzoco S, Franz M, Hultman CS, Kilbridge JF, Rosen M, Silverman RP, Vargo D. Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery. 2010;148:544–58.

    Article  Google Scholar 

  10. Clemens MW, Selber JC, Liu J, Adelman DM, Baumann DP, Garvey PB, Butler CE. Bovine versus porcine acellular dermal matrix for complex abdominal wall reconstruction. Plast Reconstr Surg. 2013;131:71–9.

    CAS  Article  Google Scholar 

  11. Janfaza M, Martin M, Skinner R. A preliminary comparison study of two noncrosslinked biologic meshes used in complex ventral hernia repairs. World J Surg. 2012;36:1760–4.

    Article  Google Scholar 

  12. Butler CE, Campbell KT. Minimally invasive component separation with inlay bioprosthetic mesh (MICSIB) for complex abdominal wall reconstruction. Plast Reconstr Surg. 2011;128:698–709.

    CAS  Article  Google Scholar 

  13. Espinosa-de-los-Monteros A, de la Torre JI, Marrero I, Andrades P, Davis MR, Vasconez LO. Utilization of human cadaveric acellular dermis for abdominal hernia reconstruction. Ann Plast Surg. 2007;58:264–7.

    CAS  Article  Google Scholar 

  14. Butler CE, Langstein HN, Kronowitz SJ. Pelvic, abdominal, and chest wall reconstruction with AlloDerm in patients at increased risk for mesh-related complications. Plast Reconstr Surg. 2005;116:1263–75.

    CAS  Article  Google Scholar 

  15. Jin J, Rosen MJ, Blatnik J, McGee MF, Williams CP, Marks J, Ponsky J. Use of acellular dermal matrix for complicated ventral hernia repair: does technique affect outcomes? J Am Coll Surg. 2007;205:654–60.

    Article  Google Scholar 

  16. Burns NK, Jaffari MV, Rios CN, Mathur AB, Butler CE. Non-cross-linked porcine acellular dermal matrices for abdominal wall reconstruction. Plast Reconstr Surg. 2010;125:167–76.

    CAS  Article  Google Scholar 

  17. Sabbagh C, Dumont F, Robert B, Badaoui R, Verhaeghe P, Regimbeau JM. Peritoneal volume is predictive of tension-free fascia closure of large incisional hernias with loss of domain: a prospective study. Hernia. 2011;15:559–65.

    CAS  Article  Google Scholar 

  18. Warren J, Desai SS, Boswell ND, Hancock BH, Abbad H, Ewing JA, Carbonell AM, Cobb WS. Safety and efficacy of synthetic mesh for ventral hernia repair in a contaminated field. J Am Coll Surg. 2020;230:405–13.

    Article  Google Scholar 

  19. de Vries FEE, Hodgkinson JD, Claessen JJM, van Ruler O, Leo CA, Maeda Y, Lapid O, Obdeijn MC, Tanis PJ, Bemelman WA, et al. Long-term outcomes after contaminated complex abdominal wall reconstruction. Hernia 2020.

  20. Jakob MO, Spari D, Zindel J, Pinworasarn T, Candinas D, Beldi G. Prophylactic, synthetic intraperitoneal mesh versus no mesh implantation in patients with fascial dehiscence. J Gastrointest Surg. 2018;22:2158–66.

    Article  Google Scholar 

  21. Booth JH, Garvey PB, Baumann DP, Selber JC, Nguyen AT, Clemens MW, Liu J, Butler CE. Primary fascial closure with mesh reinforcement is superior to bridged mesh repair for abdominal wall reconstruction. J Am Coll Surg. 2013;217:999–1009.

    Article  Google Scholar 

  22. Garvey PB, Martinez RA, Baumann DP, Liu J, Butler CE. Outcomes of abdominal wall reconstruction with acellular dermal matrix are not affected by wound contamination. J Am Coll Surg. 2014;219:853–64.

    Article  Google Scholar 

  23. Giordano SA, Garvey PB, Baumann DP, Liu J, Butler CE. Hospital readmission following open, single-stage, elective abdominal wall reconstructions using acellular dermal matrix affects long-term hernia recurrence rate. Am J Surg. 2018;216:60–6.

    Article  Google Scholar 

Download references


This project was supported by Integra LifeSciences.

Author information

Authors and Affiliations


Corresponding author

Correspondence to George Kasotakis.

Ethics declarations

Conflict of interest

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

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


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