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Biological Implant for Complex Abdominal Wall Reconstruction: A Single Institution Experience and Review of Literature

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Abstract

Aim

To present our single institution and surgeon’s complex abdominal wall reconstructions (CAWR) experience with Permacol™ mesh through a non-randomized study.

Patients and method

Data of 51 consecutive patients were prospectively collected between 2003 and 2015. Patients had a median of 3 comorbidities (range 0–10) and 68% were Center for Disease Control class II–IV. The mean previous repair was 1.3 (range, 0–12), and 25 (44%) had a mesh in situ. The median defect size was 625 cm2.

Results

Among the 56 CAWR procedures, in 16 (29%) bowel resection/anastomosis was performed. The overall post-operative complication rate was 45%, and it was wound-related except from 1 patient dead for myocardial infarction. One was lost at follow-up. Five were re-operated for recurrence with a second Permacol mesh, leading to 14 (26%) overall recurrences at a mean follow-up of 44 months (range, 4–123). In 33 (59%) cases, fascial closure was achieved. The mesh placement was intraperitoneal in 89%, retro-muscular in 9% and supra-fascial in 1% of cases. A multivariate analysis showed that predictor risk for recurrence was more than 3 previous repairs, wound class III–IV, whereas age, type of comorbidities, defect size and fascial closure did not influence the recurrence. Median post-operative performance status was 0 (range; 0–3). A satisfaction questionnaire was obtained in 43 patients, and 86% of them were satisfied with the outcome.

Conclusions

Biological materials have the potential to reduce morbidity and improve outcome of definitive repair of CAWR.

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Acknowledgements

Ms. Valentina Pannetta for the statistical support.

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Authors and Affiliations

  1. Barts Health NHS Trust, London, UK

    Elsa Limura & Pasquale Giordano

Authors
  1. Elsa Limura
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  2. Pasquale Giordano
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Correspondence to Elsa Limura.

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Limura, E., Giordano, P. Biological Implant for Complex Abdominal Wall Reconstruction: A Single Institution Experience and Review of Literature. World J Surg 41, 2492–2501 (2017). https://doi.org/10.1007/s00268-017-4066-8

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  • DOI: https://doi.org/10.1007/s00268-017-4066-8

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