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Indications and Outcomes of a Cross-Linked Porcine Dermal Collagen Mesh (Permacol) for Complex Abdominal Wall Reconstruction: A Multicenter Audit

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Abstract

Introduction

To reduce the occurrence of complications in the setting of high-risk patients with contaminated operative field, a wide range of biologic meshes has been developed. Yet, few series have reported outcomes after abdominal wall repair (AWR) using such meshes. Permacol is an acellular porcine dermal collagen matrix with a cross-linked pattern. This study reports short- and long-term outcomes after AWR for incisional hernia using Permacol.

Materials and methods

All consecutive patients undergoing single-stage open AWR using Permacol mesh at eight university hospitals were included. Mortality, complication and hernia recurrence rates were assessed. Independent risk factors for complications and hernia recurrence were identified with logistic regression and Fine and Gray analysis, respectively.

Results

Overall, 250 patients underwent single-stage AWR with Permacol. Nearly 80% had a VHWG grade 3 or 4 defect. In-hospital mortality and complication rates were 4.8% (n = 12) and 61.6% (n = 154), respectively. Reintervention for complications was required for 74 patients (29.6%). Mesh explantation rate was 4% (n = 10). Independent risk factors for complications were smoking, defect size and VHWG grade. After a mean follow-up time of 16.8 months (± 18.1 months), 63 (25.2%) experienced hernia recurrence. One-, 2- and 3-year RFS were 90%, 74% and 57%, respectively. Previous AWR, mesh location and the need for reintervention were independent predictors of hernia recurrence.

Discussion

Single-stage AWR is feasible using Permacol. Mortality and complication rates are high due to patients’ comorbidities and the degree of contamination of the operative field. Given the observed recurrence rate, the benefit of biologics remains to be ascertained.

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Acknowledgements

The authors thank Cyril Boisson (EPICAD INSERM UMR 1231, University of Bourgogne Franche-Comté, Dijon, France; LipSTIC LabEx, Fondation de Cooperation Scientifique Bourgogne Franche-Comte, Dijon) for his assistance with statistical analysis.

Author information

Author notes

  1. Alexandre Doussot and Fawaz Abo-Alhassan have contributed equally to this work.

Authors and Affiliations

  1. Department of Digestive Surgery, University Hospital of Dijon, 14 Rue Paul Gaffarel, 21079, Dijon, France

    Alexandre Doussot, Fawaz Abo-Alhassan & Pablo Ortega-Deballon

  2. Department of Digestive Surgery, University Hospital of Limoges, Limoges, France

    Sofiane Derbal & Muriel Mathonnet

  3. INSERM, CIC1432, Clinical Epidemiology Unit, 21000, Dijon, France

    Isabelle Fournel

  4. Department of Digestive Surgery, Pitié-Salpétrière Hospital, Paris, France

    Faustin Kasereka-Kisenge, Haythem Najah & Christophe Trésallet

  5. Department of Digestive Surgery, University Hospital of Rouen, Rouen, France

    Tatiana Codjia & Haitham Khalil

  6. Department of Digestive Surgery, University Hospital of Bordeaux, Bordeaux, France

    Vincent Dubuisson

  7. Department of Digestive Surgery, Henri Mondor Hospital, Créteil, France

    Alexis Laurent

  8. Department of Digestive Surgery, University Hospital of Strasbourg, Strasbourg, France

    Benoît Romain

  9. Department of Digestive Surgery, Jean Verdier Hospital, Bondy, France

    Christophe Barrat

Authors
  1. Alexandre Doussot
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  2. Fawaz Abo-Alhassan
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  3. Sofiane Derbal
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  4. Isabelle Fournel
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  6. Tatiana Codjia
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  8. Vincent Dubuisson
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  9. Haythem Najah
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  10. Alexis Laurent
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  11. Benoît Romain
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  12. Christophe Barrat
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  13. Christophe Trésallet
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  14. Muriel Mathonnet
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  15. Pablo Ortega-Deballon
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Corresponding author

Correspondence to Pablo Ortega-Deballon.

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Conflict of interest

P. Ortega-Deballon has received grants from Covidien/Medtronic, Bard and LifeCell/Acelity. The other authors have no disclosures.

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Doussot, A., Abo-Alhassan, F., Derbal, S. et al. Indications and Outcomes of a Cross-Linked Porcine Dermal Collagen Mesh (Permacol) for Complex Abdominal Wall Reconstruction: A Multicenter Audit. World J Surg 43, 791–797 (2019). https://doi.org/10.1007/s00268-018-4853-x

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  • DOI: https://doi.org/10.1007/s00268-018-4853-x

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