Langenbeck's Archives of Surgery

, Volume 403, Issue 2, pp 255–263 | Cite as

Comparison of biological and alloplastic meshes in ventral incisional hernia repair

  • A. Koscielny
  • S. Widenmayer
  • T. May
  • J. Kalff
  • P. Lingohr



The aim of our retrospective analysis was to compare the results of incisional hernia repair by porcine small intestinal submucosa-derived (SIS) meshes with those obtained by alloplastic polypropylene-based (PP) meshes in comparable surgical indications by matched-pair design. We hypothesized that in incisional hernia, SIS mesh repair is associated with fewer recurrences and SSO than PP mesh repair in incisional hernias.


Twenty-four matched pairs (SIS vs. PP mesh repair between 1 January 2005 and 31 December 2013) were identified by matching criteria: gender, age, comorbidities, body mass index, EHS hernia classification, mesh implantation technique, CDC wound classification, and source of contamination/primary surgery leading to incisional hernia. Minimal follow-up time was 24 months. Means and standard deviations were compared by paired t test; categorial data were compared by McNemar’s test. Poisson’s distribution and negative binominal distribution were employed to detect significant correlation.


There were no statistically significant differences between both groups in the pre- and perioperative factors and the follow-up times. There were significantly more wound complications (19 vs. 12, p = 0.041), longer hospital stay (22.0 ± 6.3 vs. 12.0 ± 3.1 days, p = 0.010), and significantly more recurrent hernias (25 vs. 12.5%, p = 0.004) after SIS mesh repair. Both the Poisson’s distribution and the negative binominal distribution unveiled significantly more complication points (3–6 vs. 1–2) per month after SIS mesh repair.


There is no advantage of SIS meshes compared to PP meshes in incisional hernia repair with different degrees of wound contamination in this matched-pair analysis. Further prospective and randomized trials or at least registry studies such as the EHS register with standardized and defined conditions are warranted.


Ventral incisional hernia Biologic mesh Alloplastic mesh Cross-matched pair 



Dr. Ralf Fimmers, deputy head of the institute of medical biometry, informatics, and epidemiology at the University of Bonn Medical School, deserves our acknowledgment for his highly appreciated assistance in the statistical analyses.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

423_2017_1639_MOESM1_ESM.doc (78 kb)
ESM 1 (DOC 78 kb)


  1. 1.
    Hoer J, Lawong G, Klinge U, Schumpelick V (2002) Factors influencing the development of incisional hernia. A retrospective study of 2,983 laparotomy patients over a period of 10 years. Chirurg 73(5):474–480.  10.1007/s00104-002-0425-5 CrossRefPubMedGoogle Scholar
  2. 2.
    Conze J, Krones CJ, Schumpelick V, Klinge U (2007) Incisional hernia: challenge of re-operations after mesh repair. Langenbeck’s archives of surgery / Deutsche Gesellschaft fur Chirurgie 392(4):453–457.  10.1007/s00423-006-0065-1 CrossRefGoogle Scholar
  3. 3.
    Bellows CF, Smith A, Malsbury J, Helton WS (2013) Repair of incisional hernias with biological prosthesis: a systematic review of current evidence. Am J Surg 205(1):85–101.  10.1016/j.amjsurg.2012.02.019 CrossRefPubMedGoogle Scholar
  4. 4.
    Ramshaw BBS (2007) Surgical materials for ventral hernia repair: biological mesh part 2 of 3. General Surgery News 34(2):1–15Google Scholar
  5. 5.
    Robinson TN, Clarke JH, Schoen J, Walsh MD (2005) Major mesh-related complications following hernia repair: events reported to the Food and Drug Administration. Surg Endosc 19(12):1556–1560.  10.1007/s00464-005-0120-y CrossRefPubMedGoogle Scholar
  6. 6.
    Szczerba SR, Dumanian GA (2003) Definitive surgical treatment of infected or exposed ventral hernia mesh. Ann Surg 237(3):437–441.  10.1097/01.sla.0000055278.80458.d0 PubMedPubMedCentralGoogle Scholar
  7. 7.
    Cornwell KG, Landsman A, James KS (2009) Extracellular matrix biomaterials for soft tissue repair. Clin Podiatr Med Surg 26(4):507–523.  10.1016/j.cpm.2009.08.001 CrossRefPubMedGoogle Scholar
  8. 8.
    Huerta S, Varshney A, Patel PM, Mayo HG, Livingston EH (2016) Biological mesh implants for abdominal hernia repair: US Food and Drug Administration approval process and systematic review of its efficacy. JAMA Surg 151(4):374–381.  10.1001/jamasurg.2015.5234 CrossRefPubMedGoogle Scholar
  9. 9.
    Stojiljkovic D, Kovacevic P, Visnjic M, Jankovic I, Stevanovic G, Stojiljkovic P, Stojiljkovic M, Trenkic M, Golubovic Z, Ignjatovic N, Dimitrijevic Z, Kovacevic T, Stosic B, Bagur N (2013) Comparative analysis of autodermal graft and polypropylene mesh use in large incisional hernia defects reconstruction. Vojnosanit Pregl 70(2):182–188.  10.2298/VSP1302182S CrossRefPubMedGoogle Scholar
  10. 10.
    Liang MK, Berger RL, Nguyen MT, Hicks SC, Li LT, Leong M (2014) Outcomes with porcine acellular dermal matrix versus synthetic mesh and suture in complicated open ventral hernia repair. Surg Infect 15(5):506–512.  10.1089/sur.2013.090 CrossRefGoogle Scholar
  11. 11.
    Edelman DS, Bellows CF (2010) Umbilical herniorrhaphy reinforced with biologic mesh. Am Surg 76(11):1205–1209PubMedGoogle Scholar
  12. 12.
    Gupta A, Zahriya K, Mullens PL, Salmassi S, Keshishian A (2006) Ventral herniorrhaphy: experience with two different biosynthetic mesh materials, Surgisis and Alloderm. Hernia : the journal of hernias and abdominal wall surgery 10(5):419–425.  10.1007/s10029-006-0130-2 CrossRefGoogle Scholar
  13. 13.
    Helton WS, Fisichella PM, Berger R, Horgan S, Espat NJ, Abcarian H (2005) Short-term outcomes with small intestinal submucosa for ventral abdominal hernia. Arch Surg 140(6):549–560; discussion 560-542.  10.1001/archsurg.140.6.549 CrossRefPubMedGoogle Scholar
  14. 14.
    Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, Dietz UA, Eker HH, El Nakadi I, Hauters P, Hidalgo Pascual M, Hoeferlin A, Klinge U, Montgomery A, Simmermacher RK, Simons MP, Smietanski M, Sommeling C, Tollens T, Vierendeels T, Kingsnorth A (2009) Classification of primary and incisional abdominal wall hernias. Hernia : the journal of hernias and abdominal wall surgery 13(4):407–414.  10.1007/s10029-009-0518-x CrossRefGoogle Scholar
  15. 15.
    Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control 20(5):271–274.  10.1016/S0196-6553(05)80201-9 CrossRefPubMedGoogle Scholar
  16. 16.
    Ventral Hernia Working G, Breuing K, Butler CE, Ferzoco S, Franz M, Hultman CS, Kilbridge JF, Rosen M, Silverman RP, Vargo D (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148(3):544–558.  10.1016/j.surg.2010.01.008 CrossRefGoogle Scholar
  17. 17.
    Höer J, Lawong G, Klinge U, Schumpelick V (2002) Einflussfaktoren der Narbenhernienentstehung Retrospektive Untersuchung an 2.983 laparotomierten Patienten über einen Zeitraum von 10 Jahren. Chirurg 73(5):474–480.  10.1007/s00104-002-0425-5 CrossRefPubMedGoogle Scholar
  18. 18.
    Schumpelick V, Arlt G, Klinge U (1997) Hernienchirurgie: Versorgung von Nabelhernie und Narbenhernie. Dtsch Arztebl International 94 (51-52):A-3471-3476Google Scholar
  19. 19.
    Sandvall BK, Suver DW, Said HK, Mathes DW, Neligan PC, Dellinger EP, Louie O (2014) Comparison of synthetic and biologic mesh in ventral hernia repair using components separation technique. Ann Plast Surg 76(6):674–679.  10.1097/SAP.0000000000000253 CrossRefGoogle Scholar
  20. 20.
    El-Gazzaz G, Erem HH, Aytac E, Salcedo L, Stocchi L, Kiran RP (2013) Risk of infection and hernia recurrence for patients undergoing ventral hernia repair with non-absorbable or biological mesh during open bowel procedures. Techniques in coloproctology 17(3):315–320.  10.1007/s10151-012-0928-0 CrossRefPubMedGoogle Scholar
  21. 21.
    Cheesborough JE, Liu J, Hsu D, Dumanian GA (2016) Prospective repair of Ventral Hernia Working Group type 3 and 4 abdominal wall defects with condensed polytetrafluoroethylene (MotifMESH) mesh. Am J Surg 211(1):1–10.  10.1016/j.amjsurg.2015.03.033 CrossRefPubMedGoogle Scholar
  22. 22.
    Majumder A, Winder JS, Wen Y, Pauli EM, Belyansky I, Novitsky YW (2016) Comparative analysis of biologic versus synthetic mesh outcomes in contaminated hernia repairs. Surgery 160(4):828–838.  10.1016/j.surg.2016.04.041 CrossRefPubMedGoogle Scholar
  23. 23.
    Coccolini F, Agresta F, Bassi A, Catena F, Crovella F, Ferrara R, Gossetti F, Marchi D, Munegato G, Negro P, Piccoli M, Melotti G, Sartelli M, Schiano di Visconte M, Testini M, Bertoli P, Capponi MG, Lotti M, Manfredi R, Pisano M, Poiasina E, Poletti E, Ansaloni L (2012) Italian Biological Prosthesis Work-Group (IBPWG): proposal for a decisional model in using biological prosthesis. World journal of emergency surgery : WJES 7(1):34.  10.1186/1749-7922-7-34 CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Franklin MEJ, Gonzalez JJJ, Michaelson RP, Glass JL, Chock DA (2002) Preliminary experience with new bioactive prosthetic material for repair of hernias in infected fields. Hernia : the journal of hernias and abdominal wall surgery 6(4):171–174.  10.1007/s10029-002-0078-9 CrossRefGoogle Scholar
  25. 25.
    Franklin MEJ, Trevino JM, Portillo G, Vela I, Glass JL, Gonzalez JJ (2008) The use of porcine small intestinal submucosa as a prosthetic material for laparoscopic hernia repair in infected and potentially contaminated fields: long-term follow-up. Surg Endosc 22(9):1941–1946.  10.1007/s00464-008-0005-y CrossRefPubMedGoogle Scholar
  26. 26.
    Hiles M, Record Ritchie RD, Altizer AM (2009) Are biologic grafts effective for hernia repair?: a systematic review of the literature. Surg Innov 16(1):26–37.  10.1177/1553350609331397 CrossRefPubMedGoogle Scholar
  27. 27.
    Smart NJ, Marshall M, Daniels IR (2012) Biological meshes: a review of their use in abdominal wall hernia repairs. The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 10(3):159–171.  10.1016/j.surge.2012.02.006 CrossRefPubMedGoogle Scholar
  28. 28.
    Ditzel M, Deerenberg EB, Grotenhuis N, Harlaar JJ, Monkhorst K, Bastiaansen-Jenniskens YM, Jeekel J, Lange JF (2013) Biologic meshes are not superior to synthetic meshes in ventral hernia repair: an experimental study with long-term follow-up evaluation. Surg Endosc 27(10):3654–3662.  10.1007/s00464-013-2939-y CrossRefPubMedGoogle Scholar
  29. 29.
    Coccolini F, Poiasina E, Bertoli P, Gossetti F, Agresta F, Dassatti MR, Riccio P, Cavalli M, Agrusti S, Cucchi M, Negro P, Campanelli G, Ansaloni L, Catena F (2013) The Italian Register of Biological Prostheses. Eur Surg Res 50(3–4):262–272.  10.1159/000351333 CrossRefPubMedGoogle Scholar
  30. 30.
    Fischer JP, Basta MN, Krishnan NM, Wink JD, Kovach SJ (2016) A cost-utility assessment of mesh selection in clean-contaminated ventral hernia repair. Plast Reconstr Surg 137(2):647–659.  10.1097/01.prs.0000475775.44891.56 CrossRefPubMedGoogle Scholar
  31. 31.
    Gruber-Blum S, Brand J, Keibl C, Fortelny RH, Redl H, Mayer F, Petter-Puchner AH (2016) Abdominal wall reinforcement: biologic vs. degradable synthetic devices. Hernia : the journal of hernias and abdominal wall surgery.  10.1007/s10029-016-1556-9
  32. 32.
    Primus FE, Harris HW (2013) A critical review of biologic mesh use in ventral hernia repairs under contaminated conditions. Hernia : the journal of hernias and abdominal wall surgery 17(1):21–30.  10.1007/s10029-012-1037-8 CrossRefGoogle Scholar
  33. 33.
    Slater NJ, van der Kolk M, Hendriks T, van Goor H, Bleichrodt RP (2013) Biologic grafts for ventral hernia repair: a systematic review. Am J Surg 205(2):220–230.  10.1016/j.amjsurg.2012.05.028 CrossRefPubMedGoogle Scholar
  34. 34.
    Totten CF, Davenport DL, Ward ND, Roth JS (2016) Cost of ventral hernia repair using biologic or synthetic mesh. J Surg Res 203(2):459–465.  10.1016/j.jss.2016.02.040 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • A. Koscielny
    • 1
  • S. Widenmayer
    • 1
  • T. May
    • 1
  • J. Kalff
    • 1
  • P. Lingohr
    • 1
  1. 1.Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und GefäßchirurgieRheinische Friedrich-Wilhelms-Universität BonnBonnGermany

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