The advantages of biological meshes for ventral hernia repair are still under debate. Given the high financial cost, the proper indications for biological meshes should be clarified to restrict their use to properly selected patients.
A retrospective database was instituted to register all cases of abdominal wall defect treated with biological meshes from 1/2010 to 3/2016.
A total of 227 patients (mean age: 64 years) whose ventral abdominal defects were reconstructed with a biological mesh were included in the study. Patients were divided according to the 2010 four-level surgical-site complication risk grading system proposed by the Ventral Hernia Working Group (VHWG): Grade 1 (G1, 12 cases), Grade 2 (G2, 68 cases), Grade 3 (G3, 112 cases), and Grade 4 (G4, 35 cases). The surgical site complication rate was higher in patients with one or more risk factors (33.6% vs 19% in patients with no risk factors) (P = 0.68). Statistically significant risk factors associated with the onset of one or more postoperative surgical site complications included: diabetes, coronary artery disease, immunosuppression, and obesity. Recurrence was more common in patients with surgical site complications and mainly associated with infection (38.9%) and wound necrosis (44.4%), and in cases of inlay positioning of the mesh (36%).
Due to their high costs, biological mesh should not be used in G1 patients. In infected fields (G4), they should only be used if no other surgical solution is feasible. There is a clear need to prospectively evaluate the performance of biological meshes.
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Hodgson NC, Malthaner RA, Ostbye T (2000) The search for an ideal method of abdominal fascial closure. A meta-analysis. Ann Surg 231:436–442
Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J (2004) Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 240:578–583
Milburn ML, Holton LH, Chung TL et al (2008) Acellular dermal matrix compared with synthetic implant material for repair of ventral hernia in the setting of peri-operative Staphylococcus aureus implant contamination: a rabbit model. Surg Infect (Larchmt) 9:433–442
Ventral Hernia Working Group, Breuing K, Butler CE, Ferzoco S et al (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148:544–558
Alaedeen DI, Lipman J, Medalie D, Rosen MJ (2007) The single-staged approach to the surgical management of abdominal wall hernias in contaminated fields. Hernia 11:41–45
Köckerling F, Alam NN, Antoniou SA, Daniels IR et al (2018) What is the evidence for the use of biologic or biosynthetic meshes in abdominal wall reconstruction? Hernia 22:249–269
Cederholm T, Barazzoni R, Austin P, Ballmer P et al (2017) ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr 36:49–64
Muysoms F, Campanelli G, Champault GG, DEBeaux AC et al (2012) Eura HS: the development of an international online platform for registration and outcome measurement of ventral abdominal wall hernia repair. Hernia 16:239–250
Morales-Conde S (2012) A new classification for seroma after laparoscopic ventral hernia repair. Hernia 16:261–267
Muysoms FE, Miserez M, Berrevoet F, Campanelli G et al (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13:407–414
Choi JJ, Palaniappa NC, Dallas KB, Rudich TB, Colon MJ, Divino CM (2012) Use of mesh during ventral hernia repair in clean-contaminated and contaminated cases: outcomes of 33,832 cases. Ann Surg 255:176–180
Harth KC, Blatnik JA, Anderson JM, Jacobs MR, Zeinali F, Rosen MJ (2013) Effect of surgical wound classification on biologic graft performance in complex hernia repair: an experimental study. Surgery 153:481–492
Hawn MT, Gray SH, Snyder CW, Graham LA, Finan KR, Vick CC (2011) Predictors of mesh explantation after incisional hernia repair. Am J Surg 202:28–33
Rosen MJ, Krpata DM, Ermlich B, Blatnik JA (2013) A 5-year clinical experience with single-staged repairs of infected and contaminated abdominal wall defects utilizing biologic mesh. Ann Surg 257:991–996
Itani KM, Rosen M, Vargo D, Awad SS, Denoto G 3rd, Butler CE, RICH Study Group (2012) Prospective study of single-stage repair of contaminated hernias using a biologic porcine tissue matrix: The RICH Study. Surgery 152:498–505
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 160:828–838
Satterwhite TS, Miri S, Chung C, Spain D, Lorenz HP, Lee GK (2012) Outcomes of complex abdominal herniorrhaphy. Experience with 106 cases. Ann Plast Surg 68:382–388
Atema JJ, de Vries FE, Boermeester MA (2016) Systematic review and meta-analysis of the repair of potentially contaminated and contaminated abdominal wall defects. Am J Surg 212:982–995
Dunne JR, Malone DL, Tracy LK, Napolitano LM (2003) Abdominal wall hernias: risk factors for infection and resource utilization. J Surg Res 111:78–84
Carbonell AM, Criss CN, Cobb WS, Novitsky YW, Rosen MJ (2013) Outcomes of synthetic mesh in contaminated ventral hernia repairs. J Am Coll Surg 217:991–998
Garvey PB, Martinez RA, Baumann DP, Liu J, Butler CE (2014) Outcomes of abdominal wall reconstruction with acellular dermal matrix are not affected by wound contamination. J Am Coll Surg 219:853–864
Sailes FC, Walls J, Guelig D et al (2010) Synthetic and biological mesh in component separation: a 10-year single institution review. Ann Plast Surg 64:696–698
Novitsky YW, Porter JR, Rucho ZC, Getz SB, Pratt BL, Kercher KW, Heniford BT (2006) Open preperitoneal retrofascial mesh repair for multiple recurrent ventral incisional hernias. J Am Coll Surg 203:283–289
Owei L, Swendiman RA, Kelz RR, Dempsey DT, Dumon KR (2017) Impact of body mass index on open ventral hernia repair: A retrospective review. Surgery 162:1320–1329
Helgstrand F (2016) National results after ventral hernia repair. Dan Med J 63:1–17
Giordano P, Pullan RD, Ystgaard B, Gossetti F et al (2015) The use of an acellular porcine dermal collagen implant in the repair of complex abdominal wall defects: a European multicenter retrospective study. Tech Coloproctol 19:411–417
Mercoli H, Tzedakis S, D’Urso A et al (2017) Postoperative complications as an independent risk factor for recurrence after laparoscopic ventral hernia repair: a prospective study of 417 patients with long-term follow-up. Surg Endosc 31:1469–1477
Patel KM, Nahabedian MY, Albino F, Bhanot P (2013) The use of porcine acellular dermal matrix in a bridge technique for complex abdominal wall reconstruction: an outcome analysis. Am J Surg 205:209–212
Negro P, D’Amore L, Ceci F, Gossetti F, Rostambeigi N, Podgaetz E, Sarr MG (2015) Comment to “Long-term outcomes (> 5 year follow-up) with porcine acellular dermal matrix (Permacol TM) in incisional hernias at risk for infection” by Abdelfatah MM. Hernia 19:1023–1024. (https://doi.org/10.1007/s10029-013-1165-9)
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 205:85–101
Conflict of interest
All the authors declare that they have no conflict of interest.
According to Italian law, approval from a local ethics committee was not required.
Human or animal studies
This article does not contain any studies with animals performed by any of the authors.
According to Italian law, informed consent from included individuals are not required for this type of study.
N. Baldan and G. Munegato are joint first authors.
Previous communication to meeting: oral presentation at the 29th Annual International Congress of the European Hernia Society (EHS) in Vienna, Austria, May 2017.
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Baldan, N., Munegato, G., Di Leo, A. et al. Lessons learned from 227 biological meshes used for the surgical treatment of ventral abdominal defects. Hernia 24, 57–65 (2020). https://doi.org/10.1007/s10029-019-01883-2
- Biological mesh
- Ventral hernia
- Abdominal wall repair