A retrospective, Italian multicenter study of complex abdominal wall defect repair with a Permacol biological mesh

Maria Sofia,Francesco Scaravilli,Domenico Russello,Piero Conti,Giovanni Trombatore,Antonella Agodi,Gaetano La Greca,Fabio Vasta,Valentina Randazzo,Elena Schembari,Martina Barchitta,Antonino Pesce,Saverio Latteri

doi:10.1038/s41598-020-60019-0

Abstract

Complex abdominal wall defects (CAWDs) can be difficult to repair and using a conventional synthetic mesh is often unsuitable. A biological mesh might offer a solution for CAWD repair, but the clinical outcomes are unclear. Here, we evaluated the efficacy of a cross-linked, acellular porcine dermal collagen matrix implant (Permacol) for CAWD repair in a cohort of 60 patients. Here, 58.3% patients presented with a grade 3 hernia (according to the Ventral Hernia Working Group grading system) and a contaminated surgical field. Permacol was implanted as a bridge in 46.7%, as an underlay (intraperitoneal position) in 38.3% and as a sublay (retromuscolar position) in 15% of patients. Fascia closure was achieved in 53.3% of patients. The surgical site occurrence rate was 35% and the defect size significantly influenced the probability of post-operative complications. The long-term (2 year) hernia recurrence rate was 36.2%. This study represents the first large multi-centre Italian case series on Permacol implants in patients with a CAWD. Our data suggest that Permacol is a feasible strategy to repair a CAWD, with acceptable early complications and long-term (2 year) recurrence rates.

Highlights

Complex abdominal wall defects (CAWDs) can be difficult to repair and using a conventional synthetic mesh is often unsuitable
We consider that using a biological mesh for CAWD repair at least avoids the problems and risks directly incurred by a synthetic mesh
The wound class has been suggested to increase the risk of hernia recurrence following CAWD repair[5], we found no such effect on the recurrence rate in our series

Summary

Introduction

Complex abdominal wall defects (CAWDs) can be difficult to repair and using a conventional synthetic mesh is often unsuitable. A synthetic mesh is generally thought to be safe and effective for standard hernia repair[2], where it has a low associated risk of complications Whether this consensus is true for patients with a complex abdominal wall defect (CAWD), is unclear. Short-term and long-term outcomes after biological mesh repair have been reported[5,11,12,13,14,15,16], the wide range of variables affecting surgical management has resulted in conflicting patient outcomes. These inconsistencies cast doubt on the utility of biologic materials for CAWD repair[17,18,19,20,21,22]

Results

Discussion

Conclusion