Major Complex Abdominal Wall Repair in Contaminated Fields with Use of a Non-cross-linked Biologic Mesh: A Dual-Institutional Experience

J J Atema,P J Tanis,M A Boermeester,W A Bemelman,Y Maeda,C J Vaizey,J Warusavitarne,E J Furnée

doi:10.1007/s00268-017-3962-2

J J Atema, P J Tanis + Show 6 more

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BackgroundData on the use of biologic mesh in abdominal wall repair in complex cases remain sparse. Aim of this study was to evaluate a non-cross-linked porcine acellular dermal matrix for repair of complex contaminated abdominal wall defects.MethodsRetrospective observational cohort study of consecutive patients undergoing abdominal wall repair with use of Strattice™ Reconstructive Tissue Matrix (LifeCell Corporation, Oxford, UK) between January 2011 and February 2015 at two National Intestinal Failure Units.ResultsEighty patients were identified. Indications for abdominal wall repair included enterocutaneous fistula takedown (n = 50), infected synthetic mesh removal (n = 9), restoration of continuity or creation of a stoma with concomitant ventral hernia repair (n = 12), and others (n = 9). The median defect area was 143.0 cm2 (interquartile range or IQR 70.0–256.0 cm2). All had a grade III or IV hernia. Component separation technique (CST) was performed in 54 patients (68%). Complete fascial closure was not possible despite CST and biologic mesh-assisted traction (bridged repair) in 20 patients (25%). In-hospital mortality was 1%. Thirty-six patients (45%) developed a wound infection. None required mesh removal. Of 76 patients with a median clinical follow-up of 7 months (IQR 4–15) available for analysis, 10 patients (13%) developed a hernia recurrence, of whom 3 had undergone bridged repairs. Seven patients developed a postoperative (recurrent) fistula (9%).ConclusionRepair of challenging and contaminated abdominal wall defects can be done effectively with non-cross-linked biologic mesh and component separation technique without the need for mesh removal despite wound infections.

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The paper is based on data previously presented to a scientific meeting of the European Society of Coloproctology, Dublin, Ireland, September 2015.Department of Surgery, Academic Medical Centre, 1105 AZ Amsterdam, The NetherlandsDepartment of Surgery, St Mark’s Hospital, London, UKSynthetic mesh repair is generally accepted as the preferred treatment strategy for clean abdominal wall defects
Eighty-two per cent (71 of 80) of the patients had a hernia that could be classified as a major complex abdominal wall defect [7]
Abdominal wall repair with concomitant enteric fistula takedown or removal of an infected synthetic mesh is known to be associated with significant complications

Summary

Introduction

Synthetic mesh repair is generally accepted as the preferred treatment strategy for clean abdominal wall defects. The use of synthetic material is frequently perceived as contraindicated for more complex cases, especially in the presence of contamination. The introduction of biologic prosthetics has provided new meshes that have the potential to resist infection [1, 2]. Numerous biologic prostheses have been developed using human or animal source material and different processing techniques such as collagen cross-linking. Data on the use of biologic mesh in abdominal wall repair in complex cases remain sparse. Aim of this study was to evaluate a non-cross-linked porcine acellular dermal matrix for repair of complex contaminated abdominal wall defects

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