Complex Incisional Hernias Research Articles

S116: Impact of incisional negative pressure wound therapy on surgical site infection after complex incisional hernia repair: a retrospective matched cohort study.

Incisional negative pressure wound therapy (iNPWT) may reduce surgical site infections (SSI), which can have devastating consequences after incisional hernia repair. Few comparative studies investigate the effectiveness of this wound management strategy in this population. The objective of this study is to determine the effect of iNPWT on the incidence of SSI after complex incisional hernia repair. All adult patients undergoing open incisional hernia repair at a single center from 2016 to 2019 were reviewed. A commercial iNPWT dressing was used at the discretion of the surgeon. Patients were grouped by type of dressing; iNPWT and standard sterile dressings (SSD). Coarsened exact matching was used to create balanced cohorts for comparison using age, sex, American Society ofAnesthesiologists classification, wound classification, and surgical urgency. The primary outcome was the composite incidence of superficial and deep SSI within 30days. Secondary outcomes included non-infectious surgical site occurrences (SSO), overall complications, length of stay (LOS), emergency department visits, and readmission at 30days. 134 patients underwent complex hernia repair, with 114 patients included after matching (34 iNPWT, 51 SSD). Composite incidence of superficial and deep SSI was 19.3% (11.8% vs. 27.5%, p = 0.107), with significantly lower rates of deep SSI in patients receiving iNPWT (2.9% vs. 17.6%, p = 0.045). After accounting for residual differences between groups, iNPWT was associated with decreased incidence of composite SSI (RR 0.36, 95% CI [0.16, 0.87]). Median LOS was longer in patients with iNPWT (7 vs. 5days, p = 0.001). There were no differences in SSO, overall complications, readmission, or emergency department visits. In patients undergoing incisional hernia repair, the use of iNPWT was associated with a lower incidence of SSI at 30days. Future studies should focus on cost effectiveness of iNPWT, its impact on long-term hernia recurrences, and the identification of patient selection criteria in this population.

Compartive Study between use of Onlay Mesh and Composite Mesh in Repair of Complex Incisional Hernia

Patients with huge abdominal wall defects pose a great challenge to general surgeons. Failure of abdominal wall function cause many economic, medical and social problems such as chronic back pain, respiratory compromise, and altered body image. As patients are compelled to modify their way of life, their capacity to work become hindered which has negative monetary results; this reality drove the consideration of human services organizations to this issue. was to Compare between utilization of onlay work and Inlay composite work in fix of complex incisional hernia stressing repeat rate¸ post employable difficulties and come back to work… etc.This forthcoming examination was done on 40 sequential patients introduced to the benha unversity medical clinic, kobry elkoppa military Hospital for the board of complex incisional hernia. After endorsement of nearby morals board, all patients remembered for the investigation were educated about the system and a composed assent was acquired from each patient before conveying the procedur from May 2018 to May 2019 Follow up is intended for one year.In the examination we had no mortality. Among early postoperative complexities seroma happened in (15%), injury disease (10%), hematoma (5%) which were all treated minimalistically. Late postoperative inconvenience on follow up period no repeat among the cases was accounted for, no work evacuation and no fistula or intestinal attachments were accounted for just (15%) grumbled of outside body sensation. Intra-peritoneal composite work method is protected with low dismalness and confusions rate, okay of seroma and wound contamination. No revealed intestinal fistula or glue intestinal deterrent in examination with on lay work. Intra-peritoneal composite work application is a powerful technique in the executives of huge stomach divider absconds bigger than 10 cm because of any reason like enormous incisional hernia.

Long-term results of botulinum toxin type A in complex abdominal wall repair and review of the literature.

Administration of botulinum toxin (BTX) is being used in cases of complex ventral hernia for the reconstruction of the linea alba and closure of the abdominal wall. However, there are no published results regarding the long-term effects of BTX and its implication in hernia recurrence. Our purpose is to evaluate the outcomes in hernia recurrence of the administration of BTX in complex ventral hernia repair. 36 patients underwent elective surgery for complex ventral hernia and were evaluated retrospectively. The study included patients with a transverse hernia defect ≥ 100mm and loss of domain hernias, receiving BTX injections 6weeks prior to elective surgery. Global results and long-term recurrence were analysed. There were no complications related to BTX administration. The mean transverse hernia defect was 139.44 ± 50.98mm, the mean abdominal cavity volume (ACV) was 10.19 ± 3.33dm3, the mean hernia sac volume (HSV) was 1.93 ± 1.79dm3, presenting a mean volume ratio (VR) of 20.71 ± 19.76%. Primary closure was achieved in 28 patients (77.8%), 21 of whom (75%) needed an anterior component separation technique. Recurrence rate was 11.4% at 2-years follow-up. BTX administration is a safe and feasible method for abdominal wall expansion prior to complex incisional hernia repair, achieving high rates of primary closure. Long-term follow-up shows good results in terms of recurrence in these patients.

Do drain tubes help reduce risks of post-operative complications in complex incisional hernia repair (as defined by a recent court ruling)?

A recent legal case described in the ANZ Journal of Surgery has sparked significant topical interest in drain tube use in incisional hernia repairs in Australia. This study reviews a single centre experience of drain tube use in incisional hernia repair. Data from online clinical records was collected retrospectively from patients that underwent incisional hernia repair from 1 January 2013 to 31 December 2017. 'Complexity' factors of smoking, obesity and lower midline incision (as identified by the legal case) were also used to stratify groups. A total of 410 incisional hernia repair cases were identified during the 5-year period. Median length of stay of the non-drain placement group was significantly shorter than that of the drain placement group (2 versus 6 days, P < 0.001). In total, 10.8% of patients with drain suffered from post-op wound infection compared to 3.6% in patients without a drain tube in-situ (P = 0.005). Seroma rates were no different with or without a drain (15.7% versus 16.9% P = 0.78). When stratified by 'complexity', there was a trend towards increased complications when drains were used. Drain tubes were placed in only a small proportion of patients during incisional hernia repairs and were associated with a higher post-operative wound infection rate. When stratified by the 'complexity' factors outlined by the recent legal case, complications in more 'complex' patients may actually increase when a drain tube is used.

Combining anterior and posterior component separation for extreme cases of abdominal wall reconstruction

PurposeThe closure of midline in abdominal wall incisional hernias is an essential principle. In some exceptional circumstances, despite adequate component separation techniques, this midline closure cannot be achieved. This study aims to review the results of using both anterior and component separation in these exceptional cases.MethodsWe reviewed our experience using the combination of both anterior and posterior component separation in the attempt to close the midline. Our first step was to perform a TAR and a complete extensive dissection of the retromuscular preperitoneal plane developed laterally as far as the posterior axillary line. When the closure of midline was not possible, an external oblique release was made. A retromuscular preperitoneal reinforcement was made with the combination of an absorbable mesh and a 50 × 50 polypropylene mesh.ResultsTwelve patients underwent anterior and posterior component separation. The mean hernia width was 23.5 ± 5. The majority were classified as severe complex incisional hernia and had previous attempts of repair. After a mean follow-up of 27 months (range 8–45), no case of recurrence was registered. Only one patient (8.33%) presented with an asymptomatic bulging in the follow-up. European Hernia Society’s quality of life scores showed a significant improvement at 2 years postoperatively in the three domains: pain (p = 0.01), restrictions (p = 0.04) and cosmetic (p = 0.01).ConclusionsThe combination of posterior and anterior component separation can effectively treat massive and challenging cases of abdominal wall reconstruction in which the primary midline closure is impossible to achieve despite appropriate optimization of surgery.

Effects of polypropylene mesh on the component separation technique in complex incisional hernia surgery

Aim: Giant or complex hernia repair is an important risk factor for poor outcome compared with results after repair for smaller hernias. Various operation techniques have been described for this hernia types. In this study, we aimed to present our outcomes of component separation technique (CST) repair in patients with giant incisional hernia and compare the results of CST with or without mesh.Material and Methods: A comprehensive retrospective study was planned and performed on all patients who underwent the CST for complex incisional hernia between 2007 and2013 at study institution. Patients were divided into two groups according to polypropylene mesh use. Follow-up appointments were typically done at 2 weeks, 4 weeks, 2 months, 3 months, 6 months, 1 year and 2 years. Hernia recurrence was diagnosed by physical examinations and ultrasonography if needed.Results: A total of 91 patients were evaluated in this study, with 45 (49.4%) men and 46 (50.6%) women. The median age was 55(23-83) years and hernia defect size was 314 cm2 (62-940 cm2). Component separation group (CS) consisted of 13 women and 10 men with median age 56 years, whereas Component separation with mesh group (CS-M) comprised 35 women and 33 men with median age 55 years. A total of three patients (13%) had recurrence hernia in CS group vs. none of patients in CS-M group (p=0.015). Surgical site complication developed in 8 (34.7 %) patients in CS group, whereas in 28 (40.5%) patients in CS-M group (p=0.66). Statistical significant factors were associated with the development of complications including male gender (p=0.032), older than 60 years (p=0.045), and ASA score was 3 (p=0.017).Conclusion: Component separation technique could be preferred by surgeons in complex ventral hernias. Contrary to common belief, onlay polypropylene mesh placement was not increase the surgical site complications. Also, recurrence rates were lower in mesh group statistically significantly.

Comparing outcomes of the endoscopic and open external oblique myofascial release

AIMS: The external oblique release (EOR) is a well-described technique for myofascial advancement during hernia repair. One of the reported drawbacks of an open approach is the high wound morbidity associated with this procedure. One proposed technique to reduce wound morbidity is the endoscopic EOR. The purpose of this study was to compare the outcomes of the open and endoscopic EOR. METHODS: Data from the Americas Hernia Society Quality Collaborative were queried on May 10, 2017. All patients undergoing open or endoscopic incisional hernia repair with an EOR were evaluated with comparative outcomes including hernia recurrence, quality of life, and 30-day wound complications. RESULTS: Four hundred and eighty-five patients met inclusion criteria of undergoing open or endoscopic EOR. Surgical site infections (SSIs) occurred in 6% of the patients undergoing open EOR and 14% undergoing endoscopic EOR. There were no differences in outcomes comparing open and endoscopic EOR for hernia recurrence, quality of life, or 30-day SSI rate (P > 0.05). Laparoscopic EOR had a significantly higher rate of surgical site occurrences (SSOs) compared with open EOR (P 0.05). CONCLUSIONS: Equivalent outcomes were achieved using the open or endoscopic EOR technique in open repair of incisional hernia. Both techniques offer good outcomes and are important adjuncts in the repair of complex incisional hernias.

Outcomes using indocyanine green angiography with perforator-sparing component separation technique for abdominal wall reconstruction.

Usage of intraoperative indocyanine green (ICG) to assess skin flaps prior to abdominal wall closure has been shown to decrease postoperative wound-related complications. Primary outcome assessed is the utility of ICG in intraoperative decision making. Secondary outcomes analyzed are the incidence of surgical site occurrence (SSO) and hernia recurrence rates. A retrospective study using the MedStar Georgetown University Hospital database was conducted, incorporating all consecutive patients undergoing complex incisional hernia repair from 2008 to 2018. 146 patients underwent perforator-sparing component separation (PSCST), 88 underwent flap assessment using intraoperative ICG angiography; they were then analyzed based on patient comorbidities, Ventral Hernia Working Group grade, operative factors, and complications. A total of 146 patients were analyzed with no statistical difference in patient characteristics between the SPY and no SPY group except in BMI (30.2 vs. 33.2kg/m2, p = 0.036). The no SPY group also had higher numbers of patients undergoing concurrent panniculectomy (12 vs. 1, p < 0.001), and extensive lysis of adhesions (30 vs. 31, p = 0.048). Of the 88 patients undergoing intraoperative SPY, 37 (42%) patients had a change of intraoperative management as defined by further subcutaneous skin flap debridement. Despite this change, there was no statistical difference in incidence of SSO between SPY and no SPY (24.3% vs. 11.8%, p = 0.12), and no difference in hernia recurrence rates 5.6% (n = 5) versus 13.7% (n = 8), p = 0.09. Intraoperative ICG assessment of subcutaneous skin flaps with a perforator-sparing component separation does not result in a decrease in surgical site occurrences.

Role of botulinum toxin a in the management of complex incisional hernias

Role of botulinum toxin a in the management of complex incisional hernias

Role of botulinum toxin a in the management of complex incisional hernias

Role of botulinum toxin a in the management of complex incisional hernias

Posterior component separation with transversus abdominis release (TAR) for repair of complex incisional hernias after orthotopic liver transplantation.

Incisional hernias (IH) after orthotopic liver transplant (OLT) are challenging due to their concurrent midline and subcostal defects adjacent to bony prominences in the context of lifelong immunosuppression. To date, no studies evaluated the posterior component separation with transversus abdominis release (TAR) to repair complex IH after OLT. We aim to report the outcomes of TAR in this scenario. OLT patients who underwent open, elective IH repair with TAR performed at two centers and with a minimum of 1-year follow-up were identified in the Americas Hernia Society Quality Collaborative (AHSQC). Outcomes included 30-day surgical site infections (SSI), surgical site occurrences requiring procedural intervention (SSOPI), unplanned readmissions, reoperations, and hernia recurrence. Forty-four patients were identified (mean age 60 ± 8, 75% male, median BMI 30.7kg/m2) at two centers. Median hernia width was 20cm [IQR 15-28] and 98% (43) were clean cases. Retromuscular synthetic mesh was used in all cases, and 93% (41) achieved fascial closure with no intraoperative complications. Postoperatively, there were 5 SSIs (4 deep, 1 superficial), 6 SSOPIs (4 wound opening, 1 debridement, 1 seroma drainage), four (9%) readmissions, and 3 (7%) reoperations. One patient developed a mesh infection that did not require mesh excision. After a median follow-up of 13 months [IQR 12-17], there were 11 (25%) recurrences; 8 due to central mesh fractures (CMF). Seven recurrences have been repaired either laparoscopically or using an onlay. In a challenging cohort of immunosuppressed patients with large IH, TAR was shown to have acceptable medium-term results, but high recurrence rate driven by CMF. Further studies investigating the mechanism of central mesh fractures are necessary to reduce these recurrences.

#9 An in-depth analysis and cohort study of the techniques used to repair complex incisional hernias after abdominal surgery (oral presentation)

#9 An in-depth analysis and cohort study of the techniques used to repair complex incisional hernias after abdominal surgery (oral presentation)

A461 - Outcomes of bariatric surgery in patients undergoing complex incisional hernias with loss of domain

A461 - Outcomes of bariatric surgery in patients undergoing complex incisional hernias with loss of domain

Budget Impact Analysis of a Biosynthetic Mesh for Incisional Hernia Repair

PurposeWith the development of newer prostheses for hernia repair, it is nowadays difficult to understand the total cost of managing patients treated with these advanced medical devices, especially in the complex abdomen, in which various complications may occur. The aim of this study was to determine the economic implications of these prostheses in order to inform decision making in the management of incisional hernia repair. MethodsA budget impact analysis model was developed to evaluate the economic consequences related to the management of patients undergoing complex (Centers for Disease Control and Prevention wound class II–III or Ventral Hernia Working Group grade 2/3) incisional hernia repair through biosynthetic, synthetic, or biological meshes, from the hospital perspective in Italy. The model was populated with complication rates mainly retrieved from the literature to compare the current scenario with 60%, 10%, and 30% rates of synthetic, biosynthetic, and biological mesh utilization, respectively, with future hypothetical scenarios that consider increasing rates of biosynthetic mesh utilization with respect to the other types of mesh in the next 5 years. Hospital costs of the different events were estimated based on health care resource consumption derived from an electronic survey addressed to key opinion leaders in the field. FindingsThe analysis compared the current scenario with future hypothetical scenarios that consider increasing utilization rates of biosynthetic meshes of 25%, 38%, and 44% in the next 1, 3, and 5 years, as estimated by clinicians. Considering 40,000 incisional hernia repairs per year, an increasing use of the biosynthetic meshes may result in a decrease in the total hospital budget of about €153 million in the next 5 years, with a savings per patient of about €770. ImplicationsThe findings of this study support the use of biosynthetic meshes for complex abdominal wall repairs in Italy, showing a potential decrease in the hospital budget in Italy after the diffusion of the new biosynthetic prostheses. Further studies and data from clinical practice would provide additional information to increase the understanding of the economic sustainability of these advanced devices.

Complex Incisional Hernias in Morbidly Obese Patients: Hernia Repair Outcomes with Weight Loss Surgery

Complex Incisional Hernias in Morbidly Obese Patients: Hernia Repair Outcomes with Weight Loss Surgery

Long-term clinical, radiological, and histological follow-up after complex ventral incisional hernia repair using urinary bladder matrix graft reinforcement: a retrospective cohort study

BackgroundComplex ventral incisional hernia repair represents a challenging clinical condition in which biologically derived graft reinforcement is often utilized, but little long-term data inform that decision. Urinary bladder matrix (UBM) has shown effectiveness in diverse clinical settings as durable reinforcement graft material, but it has not been studied over a long term in ventral incisional hernia repair. This study evaluates the clinical, radiographic, and histological outcome of complex incisional hernia repair using UBM reinforcement with 12–70 months of follow-up.MethodsA single-arm, retrospective observational study of all ventral incisional hernia repairs utilizing UBM reinforcement over a 6-year time frame by a single surgeon was performed. Patients were assessed in long-term follow-up clinically and with the Carolina Comfort Scale. A subset of patients was assessed with abdominal wall ultrasound or CT scan. Three patients had abdominal wall fascial biopsies years after the incisional hernia repair with UBM graft, and the histology is analyzed.Results64 patients underwent repair of complex incisional hernias with UBM graft reinforcement by a single surgeon. 42 patients had concomitant procedures including large or small bowel resection, excision of infected mesh, evacuation of abscess or hematoma, cholecystectomy, or panniculectomy with abdominoplasty. 16 patients had ostomies at the time of repair. Median follow-up time is 36 months, with a range of 12–70 months. Nine patients (14%) have required surgical repair of a recurrent hernia, and a tenth patient has a recurrence that is managed non-surgically, for a total recurrence rate of 15.6% over the entire time frame. Median time to recurrence was 32 months, and a Kaplan–Meier freedom from recurrence curve is depicted. 28 patients have undergone ultrasound or CT assessments of the abdominal wall which demonstrate radiographic fascial integrity 12–70 months after repair. Three patients have been re-explored for unrelated reasons in the years following ventral incisional hernia repair with UBM, and full thickness fascial biopsies demonstrate a robust remodeling response histologically similar to native myofascial tissue. No patients have developed graft infection, fistulization to the graft, or required graft explantation. Carolina Comfort Scale assessment of 45 patients 3 years after the repair averaged 16 out of a possible 115.ConclusionIn 64 patients undergoing complex ventral incisional hernia repair with UBM reinforcement, all have experienced successful resolution of complex clinical conditions and 15.6% of these repairs have recurred at a median follow-up of 3 years. Three full-thickness biopsies of the repaired fascia years later shed light on a promising remodeling response which may signal strength and durability comparable to native fascia.

The results of surgical treatment of patients with large and complex incisional hernias of the anterior abdominal wall in a multidisciplinary hospital

Objectives. To evaluate the immediate results of surgical treatment of patients with large incisional hernia of the anterior abdominal wall with the use of the mesh implants.Materials and methods. The data were retrospectively collected and analyzed. The study included patients with a large and / or complex incisional hernia. There were 108 patients who underwent incisional hernia repair with mesh reinforcement in the period from 2012 to 2016. In all cases the repairs were made with mesh implants. The average age of patients was (56.4 ± 10.4) years. The body mass index (BMI) was on average (32.6 ± 6.24) kg/m2. The medial localization of the hernia was 102 (94.44%). The width of the hernia defect averaged (12.2 ± 3.7) cm. Implants were placement in onlay positions – 19 (17.6%), sublay – 49 (45.37%), IPOM (Intraperitoneal onlay mesh) – 30 (27.77%) patients, the component separation technique (CST) with mesh reinforcement was used in 10 (9.25%) patients. Active aspiration drainage was performed in 72 (66.66%) patients.Results. The average time for draining the postoperative wound was (5 ± 2.2) days. The number of wound complications was 23 (21.3%), the number of seromas of the postoperative wound prevailed was 16 (14.8%) patients, of which 2 (1.85%) were chronic abdominal wall seromas, hematoma occurred in 2 patients (1.85%), the number of prolonged serous exudation was 7 (6.5%), necrosis of the wound edges occurred in 4 (3.7%) patients. There was no mortality. Reliably more often wound complications occurred in patients with large hernia defects (p = 0.006), and also with an increase in the duration of surgical intervention (p = 0.01). The hospital-stay in patients with complications was significantly greater (p &lt; 0.001), the need for analgesics also increased (p &lt; 0.001).Conclusion. Prevention of wound complications after large and complex incisional hernia repair with mesh reinforcement is an important direction in improving the results of surgical treatment in this category of patients.

Abdominal Wall Reconstruction Utilizing the Combination of Absorbable and Permanent Mesh in a Retromuscular Position: A Multicenter Prospective Study.

Optimal mesh reinforcement for abdominal wall reconstruction (AWR) in complex hernias remains questionable. Use of biologic, absorbable and synthetic meshes has been described. The idea of using an absorbable mesh (AM) under a permanent mesh (PM) in a retromuscular position may help in these challenging situations. Between 2011 and 2016, consecutive patients undergoing open AWR utilizing an AM as posterior layer reinforcement and configuration of a large PM were identified in a multicenter prospectively maintained database in four hospitals. Main outcomes included demographics, ventral hernia classifications, perioperative data, complications and recurrences. A total of 169 complex incisional hernias were analyzed. Mean age was 60.9, with mean body mass index 30.7 (range: 20-46). Location of incisional hernias (IH) was: 80 midline, 59 lateral and 30 midline and lateral. 78% were grade I and II in Ventral Hernia Working Group classification. 52% of patients were discharged with no complication. There were 19% seromas, 13% hematomas, 12% surgical-site infection and 10% skin dehiscence. Only partial mesh removal was necessary in one patient. After a mean follow-up of 26months (range 15-59), there were five (3.2%) recurrences. Reoperations on patients showed a band of fibrosis separating the peritoneum from the PM. The combination of AM with very large PM in the same retromuscular position in AWR seems to be safe. The efficacy with recurrence rates below 4% in complex midline and lateral IH may be explained by the use of larger PMs that are extended and configured with the support of AMs. Reoperations on patients have confirmed the previous experimental reports on the use of the AM.

Clinical efficacy of posterior component separation with Sublay mesh repair for complex abdominal incisional hernia

Objective To explore the clinical efficacy of posterior component separation (PCS) with Sublay mesh repair for complex abdominal incisional hernia. Methods The retrospective crosssectional study was conducted. The clinical data of 30 patients with complex abdominal incisional hernia who were admitted to the Beijing ChaoYang Hospital of Capital Medical University from July 2016 to March 2017 were collected. Patients intraoperatively received PCS with Sublay mesh repair. Observation indicators: (1) intra- and post-operative situations: defect area of incisional hernia, operation time, volume of intraoperative blood loss, time of postoperative drainage-tube removal, postoperative complications and duration of postoperative hospital stay; (2) followup situation. Followup using outpatient examination and telephone interview was performed to detect recurrence of hernia and mesh-related complications up to July 2017. Outpatient examination was done once at postoperative month 1, 3 and 6 and telephone interview was done at 1 year postoperatively. Measurement data with normal distribution were represented as ±s and measurement data with skewed distribution were described as M (range). Results (1) Intra- and post-operative situations: 30 patients received successful PCS with Sublay mesh repair for complex abdominal incisional hernia. Defect area of incisional hernia, operation time, volume of intraoperative blood loss and time of postoperative drainage tube removal were respectively (222±124)cm2, 100 minutes (range, 40-235 minutes), 80 mL (range, 50-200 mL) and 5 days (range, 2-15 days). Of 7 patients with postoperative complications, 3 were complicated with shallow surgical site infection, including 1 with wound healing by vacuum sealing drainage and 2 with delayed healing by debridement and drainage; 2 with postoperative seroma were improved by aspiration and local pressurization after 1 months; 1 with fat liquefaction of abdominal incision was improved by symptomatic treatment; 1 with postoperative active hemorrhage was confirmed with arteriolar hemorrhage of muscular layer and then received hemostasis by ligation. Time of postoperative hospital stay of 30 patients was 15 days (range, 10-57 days). (2) Follow-up situation: 30 patients were followed up for (7±3)months, without occurrences of hernia recurrence, intestinal fistula and mesh-related complications. Conclusion PCS with Sublay mesh repair for complex abdominal incisional hernia is safe and feasible, with good clinical efficacies. Key words: Incisional hernia; Retrorectus hernia repair; Component separation; Mesh

Complex Ventral Hernia Repair with Acellular Dermal Matrices: Clinical and Quality of Life Outcomes

Acellular dermal matrices (ADMs) are used in conjunction with complex hernia repair, but their efficacy is often debated. This study assesses clinical and quality of life (QOL) outcomes in multiply comorbid patients undergoing complex ventral hernia repair using ADMs. After obtaining institutional review board approval, a prospective study was conducted evaluating patients undergoing complex ventral incisional hernia repair with abdominal wall reconstruction (AWR) using either human (Flex HD) or porcine ADM (Strattice). Patient accrual occurred over three years. Demographics, comorbid conditions, and operative details were recorded. Postoperative two-week, six-week, six-month, and one-year follow-up occurred. Primary outcomes measures include wound occurrence, QOL parameters using the Short Form-12 health survey, and hernia recurrence. Groups were compared using chi-squared, Fisher's exact, Mann-Whitney U, or t tests as appropriate. Significance was set at P < 0.05. Thirty-five patients underwent hernia repair using ADM: mean age = 58 years, mean body mass index = 34 kg/m2, >50 per cent Centers for Disease Control and Prevention Wound Class II and above, >50 per cent recurrent hernia repair, and 25 per cent current or previous mesh infection. Twenty patients (57%) experienced surgical site occurrences, 15 (43%) wound infections, and 5 (14%) recurrences with a median follow-up of one year. All Short Form-12 QOL indicators improved at 12 months compared with baseline (NS). Outcomes were similar between mesh types. In conclusion, abdominal wall reconstruction for complex hernias using biologic materials is safe but has significant morbidity. Wound complications occur in over half of all patients and are not impacted by ADM type. There is no decrement in QOL one year after hernia repair despite associated morbidity.