Abdominal Hernia Repair Research Articles

Abdominal necrotizing fasciitis causing acute myocardial infarction

Necrotizing fasciitis (NF) is a surgical emergency characterized by a fulminant course and high mortality rate.1,2 NF is a severe form of soft-tissue infection. When NF is complicated with acute myocardial infarction (AMI), acute respiratory distress syndrome (ARDS), and acute kidney injury (AKI), the patient's chance of survival are diminished significantly.3,4 We present a case of NF of the abdominal wall with acute non-ST segment elevated myocardial infarction (NSTEMI). No such case has previously been reported according to our review of the literature. Case: A 52-year-old female with a known case of hypothyroidism presented to the emergency department with severe abdominal pain for two days. She gave the history of abdominal hernia repair ten days back. She had sinus tachycardia but other vitals were normal, with no fever or leucocytosis. Computed Tomography (CT) of the abdomen showed anterior abdominal wall collections. Septic workup was done, cefuroxime and metronidazole were started. Her abdominal wall collection was drained under image guidance. After a few hours, her blood pressure dropped and was not responding to fluid challenges so a noradrenaline infusion was started and she was transferred to the surgical intensive care unit (SICU). Her blood work showed lactic acidosis. Her abdomen was tender all over with swelling and induration of the abdominal wall. Antibiotics were changed to meropenem and clindamycin to broaden the spectrum in view of the septic shock and she was immediately taken for exploratory laparotomy. The operative findings were suggestive of necrotizing fasciitis of the anterior abdominal wall and a bold and thorough debridement was done. She was kept intubated and ventilated for a second look and further debridement was conducted after 24 hours.Six-hours post-surgical debridement, electrocardiographic (ECG) changes were noticed, 12-lead ECG showed ST-segment depression in leads II, III, aVF, and V5-6, with raised cardiac biomarkers and lower cardiac index (Figures 1 & 2), diagnosed as NSTEMI. Heparin infusion, aspirin, and clopidogrel were started. Echocardiogram showed moderate left ventricular systolic dysfunction (ejection fraction: 45%) with septal dyskinesia. Dobutamine infusion (guided by the PiCCO study) was started, which improved her hemodynamic parameters. CT coronary angiography was inconclusive. These findings suggested that she suffered Type II myocardial infarction due to the stress. She developed oliguria which improved with the restoration of hemodynamics. Her lung condition also deteriorated (PaO2/FiO2 ratio dropped to 100), requiring maximum ventilatory support and she was managed as per ARDS guidelines.5 Blood culture showed growth of Group F Streptococci and Prevotella melaninogenica. Meropenem was continued as the growths were sensitive to it.By day six, she started to be weaned off from the ventilator and vasopressors. She was extubated on day nine and transferred to the ward on day ten. She was later discharged home to be followed up in the surgical outpatient clinic. Her length of stay was 15 days. On a six-month follow-up, she was functionally independent, on aspirin, clopidogrel, and thyroxin therapy. Conclusion: Our patient had NF of the anterior abdominal wall leading to septic shock and complicated by NSTEMI, ARDS, and AKI. Timely source control, close monitoring, quick, and effective interventions appear to have resulted in her excellent recovery.

Laparoscopic Abdominal Wall Hernia Repair.

Background and Objectives:The aim of this retrospective monocentric study was to evaluate results and recurrence rate with long-term follow-up after laparoscopic incisional/ventral hernia repair.Methods:This was a retrospective, single-center, observational trial, collecting data from patients who underwent laparoscopic incisional/ventral abdominal hernia repair using the open intraperitoneal onlay mesh technique and a single mesh type. All patients signed an informed consent form before surgery.Results:A total of 1,029 patients were included. The median surgery time was 40 min (range 30–55) and the median length of hospital stay was 2 d (range 2–3). Intraoperative complications occurred in two of 1,029 patients (0.19%), whereas early postoperative surgical complications (within 30 d) occurred in 50 patients (4.86%). Postoperative complications according to Clavien-Dindo classification were as follows: I, 3.30% (34 of 1,029); II, 0.97% (10 of 1,029); IIIB, 0.58% (six of 1,029); IV, 0.00% (none of 1,029); and V, 0.00% (none of 1,029). During follow-up, bulging mesh was diagnosed in 58 of 1,029 patients (5.6%), and hernia recurred in 40 of 1,029 patients (3.9%). A mesh overlap equal to or greater than 4 cm appeared to be a significant protective factor for hernia recurrence (P < .001); a mesh overlap equal or greater than 5 cm appeared to be a significant protective factor for bulging (P < .001), whereas the use of resorbable fixing devices was a significant risk factor for hernia recurrence (odds ratio, 111.53, P < .001, 95% confidence interval, 21.53–577.67).Conclusion:This study demonstrates that laparoscopic repair of ventral/incisional abdominal wall hernias is a safe, effective, and reproducible procedure. Identified risk factors for recurrence are an overlap of less than 4 cm and the use of resorbable fixation means.

Non-healing wounds: Can it take different diagnosis?

Wound healing is a complex cellular and biochemical process and can be affected by several systemic and local factors. In this study, we aimed to discuss the aetiologic factors of non-healing wounds and the management of this complicated process with current information. The medical data of the patients who were admitted to our clinic due to non-healing or chronic wounds were analysed retrospectively. A total of 27 patients were evaluated retrospectively during the 14 months of the study. The data of 6 patients who were followed up for chronic wound that developed after abdominal incisional hernia repair and pilonidal sinus surgery were not included in the study as their data could not be reached. A total of 21 patients were included in the study. Malignancy was diagnosed in two patients and granulomatous disease was found in four patients. The aetiology of the other cases included foreign body reaction, infection, and mechanical causes. Non-healing wounds are a serious social and economic problem for patients. Further studies on the pathophysiology of various aetiologies in non-healing wounds in both clinical settings and experimental animal models would be a useful step in treatment.

Development and preliminary characterisation of novel textiles for abdominal hernia repair

Development and preliminary characterisation of novel textiles for abdominal hernia repair

Fixation of polyvinylidene fluoride (PVDF) mesh with cyanoacrylate-derived glues in a rat experimental model: histopathologic immunohistochemical and morphometric study.

The use of cyanoacrylate (CA)-based tissue adhesives for mesh fixation in abdominal hernia repair is increasing due to the fast action and bond strength of these glues. The aim of the present study was to assess tissue changes induced by different CA glues used for mesh fixation in an animal model. Parietal defects were induced in the abdominal wall of 60 rats and repaired by polyvinylidene fluoride (PVDF) mesh fixation using different CA glues. At 1, 7, 15, and 30days post-surgery, macroscopic and histopathological studies were performed to evaluate mesh adhesion, the presence of complications and the tissue response. All meshes were successfully fixed without signs of inflammatory reaction, displacement or detachment. In areas where CA adhesives were applied, the acute tissue response was limited and transient. At 7days post-surgery, collagen fibril production around prosthetic materials was observed, and collagen maturation was achieved at 30days post-surgery. Good mesh incorporation was detected with all three glues, but the application of Glubran-2 was associated with an early macrophagic response and the early production and maturation of collagen fibrils. Our study confirmed that CA tissue adhesives induced the good incorporation of prosthetic mesh within host tissue with a low incidence of complications and reduced acute tissue reaction. At 30days post-surgery no signs of mesh disinsertion or migration were observed, the prosthetic mesh adhesion was due to the presence of a dense mature connective tissue rich in type I collagen fibres.

Preparation, characterization, and xenotransplantation of the caprine acellular dermal matrix.

Caprine skin is a promising biomaterial for tissue-engineering applications. However, tissue processing is required before its xenogenic use. Therefore, the purpose of this study was to evaluate the structural integrity and biocompatibility of the caprine skin after de-epithelialization, using sodium chloride (NaCl) and trypsin solutions, followed by de-cellularization using sodium dodecyl sulfate (SDS) solution. The caprine skin was de-epithelialized using NaCl (2-4mol/L) and trypsin (0.25%-0.5%) followed by the treatment of SDS (1%-4%) solution over a period of time. Acellularity of the prepared matrix was confirmed histologically and characterized by appropriate staining, scanning electron microscopy (SEM), DNA quantification, and Fourier-transform infrared (FTIR) spectroscopy. The caprine acellular dermal matrix (CADM) was used for the repair of spontaneously occurring abdominal hernia in ten buffaloes. The biocompatibility of the CADM was evaluated using clinical, hematological, biochemical, and anti-oxidant parameters. Histologically, the skin treated with 0.25% trypsin in 4mol/L NaCl for 8hours resulted in complete de-epithelialization. Further treatment with 2% SDS for 48hours demonstrated complete acellularity and orderly arranged collagen fibers. The SEM confirmed a preservation of collagen arrangement within CADM. The DNA content was significantly (P<.05) lower in CADM (46.20±7.94ng/mg) as compared to fresh skin (662.56±156.11ng/mg) indicating effective acellularity. The FTIR spectra showed characteristic collagen peaks of amide A, amide B, amide I, amide II, and amide III in CADM. All the 10 animals recovered uneventfully and remained sound. Hematological, biochemical, and anti-oxidants findings were unremarkable. Results indicated the acceptance and biocompatibility of the xenogenic caprine acellular dermal matrix for abdominal hernia repair in buffaloes without complications.

Clinical and Therapeutic characteristics of patients with abdominal hernias at the savalou Banté Hospital in Republic of Bénin

Background: Abdominal hernias are frequent conditions in African’s countries and mostly at Savalou-Bantè Hospital in the Republic of Benin. The objective of this study was to determine the prevalence, clinical and therapeutic characteristics of abdominal hernias at Savalou-Bantè Hospital in the Republic of Benin. Methods: This was a prospective study carried out from March 15, 2013 to August 31, 2018 including all patients with abdominal hernia. Results: Out of 146 procedures done in department of surgery at Savalou-Bantè Hospital, 77 were abdominal hernias repair either 56.84%. Inguinal hernia was the commonest (88.76% of cases). Strangulated hernia was the main complication in 17.98% of cases (16/77). Herniorrhaphy was done in all hernias and Bassini technique was used for all cases of inguinal hernia. Mortality was observed in 6.5% (5 patients / 77). The median of staying in hospital was of 4.60 days. We noted a case of recurrence (5.26%). Conclusion: there still a dire need in management of abdominal hernias and hernia repair using mesh is in need. Early consultation will avoid the arising of complications.

A novel laparoscopic approach: (e-TEP) technique in ventral abdominal hernia-our experience

Background: Enhanced view totally extra peritoneal (eTEP) repair is the novel method for inguinal hernia management. Igor Belyansky extended the principle of eTEP to ventral and incisional hernia. The eTEP technique is based on the principle that the extra peritoneal space can be created from almost anywhere in the anterior abdominal wall. The classical Totally Extra peritoneal (TEP) technique is considered closest to an ideal hernia repair, but this technique has several drawbacks such as restricted port placement, limited space for dissection and mesh placement, a low tolerance of accidental pneumoperitoneum, and difficulty in teaching and learning the technique. We present our experience with eTEP technique, which overcomes several of these drawbacks.Methods: We conducted a short term 6 months retrospective analysis of 24 patients in our hospital who underwent eTEP procedure for umbilical hernia and inguinal hernia, with a minimum of 3 months follow-up. Their data were analyzed for operative details, intra‑operative and post‑operative complications.Results: Judging from our short term results, for 24 patients we have not come across any post-operative complications like seroma, SSI, recurrence, with a minimum of 3 months follow-up.Conclusion: Our evaluation of eTEP technique in umbilical and inguinal hernias has found the approach not only novel one but also very feasible and highly effective. This technique provides flexible port set-up optimal for laparoscopic closure of defects, along with placement of wide mesh in the retro-muscular space with no transfascial fixation while restoring abdominal wall dynamics. We suggest that the eTEP technique is the most ideal option for ventral abdominal hernia repair and can be adapted in hospitals with advanced laparoscopic setup.

Minimally invasive Venetian blinds ventral hernia repair with botulinum toxin chemical component separation.

Laparoscopic ventral repair is safe, with lower wound infection rates compared with open repair. 'Venetian blinds' technique of plication in combination with mesh reinforcement, is totally intra-corporeal, with hernia defect and sac plication to reduce seroma formation. While laparoscopic suturing of the abdominal wall can represent a technical challenge, pre-operative botulinum toxin A (BTA) injections as an adjunct can assist. This study aims to demonstrate feasibility and efficacy of this technique in abdominal wall hernia repair, with BTA adjunct in midline hernias. A single-centre case series was conducted using minimally invasive 'Venetian blinds' technique for repair of complex ventral abdominal hernias. Twelve patients (seven midline, five non-midline) underwent repair (11 laparoscopic; one robotic). Midline hernias received BTA (200-300 units Botox) 4-6 weeks prior to surgery. Repairs were mesh-reinforced following fascial closure. Twelve (10 female, two male) patients, with a median age 72 years (range 31-83) and body mass index of 27.3 kg/m2 (range 22.8-61.7) were included. The median length of operation was 133 min (range 45-290) and length of hospital stay 3 days (range 1-28). To date there has been no recurrence of hernia. A single symptomatic seroma was treated with antibiotics and did not require mesh removal. One patient developed hospital-acquired pneumonia and pseudomembranous colitis. Minimally invasive 'Venetian blinds' technique has promising early results with both midline and non-midline ventral hernias. The addition of BTA is a novel and feasible combination for repair of midline ventral hernias.

Mesh removal and reconstruction with posterior components separation technique for delayed mesh infection developed 10 years after abdominal incisional hernia repair: a rare case report

BackgroundVery few literatures can be found reporting cases and treatment strategies of late-onset mesh infection after abdominal incisional hernia reconstruction. Here, we report a rare case of delayed mesh infection developed 10 years after abdominal incisional hernia repair, which was successfully treated by mesh removal and reconstruction with posterior components separation technique.Case presentationA 66-year-old man, who underwent reconstruction of abdominal incisional hernia by retroperitoneal Composix mesh application 10 years prior, developed 12 × 6.0 × 2.5 cm subcutaneous abscess followed by methicillin-resistant Staphylococcus aureus (MRSA)-related mesh infection. The operation was performed excising the abscess wall without damaging peritoneum, and huge intermuscular defect was successfully reconstructed by posterior components separation technique application.ConclusionsAn early decision of excising contaminated mesh would be preferable to extensive conservative treatments when mesh infection is suspected. Components separation technique application can be of great help when designing reconstruction of huge intramuscular defect after removal of infected mesh.

The Critical Role of Development of the Transversus Abdominis in the Prevention and Treatment of Low Back Pain

The Critical Role of Development of the Transversus Abdominis in the Prevention and Treatment of Low Back Pain

Emergency repair of complicated abdominal wall hernias: WSES guidelines.

In July 2013, the World Society of Emergency Surgery (WSES) held the first Consensus Conference on emergency repair of abdominal wall hernias in adult patients with the intention of producing evidence-based guidelines to assist surgeons in the management of complicated abdominal wall hernias. Guidelines were updated in 2017 in keeping with varying clinical practice: benefits resulting from the increased use of biological prosthesis in the emergency setting were highlighted, as previously published in the World Journal of Emergency Surgery. This executive summary is intended to consolidate knowledge on the emergency management of complicated hernias by providing the broad readership with a practical and concise version of the original guidelines. This executive manuscript summarizes the WSES guidelines reporting on the emergency management of complicated abdominal wall hernias; statements are highlighted focusing the readers' attention on the main concepts presented in the original guidelines. Emergency repair of complicated abdominal hernias remains one of the most common and challenging surgical emergencies worldwide. WSES aims to provide an essential version of the evidence-based guidelines focusing on the timing of intervention, laparoscopic approach, surgical repair following the Centers for Disease Control and Prevention (CDC) wound classification, antimicrobial prophylaxis and anesthesia in the emergency setting.

The use of implanted materials for treating women with pelvic organ prolapse and stress urinary incontinence.

To review the current clinical management of stress urinary incontinence and pelvic organ prolapse following the adverse complications seen in the use of polypropylene mesh to treat both. Materials developed for use in abdominal hernia repair have not proven risk-free when used to support pelvic organs particularly when inserted via the vagina. Following unacceptably high levels of severe complications when high-density polypropylene mesh is inserted via the vagina to treat pelvic organ prolapse, reported over the last decade, there is now an agreed consensus between surgeons about surgical approaches and materials, which should be recommended for use in stress urinary incontinence and pelvic organ prolapse. There is a need for new biomaterials and tissue engineered/regenerative medicine approaches to treat stress urinary incontinence and pelvic organ prolapse. New materials need to be evaluated critically in both preclinical and clinical studies before being adopted into routine clinical use.

Severe complications after mesh migration following abdominal hernial repair: report of two cases and review of literature.

Background: Migration of mesh after ventral and incisional hernia repair is a rare but well described complication. The aim of our work is to present two cases of mesh migration after incisional hernia repair and to review the current literature. Methods: We describe the two cases of mesh migration that occurred at our department. Additionally, we performed a systematic literature search. Results: In both cases we observed a mesh migration with formation of an entero-cutaneous fistula that required surgical therapy. In the literature search we found a total of 16 publications dealing with mesh migration after incisional (n=14) and ventral hernia (n=2) repair in adult patients (15 case reports and one retrospective study). In 9 out of 15 patients (54%) who presented with mesh migration or erosion, a polypropylene mesh was responsible for this complication.Conclusions: Mesh migration after abdominal hernia repair is rare, the only available retrospective study reports a rate of 2.7%. The ability of polypropylene mesh to migrate into hollow viscera is well known and confirmed both by our data and the results of the literature review. As the incidence of mesh erosion/migration is significantly lower than the recurrence rate after hernia repair without mesh, up to now, no better alternative exists for the treatment of abdominal wall hernia than mesh augmentation.

A novel tool to evaluate bias in literature on use of biologic mesh in abdominal wall hernia repair.

Biologic meshes are being increasingly used for abdominal hernia repair in high-risk patients or patients with a previous history of wound infection, due to their infection-resistant properties. Several studies have been carried out to assess whether biologic mesh is superior to synthetic mesh, as well as to establish guidelines for their use. Unfortunately, most of these studies were not rigorously designed and were vulnerable to different types of bias. The systematic reviews that have been published so far on this topic contain the same biases and limitations of the primary articles that are analyzed. The lack of a literature review on the bias on the use of biological mesh prompted us to conduct the literature search, assessment and plan this article. We performed a literature search in PubMed, Embase and Cochrane databases of systematic reviews on biologic mesh for ventral hernia repair. The literature review was conducted using the Population, Intervention, Comparisons, Outcomes and Design approach. We identified 40 studies that matched the stringent criteria we had set. We then created a 13-point instrument to assess for bias and applied it on the primary studies that we intended to analyze. Most primary studies are case series or case reports of patients undergoing abdominal hernia repair with biologic mesh, without any comparison group, and the inclusion of cases was only specified to be consecutive in 6 out of 40 cases. In terms of assessing outcomes, in none of the 40 articles were the outcome assessors blinded to the intervention or exposure status of participants. The instrument that we created could allow to assess the risk of bias in different kind of studies. Our assessment of the studies based on the criteria that we had set up in the instrument clearly identified that further research needs to be done due to the lack of unbiased studies regarding the use of biologic meshes for abdominal hernia repair.

Bubaline Aortic Matrix: Histologic, Imaging, Fourier Transform Infrared Spectroscopic Characterization and Application into Cattle Abdominal Hernia Repair

Extracellular matrix (ECM) scaffolds have been shown to promote constructive remodeling response into a host. Minimal disruption of ECM ultrastructure during tissue processing is typically desirable. The purpose of the study was to prepare and characterize bubaline aortic matrix (BAM) for abdominal hernia repair in cattle. The bubaline aorta was decellularized with 1% sodium dodecyl sulfate (SDS) for 24 h followed by 0.25% trypsin for 2 h and again with 1% SDS for 24 h. Native and decellularized aortae were examined for residual cells, collagen structure and integrity by histologic examination and scanning electron microscopy (SEM). Masson’s trichrome and Weigert’s staining, DNA quantification and Fourier transform infrared (FTIR) spectroscopy were used for further characterization of BAM. BAM was used for repair of abdominal hernia in six cattle having mean weight of 132.50 ± 21.86 kg and hernial ring size of 40.55 ± 15.42 cm2. Clinical, hemato-biochemical and antioxidant parameters were evaluated to assess biocompatibility of xenogenic BAM. Histologically, the absence of cells and orderly arranged collagen fibers were observed in treated aorta. SEM confirmed the preservation of collagen structure and integrity. DNA content was significantly (P < 0.001) reduced in BAM (6.47 ± 1.26 ng/mg) as compared to the native aorta (488.11 ± 49.12 ng/mg). DNA extracts from BAM show marked removal of DNA material, with the absence of DNA band in agarose gel. FTIR spectrum of BAM showed all characteristic transmittance peaks of native aorta collagen indicating preserved collagen structure within decellularized aorta. Cattle with the BAM implant recovered uneventfully and remained sound. Hemato-biochemical and antioxidant findings were unremarkable. Bubaline aortic matrix shows excellent repair efficiency and biocompatibility for abdominal hernia repair in cattle without complications.

Use of Prolonged Prophylactic Antibiotics with Closed Suction Drains in Ventral Abdominal Hernia Repair

Closed suction drains (CSD) are commonly used in ventral hernia repair (VHR), with or without prolonged postoperative prophylactic antibiotics (PPA) for the duration of their use. We examine the evidence that PPA with CSD reduce surgical site infection (SSI) in patients undergoing VHR. We also examine the evidence assessing the association between SSI and CSD in VHR. A systematic review of PubMed, CIHNL, and Cochrane databases was performed to identify studies analyzing rates of SSI with CSD in patients undergoing abdominal VHR and related procedures with or without the concomitant use of PPA. The primary outcome was the rate of SSI. Five studies totaling 772 patients were identified, 525 patients were confirmed to have CSD, and 434 patients received prolonged antibiotics while drains were in place. PPA had no significant effect on SSI in two studies and were associated with decreased SSI in one study (Odds ratio 0.235, 95% confidence interval 0.090-0.617, P = 0.003). Two studies documented a higher rate of SSI in patients with CSD (79% vs 49% and 19% vs 10%) on univariate analysis. One study demonstrated a very low risk of SSI despite CSD (4.2%) and another demonstrated no increased risk with or without CSD. The use of drains is not clearly associated with an increased risk of SSI in VHR, and there is limited evidence to support antibiotic use while the drains are in place to decrease the potential risk. Prospective randomized studies are needed to more clearly assess these associations.

Biomaterial Implants in Abdominal Wall Hernia Repair: A Review on the Importance of the Peritoneal Interface

Biomaterials have long been used to repair defects in the clinical setting, which has led to the development of a wide variety of new materials tailored to specific therapeutic purposes. The efficiency in the repair of the defect and the safety of the different materials employed are determined not only by the nature and structure of their components, but also by the anatomical site where they will be located. Biomaterial implantation into the abdominal cavity in the form of a surgical mesh, such as in the case of abdominal hernia repair, involves the contact between the foreign material and the peritoneum. This review summarizes the different biomaterials currently available in hernia mesh repair and provides insights into a series of peculiarities that must be addressed when designing the optimal mesh to be used in this interface.

Mesh migration following abdominal hernia repair: a comprehensive review.

This study reviewed the literature regarding mesh migration in abdominal hernia repair. The aim of this study is to interrogate incidence, common type of abdominal hernia repair leading to migration, patterns of mesh migration, and materials associated with migration. A comprehensive literature review was conducted. PubMed and MEDLINE were searched for relevant articles in the English literature. We employed Ovid syntax from 1949 to January 2010, the Cochrane Library, Google and Google Scholar. The clinical trial database Clinicaltrials.gov was reviewed. Letters to the editor were reviewed to extract cross-references. Multiple keywords were used alone and in combination to extract all relevant articles. In total, 287 unique English citations were reviewed. Of these, 84 articles were selected and consisted of 3 case series, 77 case reports, 2 literature reviews, 1 retrospective study, and 1 prospective, observational study. In an analysis of available cases, the average age was 59.8 ± 13.8years with a male predominance (76.2%). The index hernia repair was inguinal in 62.9%, incisional/ventral in 28.1%, umbilical in 6.7%, and other in 2.2%. Within the inguinal hernia group, 51.8% were open repairs, 42.9% were laparoscopic, and 1.8% were robotic. Implicated mesh materials included polypropylene, PTFE, and composite mesh. Migration commonly affected multiple organs (31.5%). It is likely that more cases of mesh migration will appear in the literature. Reports are heterogeneous and highlight the diversity of this complication. A standardized method of reporting is needed to develop guidelines and recommendations for this presentation.

Bubaline Diaphragm Matrix: Development and Clinical Assessment into Cattle Abdominal Hernia Repair

Abstract The purpose of the study was to develop a xenogenic bubaline diaphragm matrix (BDM) for abdominal hernia repair. A fresh diaphragm was decellularized using aqueous sodium dodecyl sulfate (SDS) solutions (0.5-4% w/v) over a period. Acellularity was confirmed histologically and characterized by Masson’s trichrome staining, scanning electron microscopy (SEM), DNA quantification, agarose gel electrophoresis, and Fourier-transform infrared spectroscopy. The BDM was used for clinical abdominal hernia repair in six cattle. Clinical, hemato-biochemical and antioxidant parameters were evaluated to assess biocompatibility of xenogenic BDM. Histologically, the diaphragm treated with 2% SDS for 48 h showed complete acellularity and orderly arranged collagen fibers. The SEM confirmed preservation of collagen structure and integrity. The DNA content was significantly (P < 0.05) reduced in BDM (33.12 ± 5.40 ng/mg) as compared to the native diaphragm (443.96 ± 162.60 ng/mg). DNA extracts from BDM show considerable removal of DNA material, with absence of DNA band in agarose gel. The FTIR spectrum of BDM has shown all characteristic transmittance peaks of bovine skin collagen indicating preserved collagen structure. Six cattle with BDM implant recovered uneventfully and remained sound at least upto 6 months. Hemato-biochemical and antioxidant findings were unremarkable. Bubaline diaphragm matrix shows excellent repair efficiency and biocompatibility for abdominal hernia repair in cattle without complications.