Abstract

Background: Although the efficacy of various biologic meshes in the abdominal reconstruction of complex ventral hernia has been shown, the performance profile of various biologic mesh scaffolds in terms of hernia-specific outcomes such as recurrence, mesh explantation, and mesh infections has not been examined. Aim: To evaluate the clinical outcomes of patients who underwent complex ventral hernia repair with bioprosthetic material. Methods: This study is a retrospective analysis of the use of bioprosthetic material in complex ventral hernia at an academic institution from January 2002 to December 2007. Results: A total of 58 patients with a mean age of 57.2 years and mean body mass index (BMI) of 33.8 who underwent reconstruction of ventral abdominal defects with a bioprosthetic from January 2002 to February 2009 were included in the study. The study patients had about 4.8 previous surgeries and 43.1% of patients had reconstruction in a setting of enterocutaneous fistula, while 46.6% had a previous mesh infection. Complex ventral hernia was seen in 50 patients, while eight patients had ventral and parastomal hernia. The type of biologic used for reconstruction was human-derived (AlloDerm, 29), porcine cross-linked (CollaMend, 3; Permacol, 2), and non-cross-linked porcine (Surgisis, 16; Strattice, 8). At least one complication was seen in 72.4% of patients. Major complications noted were surgical wound infections (19.0%), seroma (8.6%), and abscess formation (5.2%). The one-year hernia recurrence rate was 27.9% and mesh explantation was needed in 17.2% of patients. AlloDerm was less likely to be explanted (13.8%) or become infected (37.9%) but more likely to recur (28.6%) compared to porcine cross-linked bioprosthesis. Porcine cross-linked biologics were more likely to become infected (60%) and explanted (40%) but less likely to recur (20%) compared to AlloDerm. Non-cross-linked porcine biologics were less likely to be explanted (16.7%) but had higher recurrence (29.4%) compared to cross-linked porcine biologics and a higher infection rate (54.2%) compared to AlloDerm. Conclusions: The results from this study underscore the difficulty of repairing complex abdominal wall defects in contaminated fields. Cross-linked porcine biologics showed relatively higher infection and explantation rates. Equivalent recurrence and explantation rates were observed for the non-cross-linked porcine biologics and AlloDerm. These data indicate that there is currently no ideal biologic for complex ventral hernia repair.

Original languageEnglish (US)
Pages (from-to)165-171
Number of pages7
JournalHernia
Volume15
Issue number2
DOIs
StatePublished - Apr 1 2011

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Ventral Hernia
Biological Products
Swine
Recurrence
Herniorrhaphy
Hernia
Infection
Intestinal Fistula
Seroma
Surgical Wound Infection
Bioprosthesis
Abdominal Wall
Abscess
Body Mass Index
Alloderm

Keywords

  • Bioprosthetic grafts
  • Contaminated field
  • Cross-linked porcine
  • Hernia recurrence
  • Human cadaveric acellular dermis
  • Mesh infection
  • Porcine non-cross-linked dermis
  • Small intestinal submucosa
  • Ventral hernia repair

ASJC Scopus subject areas

  • Surgery

Cite this

Not all biologics are equal! / Shah, B. C.; Tiwari, Manish M; Goede, Matthew R; Eichler, M. J.; Hollins, Ronald Ray; McBride, Corrigan L; Thompson, Jon S; Oleynikov, Dmitry.

In: Hernia, Vol. 15, No. 2, 01.04.2011, p. 165-171.

Research output: Contribution to journalArticle

Shah, B. C. ; Tiwari, Manish M ; Goede, Matthew R ; Eichler, M. J. ; Hollins, Ronald Ray ; McBride, Corrigan L ; Thompson, Jon S ; Oleynikov, Dmitry. / Not all biologics are equal!. In: Hernia. 2011 ; Vol. 15, No. 2. pp. 165-171.
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title = "Not all biologics are equal!",
abstract = "Background: Although the efficacy of various biologic meshes in the abdominal reconstruction of complex ventral hernia has been shown, the performance profile of various biologic mesh scaffolds in terms of hernia-specific outcomes such as recurrence, mesh explantation, and mesh infections has not been examined. Aim: To evaluate the clinical outcomes of patients who underwent complex ventral hernia repair with bioprosthetic material. Methods: This study is a retrospective analysis of the use of bioprosthetic material in complex ventral hernia at an academic institution from January 2002 to December 2007. Results: A total of 58 patients with a mean age of 57.2 years and mean body mass index (BMI) of 33.8 who underwent reconstruction of ventral abdominal defects with a bioprosthetic from January 2002 to February 2009 were included in the study. The study patients had about 4.8 previous surgeries and 43.1{\%} of patients had reconstruction in a setting of enterocutaneous fistula, while 46.6{\%} had a previous mesh infection. Complex ventral hernia was seen in 50 patients, while eight patients had ventral and parastomal hernia. The type of biologic used for reconstruction was human-derived (AlloDerm, 29), porcine cross-linked (CollaMend, 3; Permacol, 2), and non-cross-linked porcine (Surgisis, 16; Strattice, 8). At least one complication was seen in 72.4{\%} of patients. Major complications noted were surgical wound infections (19.0{\%}), seroma (8.6{\%}), and abscess formation (5.2{\%}). The one-year hernia recurrence rate was 27.9{\%} and mesh explantation was needed in 17.2{\%} of patients. AlloDerm was less likely to be explanted (13.8{\%}) or become infected (37.9{\%}) but more likely to recur (28.6{\%}) compared to porcine cross-linked bioprosthesis. Porcine cross-linked biologics were more likely to become infected (60{\%}) and explanted (40{\%}) but less likely to recur (20{\%}) compared to AlloDerm. Non-cross-linked porcine biologics were less likely to be explanted (16.7{\%}) but had higher recurrence (29.4{\%}) compared to cross-linked porcine biologics and a higher infection rate (54.2{\%}) compared to AlloDerm. Conclusions: The results from this study underscore the difficulty of repairing complex abdominal wall defects in contaminated fields. Cross-linked porcine biologics showed relatively higher infection and explantation rates. Equivalent recurrence and explantation rates were observed for the non-cross-linked porcine biologics and AlloDerm. These data indicate that there is currently no ideal biologic for complex ventral hernia repair.",
keywords = "Bioprosthetic grafts, Contaminated field, Cross-linked porcine, Hernia recurrence, Human cadaveric acellular dermis, Mesh infection, Porcine non-cross-linked dermis, Small intestinal submucosa, Ventral hernia repair",
author = "Shah, {B. C.} and Tiwari, {Manish M} and Goede, {Matthew R} and Eichler, {M. J.} and Hollins, {Ronald Ray} and McBride, {Corrigan L} and Thompson, {Jon S} and Dmitry Oleynikov",
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doi = "10.1007/s10029-010-0768-7",
language = "English (US)",
volume = "15",
pages = "165--171",
journal = "Hernia : the journal of hernias and abdominal wall surgery",
issn = "1265-4906",
publisher = "Springer Paris",
number = "2",

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TY - JOUR

T1 - Not all biologics are equal!

AU - Shah, B. C.

AU - Tiwari, Manish M

AU - Goede, Matthew R

AU - Eichler, M. J.

AU - Hollins, Ronald Ray

AU - McBride, Corrigan L

AU - Thompson, Jon S

AU - Oleynikov, Dmitry

PY - 2011/4/1

Y1 - 2011/4/1

N2 - Background: Although the efficacy of various biologic meshes in the abdominal reconstruction of complex ventral hernia has been shown, the performance profile of various biologic mesh scaffolds in terms of hernia-specific outcomes such as recurrence, mesh explantation, and mesh infections has not been examined. Aim: To evaluate the clinical outcomes of patients who underwent complex ventral hernia repair with bioprosthetic material. Methods: This study is a retrospective analysis of the use of bioprosthetic material in complex ventral hernia at an academic institution from January 2002 to December 2007. Results: A total of 58 patients with a mean age of 57.2 years and mean body mass index (BMI) of 33.8 who underwent reconstruction of ventral abdominal defects with a bioprosthetic from January 2002 to February 2009 were included in the study. The study patients had about 4.8 previous surgeries and 43.1% of patients had reconstruction in a setting of enterocutaneous fistula, while 46.6% had a previous mesh infection. Complex ventral hernia was seen in 50 patients, while eight patients had ventral and parastomal hernia. The type of biologic used for reconstruction was human-derived (AlloDerm, 29), porcine cross-linked (CollaMend, 3; Permacol, 2), and non-cross-linked porcine (Surgisis, 16; Strattice, 8). At least one complication was seen in 72.4% of patients. Major complications noted were surgical wound infections (19.0%), seroma (8.6%), and abscess formation (5.2%). The one-year hernia recurrence rate was 27.9% and mesh explantation was needed in 17.2% of patients. AlloDerm was less likely to be explanted (13.8%) or become infected (37.9%) but more likely to recur (28.6%) compared to porcine cross-linked bioprosthesis. Porcine cross-linked biologics were more likely to become infected (60%) and explanted (40%) but less likely to recur (20%) compared to AlloDerm. Non-cross-linked porcine biologics were less likely to be explanted (16.7%) but had higher recurrence (29.4%) compared to cross-linked porcine biologics and a higher infection rate (54.2%) compared to AlloDerm. Conclusions: The results from this study underscore the difficulty of repairing complex abdominal wall defects in contaminated fields. Cross-linked porcine biologics showed relatively higher infection and explantation rates. Equivalent recurrence and explantation rates were observed for the non-cross-linked porcine biologics and AlloDerm. These data indicate that there is currently no ideal biologic for complex ventral hernia repair.

AB - Background: Although the efficacy of various biologic meshes in the abdominal reconstruction of complex ventral hernia has been shown, the performance profile of various biologic mesh scaffolds in terms of hernia-specific outcomes such as recurrence, mesh explantation, and mesh infections has not been examined. Aim: To evaluate the clinical outcomes of patients who underwent complex ventral hernia repair with bioprosthetic material. Methods: This study is a retrospective analysis of the use of bioprosthetic material in complex ventral hernia at an academic institution from January 2002 to December 2007. Results: A total of 58 patients with a mean age of 57.2 years and mean body mass index (BMI) of 33.8 who underwent reconstruction of ventral abdominal defects with a bioprosthetic from January 2002 to February 2009 were included in the study. The study patients had about 4.8 previous surgeries and 43.1% of patients had reconstruction in a setting of enterocutaneous fistula, while 46.6% had a previous mesh infection. Complex ventral hernia was seen in 50 patients, while eight patients had ventral and parastomal hernia. The type of biologic used for reconstruction was human-derived (AlloDerm, 29), porcine cross-linked (CollaMend, 3; Permacol, 2), and non-cross-linked porcine (Surgisis, 16; Strattice, 8). At least one complication was seen in 72.4% of patients. Major complications noted were surgical wound infections (19.0%), seroma (8.6%), and abscess formation (5.2%). The one-year hernia recurrence rate was 27.9% and mesh explantation was needed in 17.2% of patients. AlloDerm was less likely to be explanted (13.8%) or become infected (37.9%) but more likely to recur (28.6%) compared to porcine cross-linked bioprosthesis. Porcine cross-linked biologics were more likely to become infected (60%) and explanted (40%) but less likely to recur (20%) compared to AlloDerm. Non-cross-linked porcine biologics were less likely to be explanted (16.7%) but had higher recurrence (29.4%) compared to cross-linked porcine biologics and a higher infection rate (54.2%) compared to AlloDerm. Conclusions: The results from this study underscore the difficulty of repairing complex abdominal wall defects in contaminated fields. Cross-linked porcine biologics showed relatively higher infection and explantation rates. Equivalent recurrence and explantation rates were observed for the non-cross-linked porcine biologics and AlloDerm. These data indicate that there is currently no ideal biologic for complex ventral hernia repair.

KW - Bioprosthetic grafts

KW - Contaminated field

KW - Cross-linked porcine

KW - Hernia recurrence

KW - Human cadaveric acellular dermis

KW - Mesh infection

KW - Porcine non-cross-linked dermis

KW - Small intestinal submucosa

KW - Ventral hernia repair

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DO - 10.1007/s10029-010-0768-7

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JO - Hernia : the journal of hernias and abdominal wall surgery

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