Xenogeneic Mesh Provides Safe and Durable Long-Term Outcomes in Abdominal Wall Reconstruction of High-Risk Centers for Disease Control and Prevention Class III and IV Defects

Overview

Journal Ann Surg Open

Publisher Wolters Kluwer

Specialty General Surgery

Date 2023 Aug 21

PMID 37601613

Authors

Abbas M Hassan

Malke Asaad

Jun Liu

Anaeze C Offodile 2nd

Charles E Butler

Affiliations

Soon will be listed here.

Abstract

Objective: Evaluate long-term outcomes of abdominal wall reconstruction (AWR) using xenogeneic mesh in patients with Centers for Disease Control and Prevention (CDC) class III/IV defects. We hypothesized that AWR with xenogeneic mesh results in acceptable outcomes.

Background: Optimal mesh selection in AWR of CDC class III/IV defects is controversial. Outcomes using xenogeneic mesh are lacking.

Methods: We conducted a retrospective cohort study of patients who underwent AWR using xenogeneic mesh in CDC class III/IV defects from March 2005 to June 2019. Primary outcome was hernia recurrence (HR). Secondary outcomes were surgical site occurrence (SSO) and surgical site infection (SSI).

Results: Of consecutive 725 AWRs, we identified 101 patients who met study criteria. Sixty-eight patients had class III defects, while 33 had class IV defects. Patients had a mean age of 61.3 ± 11.1 years, mean body mass index of 31.8 ± 7.3 kg/m, and mean follow-up time of 41.9 ± 26.3 months. Patients had HR rate of 21%, SSO rate of 49%, and SSI rate of 24. Class IV defects were predictive of SSOs (odds ratio [OR], 2.88; 95% confidence interval [CI], 1.11-7.42; = 0.029) but not HR (hazard ratio, 1.60; 95% CI, 0.59-4.34; = 0.355) or SSIs (OR, 2.62; 95% CI, 0.85-8.10; = 0.094).

Conclusions: Patients with class IV defects have a higher risk of SSOs, but not HR or SSIs, compared with patients with class III defects. Despite the high level of defect contamination, AWR with xenogeneic mesh demonstrated acceptable HR, SSO, and SSI rates. Therefore, safe and durable long-term outcomes are achievable in single-stage AWR using xenogeneic mesh for CDC class III/IV defects.

Citing Articles

Outcomes of Complex Abdominal Wall Reconstruction with Biologic Mesh in Patients with 8 Years of Follow-Up.

Hassan A, Franco C, Shah N, Talanker M, Asaad M, Mericli A World J Surg. 2023; 47(12):3175-3181.

PMID: 37667067 DOI: 10.1007/s00268-023-07154-7.

Comparison of Long-term Surgical Outcomes and Microsurgical Skills between Independent and Integrated Plastic Surgery Trainees.

Hassan A, Egro F, Talanker M, Shah N, Liu J, Maricevich R Plast Reconstr Surg Glob Open. 2023; 11(3):e4709.

PMID: 36910735 PMC: 9995086. DOI: 10.1097/GOX.0000000000004709.

References

Menon N, Rodriguez E, Byrnes C, Girotto J, Goldberg N, Silverman R . Revascularization of human acellular dermis in full-thickness abdominal wall reconstruction in the rabbit model. Ann Plast Surg. 2003; 50(5):523-7. DOI: 10.1097/01.SAP.0000044252.76804.6B. View

El-Gazzaz G, Farag S, El-Sayd M, Mohamed H . The use of synthetic mesh in patients undergoing ventral hernia repair during colorectal resection: risk of infection and recurrence. Asian J Surg. 2012; 35(4):149-53. DOI: 10.1016/j.asjsur.2012.06.003. View

Itani K, Rosen M, Vargo D, Awad S, DeNoto 3rd G, Butler C . Prospective study of single-stage repair of contaminated hernias using a biologic porcine tissue matrix: the RICH Study. Surgery. 2012; 152(3):498-505. DOI: 10.1016/j.surg.2012.04.008. View

Mericli A, Baumann D, Butler C . Reconstruction of the Abdominal Wall after Oncologic Resection: Defect Classification and Management Strategies. Plast Reconstr Surg. 2018; 142(3 Suppl):187S-196S. DOI: 10.1097/PRS.0000000000004877. View

Garvey P, Giordano S, Baumann D, Liu J, Butler C . Long-Term Outcomes after Abdominal Wall Reconstruction with Acellular Dermal Matrix. J Am Coll Surg. 2016; 224(3):341-350. DOI: 10.1016/j.jamcollsurg.2016.11.017. View

Mangram A, Horan T, Pearson M, Silver L, Jarvis W . Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999; 27(2):97-132; quiz 133-4; discussion 96. View

Majumder A, Winder J, Wen Y, Pauli E, Belyansky I, Novitsky Y . Comparative analysis of biologic versus synthetic mesh outcomes in contaminated hernia repairs. Surgery. 2016; 160(4):828-838. DOI: 10.1016/j.surg.2016.04.041. View

de Vries Reilingh T, van Goor H, Charbon J, Rosman C, Hesselink E, van der Wilt G . Repair of giant midline abdominal wall hernias: "components separation technique" versus prosthetic repair : interim analysis of a randomized controlled trial. World J Surg. 2007; 31(4):756-63. PMC: 1913177. DOI: 10.1007/s00268-006-0502-x. View

Finan K, Vick C, Kiefe C, Neumayer L, Hawn M . Predictors of wound infection in ventral hernia repair. Am J Surg. 2005; 190(5):676-81. DOI: 10.1016/j.amjsurg.2005.06.041. View

10.

Breuing K, Butler C, Ferzoco S, Franz M, Hultman C, Kilbridge J . Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery. 2010; 148(3):544-58. DOI: 10.1016/j.surg.2010.01.008. View

11.

Giordano S, Garvey P, Baumann D, Liu J, Butler C . Prior Radiotherapy Does Not Affect Abdominal Wall Reconstruction Outcomes: Evidence from Propensity Score Analysis. Ann Surg Oncol. 2016; 24(3):816-822. DOI: 10.1245/s10434-016-5603-7. View

12.

Booth J, Garvey P, Baumann D, Selber J, Nguyen A, Clemens M . Primary fascial closure with mesh reinforcement is superior to bridged mesh repair for abdominal wall reconstruction. J Am Coll Surg. 2013; 217(6):999-1009. DOI: 10.1016/j.jamcollsurg.2013.08.015. View

13.

Gurrado A, Franco I, Lissidini G, Greco G, De Fazio M, Pasculli A . Impact of pericardium bovine patch (Tutomesh(®)) on incisional hernia treatment in contaminated or potentially contaminated fields: retrospective comparative study. Hernia. 2014; 19(2):259-66. DOI: 10.1007/s10029-014-1228-6. View

14.

Asaad M, Kapur S, Baumann D, Liu J, Butler C . Acellular Dermal Matrix Provides Durable Long-Term Outcomes in Abdominal Wall Reconstruction: A Study of Patients with Over 60 Months of Follow-up. Ann Surg. 2020; 276(5):e563-e570. DOI: 10.1097/SLA.0000000000004454. View

15.

Silverman R, Li E, Holton 3rd L, Sawan K, Goldberg N . Ventral hernia repair using allogenic acellular dermal matrix in a swine model. Hernia. 2004; 8(4):336-42. DOI: 10.1007/s10029-004-0241-6. View

16.

Holton 3rd L, Kim D, Silverman R, Rodriguez E, Singh N, Goldberg N . Human acellular dermal matrix for repair of abdominal wall defects: review of clinical experience and experimental data. J Long Term Eff Med Implants. 2005; 15(5):547-58. DOI: 10.1615/jlongtermeffmedimplants.v15.i5.70. View

17.

Hassan A, Asaad M, Seitz A, Liu J, Butler C . Effect of Wound Contamination on Outcomes of Abdominal Wall Reconstruction Using Acellular Dermal Matrix: 14-Year Experience with More than 700 Patients. J Am Coll Surg. 2021; 233(6):676-684. DOI: 10.1016/j.jamcollsurg.2021.08.679. View

18.

de Vries F, Hodgkinson J, Claessen J, van Ruler O, Leo C, Maeda Y . Long-term outcomes after contaminated complex abdominal wall reconstruction. Hernia. 2020; 24(3):459-468. PMC: 7210226. DOI: 10.1007/s10029-020-02124-7. View

19.

Giordano S, Garvey P, Baumann D, Liu J, Butler C . Primary fascial closure with biologic mesh reinforcement results in lesser complication and recurrence rates than bridged biologic mesh repair for abdominal wall reconstruction: A propensity score analysis. Surgery. 2016; 161(2):499-508. DOI: 10.1016/j.surg.2016.08.009. View

20.

Nockolds C, Hodde J, Rooney P . Abdominal wall reconstruction with components separation and mesh reinforcement in complex hernia repair. BMC Surg. 2014; 14:25. PMC: 4009060. DOI: 10.1186/1471-2482-14-25. View