A Pragmatic Study Of Porcine Acellular Dermal Matrix Mesh In Ventral And Parastomal Hernia Repairs. Evaluation Of Outcomes From A Tertiary Centre.
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Abstract
Aims and Objectives: Incidence of complex ventral hernias and those with contamination are increasing. Synthetic meshes are not favoured due to increased risk of wound complications. Biologic meshes are used as an alternative given their biocompatible safety, but, there is lack of strong evidence to recommend its routine use. Hence, it is up to institutions to evaluate the safety and efficacy to support its continuing usage, which is the basis of this study.
Methods: A retrospective review of a prospectively maintained PADM mesh database was performed focussing on midline and parastomal hernias. Demographic data, surgical techniques and short- and long-term complications were reviewed.
Results: 71cases, (acute/elective 10/61) were included. The median age group, sex ratio in the acute and elective groups were 67 years (36-83yrs) and 62years (25-93yrs), 2:1 and 4:3 respectively. Mean ASA score was 3.4 in acute and 2.4 in elective group. Midline hernias constituted 37/ 61 (60%) and Parastomal hernias, 40% (24/61). Component separation was performed in 29 cases, which includes bilateral anterior component separation in 16, unilateral anterior component in 11 and posterior component separation in 2. Median length of stay was 11days (1-180d) and 15 days (1-159d) in the elective and acute groups respectively. Median length of follow up was 18 months (12 -72 months). There were 5 deaths within 90 days. Recurrences were noted in 6/37 (16%) midline repairs and 8/24 (33%) parastomal hernias.
Conclusion: Our limited PADM series showed acceptable results in comparison with available studies. As such we find it a useful adjunct in the repair of complex ventral hernias.
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