Use of porcine small intestinal submucosa as a prosthetic device for laparoscopic repair of hernias in contaminated fields: 2-year follow-up.
BACKGROUND
Surgisis is a new four- or eight-ply bioactive, prosthetic mesh for hernia repair derived from porcine small intestinal submucosa (SIS). It is a naturally occurring extracellular matrix, which is easily absorbed, supports early and abundant new vessel growth, and serves as a template for the constructive remodeling of many tissues. As such, we believe that Surgisis mesh is ideal for use in contaminated or potentially contaminated fields in which ventral, incisional, or inguinal hernia repairs are required.


METHODS
From November 2000-May 2003, 53 patients (23 male, 30 female) underwent placement of Surgisis mesh for a variety of different hernia repairs. A total of 58 hernia repairs were performed in our patient population. Twenty procedures (34%) were performed in a potentially contaminated setting (i.e., with incarcerated/strangulated bowel within the hernia or coincident with a laparocopic cholecystectomy/colectomy). Thirteen repairs (22%) were performed in a grossly contaminated field, including one in which an infected polypropylene mesh from a previous inguinal hernia repair was replaced with Surgisis mesh and one in which dead bowel was discovered within the hernia sac. Median follow-up is 19 months with a range of 1-30 months.


RESULTS
Of the 58 total repairs, there was one wound infection complicated by enterocutaneous fistula in a patient originally operated on for ischemic bowel. The fistula was in a location independent of the Surgisis mesh. There have been no mesh-related complications or recurrent hernias in our early postoperative follow-up period.


CONCLUSIONS
Surgisis mesh appears to be a promising new prosthetic material for hernia repair and appears to function well, especially in contaminated or potentially contaminated fields. Obviously, long-term follow-up is still required.
Texas Endosurgery Institute, 4242 E. Southcross Suite 1, San Antonio, TX 78222, USA.
M E
ME
Franklin
J J
JJ
Gonzalez
J L
JL
Glass
D000818:Animals; D001707:Biopsy, Needle; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000382:microbiology* / Q000601:surgery*; D006801:Humans; D007150:Immunohistochemistry; D007413:Intestinal Mucosa / Q000637:transplantation*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D019736:Prostheses and Implants; D012189:Retrospective Studies; D018570:Risk Assessment; D013526:Surgical Mesh; D013718:Tensile Strength; D020858:Tissue and Organ Harvesting; D016896:Treatment Outcome