title: Repair of high-risk incisional hernias and traumatic abdominal wall defects with porcine mesh.
abstract: Complex ventral hernias represent a significant challenge to surgeons. We hypothesized that a wide underlay technique in combination with a novel biologic mesh would result in repair with a low recurrence rate. Medical records of patients undergoing ventral herniorrhaphy with XenMatrix biologic mesh were evaluated. All patients were evaluated for hernia recurrence both immediately and after 2 to 3 years. There were 57 patients included in the study. The overall recurrence rate was 7.2 per cent; however, all recurrences were early and were likely technical failures. The average duration of follow-up was 30.6 months with no further recurrences after the early technical failures. The average number of previous recurrences was 1.5. Fascial closure was obtained over the mesh in 84 per cent of patients, with component separation being necessary in 36 per cent of patients. Lack of fascial reapproximation over the mesh was associated with early recurrence (0 vs 55%, P < 0.0001). Complex ventral hernias can be repaired with a low recurrence rate. Our technique in combination with the XenMatrix biologic mesh provides for durable repair. Whenever possible, the fascia should be closed above the underlay mesh, because this technique provides a more durable repair than using the mesh as a "fascial bridge".
authors.affiliation: Department of Trauma, North Memorial Medical Center, Robbinsdale, Minnesota 55422, USA. mbyrnes150@yahoo.com
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Byrnes
authors.forename: Eric
authors.initials: E
authors.lastname: Irwin
authors.forename: Dana
authors.initials: D
authors.lastname: Carlson
authors.forename: Amy
authors.initials: A
authors.lastname: Campeau
authors.forename: Jonathon C
authors.initials: JC
authors.lastname: Gipson
authors.forename: Alan
authors.initials: A
authors.lastname: Beal
authors.forename: J Kevin
authors.initials: JK
authors.lastname: Croston
mesh_terms: D000007:Abdominal Injuries / Q000601:surgery; D034861:Abdominal Wall / Q000601:surgery*; D046449:Hernia, Abdominal / Q000453:epidemiology / Q000601:surgery*; D006555:Hernia, Ventral / Q000601:surgery; D006801:Humans; D007813:Laparotomy; D012307:Risk Factors; D013526:Surgical Mesh