title: The use of an acellular porcine dermal collagen implant in the repair of complex abdominal wall defects: a European multicentre retrospective study.
abstract: BACKGROUND
  The use of biological materials for the repair of complex abdominal wall defects has increased over the years; however, the role of these materials in routine practice remains unclear. The aim of the study was to evaluate clinical outcomes following the use of Permacol™ porcine collagen surgical implant in complex abdominal wall repair.
  
  
  METHODS
  This subset analysis of seven European sites from a multicentre retrospective study included patients undergoing open or laparoscopic surgery and treated with Permacol™ surgical implant. Inguinal, parastomal, diaphragmatic, perineal, and hiatal repairs were excluded. Only patients with at least 12 months of follow-up after surgery were included.
  
  
  RESULTS
  A total of 109 patients (56 males and 53 females) were included. Patients had a median of two comorbidities (range 0-6). Thirty-three per cent of patients were treated for recurrent hernia. All but one case used an open approach. Sixty-six per cent were Center for Disease Control wound class II-IV at the time of surgery. Fascial closure was achieved in 69%. Median follow-up length was 720 days (range 368-2857). Recurrence rates at 1 and 2 years were 9.2 and 18.3 %, respectively, and were higher in cases without fascial closure. One-year recurrence was higher following use of an onlay technique (P = 0.025). In a multivariate analysis, among 16 comorbidities examined only fascial closure significantly impacted 1-year recurrence (P = 0.049).
  
  
  CONCLUSIONS
  Data from this large retrospective multicentre European study strongly suggest the use of Permacol™ porcine collagen surgical implant to be safe and effective for complex abdominal wall repair. The recurrence rate was impacted by fascial closure.
authors.affiliation: Barts Health, Whipps Cross University Hospital, Whipps Cross Rd., Leytonstone, London, E11 1NR, UK, p.giordano@londoncolorectal.org.
authors.forename: P
authors.initials: P
authors.lastname: Giordano
authors.forename: R D
authors.initials: RD
authors.lastname: Pullan
authors.forename: B
authors.initials: B
authors.lastname: Ystgaard
authors.forename: F
authors.initials: F
authors.lastname: Gossetti
authors.forename: M
authors.initials: M
authors.lastname: Bradburn
authors.forename: A J
authors.initials: AJ
authors.lastname: McKinley
authors.forename: N J
authors.initials: NJ
authors.lastname: Smart
authors.forename: I R
authors.initials: IR
authors.lastname: Daniels
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials / Q000627:therapeutic use*; D003094:Collagen / Q000627:therapeutic use*; D005060:Europe; D005205:Fascia / Q000473:pathology; D005260:Female; D006555:Hernia, Ventral / Q000145:classification / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials; C422414:Permacol; D003094:Collagen