Alexandre Doussot1, Fawaz Abo-Alhassan1, Sofiane Derbal2, Isabelle Fournel3, Faustin Kasereka-Kisenge4, Tatiana Codjia5, Haitham Khalil5, Vincent Dubuisson6, Haythem Najah4, Alexis Laurent7, Benoît Romain8, Christophe Barrat9, Christophe Trésallet4, Muriel Mathonnet2, Pablo Ortega-Deballon10. 1. Department of Digestive Surgery, University Hospital of Dijon, 14 Rue Paul Gaffarel, 21079, Dijon, France. 2. Department of Digestive Surgery, University Hospital of Limoges, Limoges, France. 3. INSERM, CIC1432, Clinical Epidemiology Unit, 21000, Dijon, France. 4. Department of Digestive Surgery, Pitié-Salpétrière Hospital, Paris, France. 5. Department of Digestive Surgery, University Hospital of Rouen, Rouen, France. 6. Department of Digestive Surgery, University Hospital of Bordeaux, Bordeaux, France. 7. Department of Digestive Surgery, Henri Mondor Hospital, Créteil, France. 8. Department of Digestive Surgery, University Hospital of Strasbourg, Strasbourg, France. 9. Department of Digestive Surgery, Jean Verdier Hospital, Bondy, France. 10. Department of Digestive Surgery, University Hospital of Dijon, 14 Rue Paul Gaffarel, 21079, Dijon, France. pablo.ortega-deballon@chu-dijon.fr.
Abstract
INTRODUCTION: To reduce the occurrence of complications in the setting of high-risk patients with contaminated operative field, a wide range of biologic meshes has been developed. Yet, few series have reported outcomes after abdominal wall repair (AWR) using such meshes. Permacol is an acellular porcine dermal collagen matrix with a cross-linked pattern. This study reports short- and long-term outcomes after AWR for incisional hernia using Permacol. MATERIALS AND METHODS: All consecutive patients undergoing single-stage open AWR using Permacol mesh at eight university hospitals were included. Mortality, complication and hernia recurrence rates were assessed. Independent risk factors for complications and hernia recurrence were identified with logistic regression and Fine and Gray analysis, respectively. RESULTS: Overall, 250 patients underwent single-stage AWR with Permacol. Nearly 80% had a VHWG grade 3 or 4 defect. In-hospital mortality and complication rates were 4.8% (n = 12) and 61.6% (n = 154), respectively. Reintervention for complications was required for 74 patients (29.6%). Mesh explantation rate was 4% (n = 10). Independent risk factors for complications were smoking, defect size and VHWG grade. After a mean follow-up time of 16.8 months (± 18.1 months), 63 (25.2%) experienced hernia recurrence. One-, 2- and 3-year RFS were 90%, 74% and 57%, respectively. Previous AWR, mesh location and the need for reintervention were independent predictors of hernia recurrence. DISCUSSION: Single-stage AWR is feasible using Permacol. Mortality and complication rates are high due to patients' comorbidities and the degree of contamination of the operative field. Given the observed recurrence rate, the benefit of biologics remains to be ascertained.
INTRODUCTION: To reduce the occurrence of complications in the setting of high-risk patients with contaminated operative field, a wide range of biologic meshes has been developed. Yet, few series have reported outcomes after abdominal wall repair (AWR) using such meshes. Permacol is an acellular porcine dermal collagen matrix with a cross-linked pattern. This study reports short- and long-term outcomes after AWR for incisional hernia using Permacol. MATERIALS AND METHODS: All consecutive patients undergoing single-stage open AWR using Permacol mesh at eight university hospitals were included. Mortality, complication and hernia recurrence rates were assessed. Independent risk factors for complications and hernia recurrence were identified with logistic regression and Fine and Gray analysis, respectively. RESULTS: Overall, 250 patients underwent single-stage AWR with Permacol. Nearly 80% had a VHWG grade 3 or 4 defect. In-hospital mortality and complication rates were 4.8% (n = 12) and 61.6% (n = 154), respectively. Reintervention for complications was required for 74 patients (29.6%). Mesh explantation rate was 4% (n = 10). Independent risk factors for complications were smoking, defect size and VHWG grade. After a mean follow-up time of 16.8 months (± 18.1 months), 63 (25.2%) experienced hernia recurrence. One-, 2- and 3-year RFS were 90%, 74% and 57%, respectively. Previous AWR, mesh location and the need for reintervention were independent predictors of hernia recurrence. DISCUSSION: Single-stage AWR is feasible using Permacol. Mortality and complication rates are high due to patients' comorbidities and the degree of contamination of the operative field. Given the observed recurrence rate, the benefit of biologics remains to be ascertained.
Authors: A N Christopher; M P Morris; V Patel; J A Mellia; C Fowler; C A Messa; R B Broach; J P Fischer Journal: Hernia Date: 2021-04-27 Impact factor: 4.739
Authors: Dharshan Sivaraj; Dominic Henn; Katharina S Fischer; Trudy S Kim; Cara K Black; John Q Lin; Janos A Barrera; Melissa C Leeolou; Nathan S Makarewicz; Kellen Chen; David P Perrault; Geoffrey C Gurtner; Gordon K Lee; Rahim Nazerali Journal: Plast Reconstr Surg Glob Open Date: 2022-02-07
Authors: Raquel Osorio; Samara Asady; Manuel Toledano-Osorio; Manuel Toledano; Juan M Bueno; Rosa M Martínez-Ojeda; Estrella Osorio Journal: Polymers (Basel) Date: 2022-08-11 Impact factor: 4.967