Acellular dermal matrix makes durable abdominal hernia fix

Last Updated: 2017-01-09

By David Douglas

NEW YORK (Reuters Health) - Complex abdominal wall reconstruction (AWR) with acellular dermal matrix (ADM) meshes can achieve effective long-lasting hernia repair, according to Houston-based researchers.

As Dr. Charles E. Butler told Reuters Health by email, "There continues to be ongoing debate about the long-term durability of ADM for abdominal wall reconstruction. This study demonstrates that long-term recurrence rates were considerably low despite a complex patient population and meticulous follow-up with physical examination and CT scanning."

He added, "Recurrence rates are known to increase with longer follow-up time, which was clearly demonstrated in this study."

For the study, online December 16 in the Journal of the American College of Surgeons, Dr. Butler of The University of Texas MD Anderson Cancer Center and colleagues followed 191 patients who had had surgery to close a defect caused by ventral hernia repair or oncologic resection. They had at least three years of follow-up with a mean of 4.4 years.

Overall, 26 patients had a documented hernia recurrence. This amounted to 11.5% at three years, and 14.6% at five years.

Factors predicting hernia recurrence included bridged repair, wound skin dehiscence, use of human cadaveric ADM and coronary disease.

"As previously described by our group and confirmed in the current study," added Dr. Butler, "the most predictive factor for recurrence was a bridged, rather than reinforced, fascial repair with an over 11-fold increased risk of recurrence."

In a subset analysis excluding bridged repairs and human cadaveric ADM patients, cumulative hernia recurrence rates were 6.4% by three years and 8.3% by five.

Mounting evidence from comparative studies, the researchers point out, also "shows better outcomes with primary fascial closure rather than bridged repair."

They conclude, "Contrary to the commonly held belief that the use of ADM, rather than synthetic mesh, in complex AWRs compromises the long-term durability of the repair with respect to hernia recurrence, we found hernia recurrence rates with ADM to be comparable to those for complex AWR with synthetic mesh reported in the current literature."

Dr. Benjamin K. Poulose, a surgeon at Vanderbilt University Medical Center in Nashville, Tennessee, told Reuters Health by email, "This article is an important contribution as it provides us reasonable information that durable long-term results can be accomplished by skilled surgeons using biologic meshes for abdominal wall reconstruction."

However, Dr. Poulose added, "The retrospective nature of the data collection and single-center experience by a highly skilled surgical team limit the generalizability of the results. The issue with biologic mesh use is less of an issue with recurrence and more of an issue about justifying their high cost."

He concluded, "The authors are on the right track - we need to focus on long-term follow-up of these patients to see how well they are doing. If we can avoid some of the long-term complications of permanent prosthetic meshes using biologic meshes, that would add value to their use; but no study has yet demonstrated that benefit."

The study had no commercial funding and the researchers declared no conflicts of interest.

SOURCE: http://bit.ly/2i5NdxU

J Am Coll Surg 2016.