Acellular Dermal Matrix Provides Durable Long-Term Outcomes in Abdominal Wall Reconstruction A Study of Patients with Over 60 Months of Follow-up

Background: Ventral hernia repair (VHR) is one of the most commonly performed procedures in the United States, but studies assessing the long-term outcomes of VHR using biologic mesh are scarce. Objective: We sought to determine the rates of hernia recurrence (HR) and surgical site occurrences (SSOs) in a large cohort of patients who underwent AWR with biologic mesh. Methods: We conducted a retrospective cohort study of patients who underwent AWR using either porcine ADM (PADM) or bovine ADM (BADM) from 2005 to 2019. We analyzed the full cohort and a subset of our population with minimum long-term follow-up (LTF) of 5 years. The primary outcome measure was HR. Secondary outcomes were SSOs. Results: We identified a total of 725 AWRs (49.5% PADM, 50.5% BADM). Mean age was 69 +/- 11.5 years and mean body mass index was 31 +/- 7 kg/m(2). Forty-two percent of the defects were clean at the time of AWR, 44% were clean-contaminated, and 14% were contaminated/infected. Mean defect size was 180 +/- 174 cm(2), mean mesh size was 414 +/- 203 cm(2). Hernia recurred in 93 patients (13%), with cumulative HR rates of 4.9%, 13.5%, 17.3%, and 18.8% at 1, 3, 5, and 7 years, respectively. There were no differences in HR (P = 0.83) and SSO (P = 0.87) between the 2 mesh types. SSOs were identified in 27% of patients. In our LTF group (n = 162), the HR rate was 16%. Obesity, bridged repair, and concurrent stoma presence/creation were independent predictors of HR; component separation was protective against HR. Conclusions: Despite its use in complex AWR, ADM provides durable long-term outcomes with relatively low recurrence rates.

Automated summary

In this study, we investigated the long-term outcomes of ventral hernia repair using biologic mesh. We found that biologic mesh provides durable results with relatively low rates of hernia recurrence. There were no differences in recurrence rates and surgical site occurrences between different types of mesh.