A series of 70 consecutive patients starting in October 2003 with
abdominal wall hernia repair using
AlloDerm was studied. This study began as a retrospective chart review, which included subsequent postoperative follow-up. SPSS version 11.5 was used for statistical analysis, and parametric tests were conducted. Various technical variables (type of
AlloDerm placement, mesh-
suture technique,
suture type) and nontechnical variables (
steroids use,
obesity, smoking status, diabetes, prior surgeries, number of comorbidities) were evaluated.
RESULTS: Of 70 study patients, 31 were men and 39 were women, with a mean age of 58 (range 25-88) years. Fifty-six patients (80%) had no complications, whereas 14 (20%) suffered one or more complications. Of those patients with complications, there was one rejection, two
infections, and 14
hernia recurrences. The overall complication rate was 24%. Of patients with
hernia recurrences, one had the initial repair with
AlloDerm implant of <1.8-mm thickness (thick) and 13 patients had their initial repair with
AlloDerm implant of >1.8-mm thickness (ultrathick). The 14 patients with recurrences include three who had a prior
AlloDerm repair with ultrathick implant. Two of these three patients reported abdominal wall protrusion, and one had a recurrence between two pieces of
AlloDerm used in the initial repair. Of these 14 patients, nine had subsequent repair of their recurrence with synthetic mesh, and four had subsequent repair with
AlloDerm with satisfactory outcomes; one patient was yet to have a repair at the time of this paper. Recurrence rates with ultrathick and thick
AlloDerm were 23% and 6%, respectively. None of the patients who were on
steroid therapy had complications. Mesh-
suture technique had no effect on recurrence. Type of placement was positively correlated with
infection (Pearson's R 0.575, p 0.05), showing that onlay mesh is better than underlay/interpositional mesh in having a lower
infection rate. Diabetes was associated with mesh
infection (Pearson's R 0.548, p 0.05), and redo
hernia repair was associated with longer length of
hospital stay (LOS). The average number of comorbidities was five for the series. LOS positively correlated with presence of comorbidities.
CONCLUSIONS: Early results in repair of
abdominal hernia with
AlloDerm appear to have a complication rate of 24%. Recurrence is the most common complication. Thinner
AlloDerm use has better outcomes with less recurrence. Careful analysis regarding the technical aspects and presence of comorbidities may be explored to improve the present outcomes to prevent recurrences.