Indications and Outcomes of a Cross-Linked Porcine Dermal Collagen Mesh (Permacol) for Complex Abdominal Wall Reconstruction: A Multicenter Audit.

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.

• Authors: Alexandre Doussot, Fawaz Abo-Alhassan, Sofiane Derbal, Isabelle Fournel, Faustin Kasereka-Kisenge, Tatiana Codjia, Haitham Khalil, Vincent Dubuisson, Haythem Najah, Alexis Laurent, Benoît Romain, Christophe Barrat, Christophe Trésallet, Muriel Mathonnet, Pablo Ortega-Deballon
• Journal: World journal of surgery (World J Surg) Vol. 43 Issue 3 Pg. 791-797 (Mar 2019) ISSN: 1432-2323 [Electronic] United States
• PMID: 30426186 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• Biocompatible Materials
• Permacol
• Collagen

Topics

• Abdominal Wall (surgery)
• Abdominoplasty (adverse effects, methods)
• Aged
• Animals
• Biocompatible Materials (therapeutic use)
• Collagen (adverse effects, therapeutic use)
• Female
• Herniorrhaphy (adverse effects, methods)
• Hospital Mortality
• Humans
• Incisional Hernia (surgery)
• Male
• Middle Aged
• Postoperative Complications (etiology, surgery)
• Recurrence
• Reoperation
• Retrospective Studies
• Risk Factors
• Surgical Mesh (adverse effects)
• Swine