First human use of hybrid biologic-permanent mesh in a complex laparoscopic hernia repair

Connor Wathen, Esam Batayyah, MD, Kevin El-Hayek, MD. Cleveland Clinic Foundation.

Currently, the standard of care for ventral hernia repair includes the concept of mesh reinforcement with permanent synthetic mesh.  This approach leads to a significantly reduced rate of hernia recurrence when compared to suture repair. However, the use of a foreign material may lead to complications such as mesh infection and erosion.  In recent years, the use of biologic mesh has been viewed as a potential alternative to synthetic mesh under certain circumstances to mitigate these potential complications.  Although high quality data about the efficacy of biologic mesh is scarce, current data suggests that biologic mesh is provides little added benefit in most cases.  Given the high rates of complications reported with currently available synthetic and biologic meshes in complex hernia repairs, there is a potential benefit to using hybrid biologic/permanent mesh for use in abdominal wall reconstruction.

Zenapro™ from Cook Medical is a graft comprised of porcine small intestine submucosa (SIS) covering a core of polypropylene material. The device has been approved by the FDA for clinical use and is intended to be implanted to reinforce soft tissues where weakness exists. Indications for use include the repair of a hernia or body wall defect requiring the addition of a reinforcing or bridging material to obtain the desired surgical result.

This video demonstrates the first reported use of Zenapro™ hybrid mesh for the repair of a symptomatic left lumbar hernia.  The hernia was secondary to a remote latissimus dorsi flap for breast reconstruction in a patient with connective tissue disease..  A laparoscopic technique was offered to the patient.  An 8 x 7 cm hernia was found with incarcerated sigmoid colon.  The hernia contents were reduced, the defect was primarily repaired, and a 15 cm circular graft was placed in an underlay fashion.  The patient was discharged on post-operative day 3 following conservative management of a tiny apical pneumothorax.  She was asymptomatic with an excellent result in early follow up.  This video demonstrates the safe use of hybrid mesh for the repair of complex ventral hernias.  Further study is needed to determine the optimal clinical use for this emerging technology.  

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