Rachel Andrew, MD, Ryan Juza, MD, Ann Rogers, MD, Jerome LynSue, MD, Randy Haluck, MD, Eric Pauli, MD. Penn State Hershey Medical Center
Introduction: The purpose of this study was to report the results of abdominal wall reconstruction (AWR) with XCM Biologic Matrix (Synthes, West Chester, PA) in Ventral Hernia Working Group Class 3 and 4 herniorraphy.
Methods: Patients undergoing AWR with XCM were identified from a prospectively collected database. XCM was utilized in two ways: definitive reconstruction with posterior component separation (PCS) or bridged repair (BR) during complex gastrointestinal (GI) reconstruction in the presence of large ventral hernias.
Results: Seven patients (6 female) underwent AWR with XCM; 5 BR, 2 PCS. Six cases involved GI contamination, one involved infected mesh. Mean patient age was 58 years (range 35-73). The average defect size was 476 cm2 for PCS, 191 cm2 for BR. Complications included one surgical site occurrence managed conservatively in PCS patients and three surgical site infections (SSI) in BR patients, two requiring surgical intervention without mesh excision. Mean follow up time was thirteen months for PCS, six months for BR. One PCS patient (50%) had a hernia recurrence at one year. This patient’s BMI was 45, and medically supervised weight loss was arranged prior to attempting another repair. Two BR patients (40%) have recurrent hernias; both had SSI and neither are definitive repair candidates.
Conclusion: This is the first multi-patient report of the use of XCM for AWR. In PCS repair, short term data suggest a low recurrence rate. Consistent with the literature, BR has a higher recurrence rate. There were no instances of chronic mesh infection. XCM performs similar to other biologic meshes in AWR.