Early Re-exploration Following Incisional Hernia with Biologic Graft

Introduction:
Biologic grafts have been used for the repair of complex abdominal wall defects. Although much is known about the remodeling process, their propensity to form adhesions in humans has not been well studied yet. We present a case of early re-exploration after a complex incisional hernia repaired with bovine pericardium graft.
Methods:
A 61 year-old man with a history of Hartmann pouch for pancreatico-colonic fistula underwent a concomitant laparoscopic Hartman reversal and incisional hernia repair with intraperitoneal placement of bovine pericardium graft (Veritas® Synovis Surgical Innovations, St Paul, MN). The graft was used intraperitoneally after a component separation and primary closure of the hernia was obtained. The patient recovered uneventfully and was discharged home. On postoperative day # 18, the patient presented to the ER with sudden onset of abdominal pain and distension, after he heard a “pop”. The patient was diagnosed with small bowel obstruction, resuscitated and taken to the operating room for laparoscopic re-exploration. Intraoperatively he was found to have detachment of the graft from the left lateral abdominal wall with small bowel herniation above the mesh itself. The adhesions between the graft and the bowel were very filmy and easily managed bluntly. The cause of the detachment was attributed to a failure of the primary hernia defect closure performed during the original repair. The small bowel was reduced, the mesh re-attached to the abdominal wall laparoscopically. Because of the insufficient lateral overlap and there was no concern about contamination, a tissue separating light weight polypropylene mesh was inserted intraperitonealy.
Results:
The patient had no intraoperative complications. The diet was resumed of postoperative day 6 and the patient discharged home on day 8. No complaints of prolonged pain or evidence of recurrence are noted 4 months postoperatively.
Conclusions:
Failure of the primary defect closure can cause early recurrence, even if good mesh overlap was originally achieved. Bovine pericardium graft seems to cause minimal amount of adhesions even in the early stages, before the remodeling process is complete.


Session: Podium Video Presentation

Program Number: V018

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