Hybrid ventral hernia repair with acellular porcine dermis mesh: A novel approach

Valerie Wu Chao Ying, MD, FRCSC, Jose M Martinez, MD, FACS. University of Miami

Intro: Acellular Porcine dermis (APD) has been increasingly used for challenging ventral hernia repair. Underlay method can be accomplished via open or laparoscopic techniques but the product’s thickness has led to challenges using it in a laparoscopic fashion mainly because of limitations in fixation devices to traverse the thickness of the mesh.

With the introduction of a thinner version of the acellular porcine dermis, we propose the mesh’s laparoscopic handling characteristics will allow for easier transfacial fixation and tacking to the anterior abdominal wall when being placed as an underlay implant in the abdominal cavity.

Methods and Procedures: Retrospective analysis of all patients who underwent laparoscopic ventral hernia repair using a biological mesh between June 2013 and August 2015 at a tertiary care center was undertaken. The laparoscopic version was used in 41 consecutive patients requiring repair of challenging ventral hernias. Cases were performed in a hybrid fashion were hernia sac, excess soft tissue and facial defects were closed in an open fashion but the mesh was introduced into the abdominal cavity prior to achieving facial closure to be fixated laparoscopically at a later point. The mesh was placed in an underlay fashion with minimum of 5 cm underlay in all directions. Implant fixation including transfacial sutures and tacking to abdominal wall was performed in a laparoscopic fashion.

Results: In all patients, a laparoscopic version of the acellular porcine dermis was fixated in a laparoscopic fashion. Average mesh size used was 16 x 20 cm. Average defect size was 60cm2. No intra-operative complications were encountered. 15 of the 41 patients (36%) developed wound events, the majority of which were asymptomatic seromas. One of the patients had a superficial wound infection treated with local wound care while the other patient was a deeper wound infection requiring wound debridement. Two patients (5%) had a hernia recurrence at seven months and one year respectively.

Conclusion: The introduction of a thinner version of a commonly used acellular porcine dermis has allowed for the fixation of this implant in a laparoscopic fashion. No significant difference to traditional thickness (APD) has been seen in this short term follow-up in regards to intraoperative complication, surgical wound occurrence and hernia recurrence. Longer follow-up studies will be needed to demonstrate improved or similar results on a long term basis. 

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