Utilization of biologic mesh materials in repair of incisional hernias among peritoneal dialysis patients: A novel approach to optimizing outcomes

Florias A Morfesis, MD, Brian P Rose, MPH. Owen Drive Surgical Clinic of Fayetteville.

Introduction: The use of mesh in ventral/incisional hernia repair has been well described. Currently, there are a number of mesh materials available for implantation, including those that are purely synthetic, partially biodegradable, full biodegradable, and biologic scaffold. The later lacks widespread consensus among its exclusive utilization in complex, often contaminated abdominal scenarios. Our group has found that using biologic materials to repair ventral/incisional hernias among peritoneal dialysis (PD) patients allows for optimum outcomes. It is well known that PD patients have higher intraabdominal wall pressures, thus putting them at higher risk for the development of abdominal wall hernias at prior incision sites. This abstract seeks to explore our institution’s experience with several biologic mesh products used in PD patients.

Methods: PD patients who presented with a primary or incisional (trocar site) defect were offered elective open repair using a biologic graft. The biologic grafts utilized include Strattice (acellular porcine dermis), Permacol (cross-linked porcine dermis), and XenMatrix (cross-linked porcine dermis). Upon repair of the abdominal wall defect, patients were placed on hemodialysis for variable periods. Retrospective chart review was then conducted to assess for pertinent clinical predictors and outcomes at follow up. 

Results: N=2 patients underwent repair with acellular procine dermis, both of which returning to peritoneal dialysis post-repair. N=1 patients underwent repair using  a heavily cross-linked porcine dermis without complication and also was able to resume peritoneal dialysis readily. Lastly, n=1 patient underwent repair utilizing a moderately cross-linked porcine dermis and developed an enterocutaneous fistula (EC), however this only required minimal operative repair and bowel rest, not explantation of the allograft.

Conclusions: We report this small, long-term case series in efforts to understand the efficacy of biologic mesh in treating abdominal wall hernias in PD patients. We believe this is the preferred method to be applied widely among surgeons repairing such hernias, allowing for optimum results, though long-term analysis must be attained.

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