Summary
Introduction
The repair of large ventral hernias is a challenging problem. This study investigated
the use of decellularized, chemically cross-linked porcine dermal xenograft in conjunction
with component separation (a.k.a. the “Pork Sandwich” Herniorraphy) in the repair
of abdominal wall defects.
Materials and methods
We prospectively collected data over a 3-year period. Primary or near-total primary
fascial closure was our goal in operative repair. A cross-linked porcine dermal xenograft
mesh underlay and overlay were used to provide maximal reinforcement of the repair.
Outcomes were compared with a case-controlled cohort of 84 patients who underwent
ventral hernia repairs with alternative methods at our institution.
Results
Nineteen patients were included. Mean age was 55 years old, and mean body mass index
(BMI) was 30 kg/m2. Mean defect size was 321 cm2. Post-operative complications were observed in ten out of 19 patients. Complications
included seroma (n = 2), wound infection (n = 2), abscess (n = 1), skin necrosis (n = 6), and fistula formation (n = 3). Seven patients required re-operation. Statistically significant factors (p < 0.05) that contributed to increased post-operative complications or re-operation
rates included smoking, presence of pre-operative enterocutaneous fistulae, extended
post-operative hospital stay (>2 weeks), and a defect size greater than 300 cm2. There were no hernia recurrences in our “Pork Sandwich” group, which contrasted
favorably to the retrospective case-control group in which the hernia recurrence rate
was 19% (p = 0.038).
Discussion
For the repair of abdominal hernias, primary closure, with component separation as
needed, with an underlay and overlay of cross-liked porcine xenograft should be considered
to minimize risk of recurrent herniation. Additional long-term prospective comparative
studies are needed for further validation of the optimal method and material for repair.
Keywords
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Article info
Publication history
Published online: October 17, 2011
Accepted:
September 27,
2011
Received:
October 7,
2010
Footnotes
☆Presented at the California Society of Plastic Surgeons Meeting, Olympic Valley, CA, May 30, 2009.
Identification
Copyright
© 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
