Long-term outcomes (>5-year follow-up) with porcine acellular dermal matrix (Permacol™) in incisional hernias at risk for infection

Purpose: We reviewed retrospectively all patients undergoing abdominal wall reconstruction using porcine acellular dermal matrix (PADM) from 2004 to 2008 with follow-up assessment in 2012. Technique, short-term (infection, seroma, wound dehiscence), and long-term (mesh infection, recurrence) complications, and hernia recurrences were evaluated by physician examination ≥5 years postoperatively.

Results: 56 patients at high risk for infection had elective operation; nine had non-elective operation for complications of prior incisional hernia/hernia repair. Operations were clean, clean-contaminated, contaminated, or grossly infected in 49, 32, 12, and 6 %, respectively. Techniques of repair included 10 onlay (six reinforced primary closures, four bridging patches), 47 sublay (20 reinforced primary closures, 27 bridging patches), six inlay, and two sandwich (sublay and onlay). Early complications (≤30 days postoperatively) occurred in 19 of the 65 patients (29 %), including two prosthetic dehiscences from fascial attachment, 13 wound infections, and 4 seromas. After a mean follow-up of ≥5 years in 59 of 65 patients, physician-reported incidences of infection requiring removal of mesh or hernia recurrence were 25 and 66 %, respectively. Hernia recurrence occurred in 12 of 26 (46 %) patients with a reinforced repair and 27 of 33 (82 %) with patched repairs. Mesh infection occurred in 7 of 24 patients with sublay patch and in 4 of 19 sublay reinforcement. The greatest recurrence rate was in contaminated (71 %) and grossly infected wounds (100 %), while recurrence rate was 63 % in clean and 63 % in clean-contaminated wounds.

Conclusions: At ≥5 years of follow-up, use of PADM as a bioprosthesis in ventral hernia in high-risk patients is unreliable as a definitive repair in the majority of patients, but may provide satisfactory outcomes in some patients.