Abdominal hernia repair with bridging acellular dermal matrix—an expensive hernia sac

Abstract 

Background

The ability of biologic mesh to remodel into native fascia and prevent hernia recurrence in complicated repairs is appealing. However, few long-term data exist evaluating these products in the setting of bridging fascial defects. These collagen-based mesh products are costly, and long-term evaluation of hernia recurrence rates are necessary to justify their expense.

Methods

This was a retrospective review of patients undergoing repair of complex abdominal defects with acellular dermal matrix (ADM) at our institution was performed.

Results

Between January 2004 and December 2005, 11 patients underwent complex ventral hernia repairs with bridging ADM. Indications for repair included resection of enterocutaneous fistula, infected mesh, and/or ventral hernia repair. A mean of 175 cm² (range 8 to 456) of ADM were used. Mean follow-up was 24 months (range 18 to 37). One patient died on postoperative day 20. Eight of the 10 (80%) remaining patients had recurrences, and 7 underwent further surgery for repair. One patient reported laxity but refused repair. The total cost of ADM alone for these 11 patients was $61,926; the cost for the 8 patients having recurrences was $40,776; and the total mean cost was $5,100/patient.

Conclusions

Although bridging fascial defects with ADM can be an appealing substitute in extremely complicated cases, our data demonstrate exceedingly high recurrence rates. The long-term outcome of bridging fascial defects with biologic prosthesis does not justify the expense of the product.

Keywords: Acellular dermal matrix, Alloderm, Complicated abdominal hernia, Infection, Recurrence