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Multi-institutional Experience Using Human Acellular Dermal Matrix for Ventral Hernia Repair in a Compromised Surgical Field
Jose J. Diaz Jr, MD;
Anne M. Conquest, MD;
Steven J. Ferzoco, MD;
Daniel Vargo, MD;
Preston Miller, MD;
Yi-Chen Wu, BS;
Rafe Donahue, PhD
Arch Surg. 2009;144(3):209-215.
Background A complex ventral hernia repair (CVHR) involves a compromised surgical field where gastrointestinal, biliary, and genitourinary procedures are performed. Complex ventral hernia is a significant problem in trauma, emergency, and elective general surgery in which prosthetic material is contraindicated. In this clinical scenario, primary fascia closure carries a 50% risk of developing a hernia. The other option is a planned ventral hernia with delayed repair.
Hypothesis Human acellular dermal matrix is a suitable implant for CVHR in a compromised surgical field.
Design Multi-institutional, 5-year retrospective review.
Setting Four academic medical centers.
Patients and Methods Each center obtained institutional review board approval. Patients included in the review had undergone CVHR with human acellular dermal matrix. Data collected included age, body mass index (calculated as weight in kilograms divided by height in meters squared), comorbidities, size of fascial defect, wound classification, hospital length of stay, length of follow-up, and mortality. Primary outcomes were surgical site infection, fistula recurrence, and hernia recurrence. Both  2 and logistic regression analyses were performed.
Results Two hundred forty patients met the study criteria. Their mean (SD) age was 52.2 (15.0) years, and 132 (55.0%) were men. The most common comorbidity was hypertension (115 patients [47.9%]), and the mean defect size was 201 cm2. The mean hospital length of stay was 17.2 days, and the mean follow-up was 317 days. The overall mortality was 2.9%. The hernia recurrence rate was 17.1% (41 patients). Repair of a fistula or stoma was associated with hernia recurrence (P = .03) and with fistula recurrence (P < .001). Logistic regression analysis demonstrated surgical site infection and body mass index of greater than 30 to be independent risks of hernia recurrence.
Conclusions Human acellular dermal matrix is a suitable alternative for CVHR in a compromised surgical field. The hernia recurrence rate with human acellular dermal matrix in a compromised surgical field is less than that seen with primary repair, offering additional and improved surgical options for CVHR in this group of patients. Stoma or fistula takedown at the time of CVHR continues to be associated with significant complications.
Author Affiliations: Division of Trauma and Surgical Critical Care, Department of Surgery (Drs Diaz and Conquest), and Department of Biomedical Statistics (Ms Wu and Dr Donahue), Vanderbilt University Medical Center, Nashville, Tennessee; Division of General and Gastrointestinal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Dr Ferzoco); Division of General Surgery, University of Utah Health Science Center, Salt Lake City (Dr Vargo); and Division of Trauma and Surgical Critical Care, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina (Dr Miller).
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