Biological implant for complex abdominal wall reconstruction: a single institution experience

Aim: to present our single institution and surgeon’s complex-abdominal-wall reconstructions (CAWR) experience with Permacol™ mesh through a non-randomized study. Patients and method: Data of 51 consecutive patients were prospectively collected between 2003-2015. Patients had a median of 3 comorbidities (range 0-10) and 68% were Center for Disease Control class II-IV. The mean previous repair was 1.3 (range, 0-12) and 25 (44%) had a mesh in-situ. The median defect size was 625cm2. Results: Among the 56 CAWR procedures, in 16 (29%) bowel resection/anastomosis was performed. The overall post-operative complication rate was 45% and it was wound-related except from 1 patient dead for myocardial infarction. One was lost at follow-up. Five were re-operated for recurrence with a second Pemacol mesh, leading to 14 (26%) overall recurrences at a mean follow-up of 44 months (range, 4-123). In 33 (59%) cases fascial closure was achieved. The mesh placement was intraperitoneal in 89%, retro-muscular in 9% and supra-fascial in 1%of cases. A multivariate analysis showed that predictor risk for recurrence were more than 3 previous repairs, wound class III- IV, whereas age, type of comorbidities, defect size and fascial closure didn’t influence the recurrence. Median post-operative performance status was 0 (range; 0-3). A satisfaction questionnaire was obtained in 43 patients and 86% of them were satisfied with the outcome. Conclusion: Biological materials have the potential to reduce morbidity and improve outcome of definitive repair of CAWR.