Ventral herniorrhaphy: experience with two different biosynthetic mesh materials, Surgisis and Alloderm.

OBJECTIVE: The aim of this study was to compare the efficacy and the complications associated with the use of two new bioactive meshes, Surgisis Gold 8-ply mesh, a product obtained by the processing of porcine small intestine sub-mucosa (Cook Surgical, Bloomington, IN, USA), and Alloderm, processed cadaveric human acellular dermis (Life Cell Corporation, Branchburg, NJ, USA), for ventral herniorrhaphy.

BACKGROUND: Ventral hernia repair in potentially contaminated or potentially infected fields limit the use of synthetic mesh products. In this scenario, biosynthetic mesh products that are absorbed and/or replaced with the body's own tissue reduce the incidence of post-operative chronic wound complications (Franklin et al. in Hernia 8(3):186-189, 2004; Franklin et al. in Hernia 6(4):171-174, 2002; Hirsch in J Am Coll Surg 198(2):324-328, 2004; Holton et al. in J Long Term Eff Med Implants 15(5):547-558, 2005; Buinewicz and Rosen in Ann Plast Surg 52(2):188-194, 2004). Rapid revascularization, repopulation, and remodeling of the matrix occur on contact with the patient's own tissue. Only limited, and mostly preliminary data, is available on the use of these types of mesh and concerning the potential complications associated with the use of these types of meshes. We publish our experience with the use of these mesh products, along with their associated complications. Furthermore, we have also provided suggestions for improvements in the mesh designs.

METHODS: Between June 2002 and March 2005, 74 patients underwent ventral hernia repair using biosynthetic or natural tissue mesh. The first 41 procedures were performed using Surgisis Gold 8-ply mesh formed from porcine small intestine sub-mucosa, and the remaining 33 patients had ventral hernia repair with Alloderm. The patients had their first follow-up 7-10 days after discharge from the hospital. They were again seen at 6 weeks, or, if needed, earlier, and, thereafter, as needed. Patients who reported any complications to the office were followed up immediately within 1-2 days. Any signs of wound infection, diastasis, hernia recurrence, changes in bowel habits, and seroma formation were evaluated.

RESULTS: Non-perforated Surgisis mesh resulted in significant seroma formation in 10/11 patients. The seroma complication was reduced, but not eliminated, with the use of the perforated Surgisis mesh (3/30 patients). Explanted material revealed separated layers of un-incorporated middle layers of the 8-ply Surgisis mesh. Three of the patients had the mesh placed in a contaminated field with no resultant sequela, and there were no hernia recurrences. Patients also had a significant degree of discomfort and pain during the immediate post-operative period. The use of the Alloderm mesh resulted in eight hernia recurrences. Fifteen of the Alloderm patients (15/33) developed a diastasis or bulging at the repair site. Seroma formation was only a problem in two patients.

CONCLUSIONS: Seroma formation was a major problem with the non-perforated Surgisis mesh repair, as was the post-operative pain. On the other hand, post-operative diastasis and hernia recurrence were a major problem with the Alloderm mesh. Further design improvements are required in both forms of these new mesh products. Surgeons should be aware of these potential complications prior to the selection of either of these products and the patient should be informed and educated accordingly.