Biological implants for the reconstruction of complex, contaminated abdominal wall defects.

Background: Approximately 2-24%% of the 100.000 laparotomy procedures performed in The Netherlands annually result in an incisional or abdominal wall hernia. Use of synthetic mesh is contra-indicated when the field is complicated, infected and/or contaminated because of the risk of adhesions, (chronic) sepsis and erosion. The results of the modern biological implants demonstrate that the biological grafts become recellularized and revascularized without being resorbed with fewer adhesions compared to synthetic meshes. Permacol, acellular porcine dermis, is the biological mesh of choice in Atrium Medical Centre Heerlen and Orbis Medical Centre Sittard.

Objective: A retrospective review of Atrium Medical Centre’s in Heerlen and Orbis Medical Centre’s in Sittard experience using Permacol for the repair of abdominal wall defects and a cost-effective analysis comparing the use of a synthetic mesh versus Permacol in complex abdominal wall hernia repair.

Methods: Retrospective review of medical records of patients undergoing abdominal wall reconstruction with Permacol compared with a case-matched control group in which a synthetic mesh has been used to determine the advantages and cost-effectiveness of the biological mesh.

The use of a biological mesh in a contaminated/infected field is expected to have better outcomes on mortality, morbidity, performance, durability, postoperative complications and reoperations compared to use of a synthetic mesh. One of the explanations is because of their compliance with the host leukocyte response.

The costs of the more expensive biological implant weigh against the benefits of its use as explained above.

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