Reconstruction of complex abdominal wall hernias using acellular human dermal matrix: a single institution experience

Hsinchen Jean Lin, Nicholas Spoerke, Clifford Deveney, Robert Martindale

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Background: Acellular human dermal matrix (AHDM) has mechanical properties suitable for complex abdominal wall reconstructions and physiologic properties that allow more resistance to infection in contaminated fields. The purpose of this study was to determine which patient and technical factors lead to optimal surgical outcomes. Methods: A retrospective review was conducted of 144 abdominal wall reconstructions using AHDM over a 33-month period. Data were recorded and analyzed. Results: Fifty-three percent were women. The average age was 55 years, with an average body mass index of 35 kg/m2. Thirty percent were smokers at the time of repair, and 24% had diabetes. Forty-three percent of the operative fields had some degree of contamination. The indication for operation in half the patients was to reconstruct a previously failed hernia repair. The recurrence rate was 27.1%. The significant factors that affected the recurrence rate were female gender (P = .02), reconstructing a failed prior repair (P = .025), and high body mass index (P = .004). An underlay mesh placement trended to a lower recurrence rate (P = .053). Average follow-up time was 23 weeks (range, 0-100 weeks). Conclusions: Three patient factors contributed significantly to the recurrence rate in this study: gender, above-normal body mass index, and repairing a recurrent hernia. Placing the matrix as an underlay appears to decrease recurrence rates. Long-term follow-up is needed to further determine the durability of hernia repairs with AHDM. AHDM offers a viable option with acceptable morbidity in complex abdominal wall reconstructions in high-risk patient populations.

Original languageEnglish (US)
Pages (from-to)599-603
Number of pages5
JournalAmerican Journal of Surgery
Volume197
Issue number5
DOIs
StatePublished - May 2009

Fingerprint

Acellular Dermis
Abdominal Hernia
Abdominal Wall
Recurrence
Body Mass Index
Herniorrhaphy
Hernia
Morbidity
Infection
Population

Keywords

  • Abdominal wall reconstruction
  • Acellular human dermal matrix

ASJC Scopus subject areas

  • Surgery

Cite this

Reconstruction of complex abdominal wall hernias using acellular human dermal matrix : a single institution experience. / Lin, Hsinchen Jean; Spoerke, Nicholas; Deveney, Clifford; Martindale, Robert.

In: American Journal of Surgery, Vol. 197, No. 5, 05.2009, p. 599-603.

Research output: Contribution to journalArticle

@article{f2548db097264b4aa2356c809ae4d12a,
title = "Reconstruction of complex abdominal wall hernias using acellular human dermal matrix: a single institution experience",
abstract = "Background: Acellular human dermal matrix (AHDM) has mechanical properties suitable for complex abdominal wall reconstructions and physiologic properties that allow more resistance to infection in contaminated fields. The purpose of this study was to determine which patient and technical factors lead to optimal surgical outcomes. Methods: A retrospective review was conducted of 144 abdominal wall reconstructions using AHDM over a 33-month period. Data were recorded and analyzed. Results: Fifty-three percent were women. The average age was 55 years, with an average body mass index of 35 kg/m2. Thirty percent were smokers at the time of repair, and 24{\%} had diabetes. Forty-three percent of the operative fields had some degree of contamination. The indication for operation in half the patients was to reconstruct a previously failed hernia repair. The recurrence rate was 27.1{\%}. The significant factors that affected the recurrence rate were female gender (P = .02), reconstructing a failed prior repair (P = .025), and high body mass index (P = .004). An underlay mesh placement trended to a lower recurrence rate (P = .053). Average follow-up time was 23 weeks (range, 0-100 weeks). Conclusions: Three patient factors contributed significantly to the recurrence rate in this study: gender, above-normal body mass index, and repairing a recurrent hernia. Placing the matrix as an underlay appears to decrease recurrence rates. Long-term follow-up is needed to further determine the durability of hernia repairs with AHDM. AHDM offers a viable option with acceptable morbidity in complex abdominal wall reconstructions in high-risk patient populations.",
keywords = "Abdominal wall reconstruction, Acellular human dermal matrix",
author = "Lin, {Hsinchen Jean} and Nicholas Spoerke and Clifford Deveney and Robert Martindale",
year = "2009",
month = "5",
doi = "10.1016/j.amjsurg.2008.12.022",
language = "English (US)",
volume = "197",
pages = "599--603",
journal = "American Journal of Surgery",
issn = "0002-9610",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Reconstruction of complex abdominal wall hernias using acellular human dermal matrix

T2 - a single institution experience

AU - Lin, Hsinchen Jean

AU - Spoerke, Nicholas

AU - Deveney, Clifford

AU - Martindale, Robert

PY - 2009/5

Y1 - 2009/5

N2 - Background: Acellular human dermal matrix (AHDM) has mechanical properties suitable for complex abdominal wall reconstructions and physiologic properties that allow more resistance to infection in contaminated fields. The purpose of this study was to determine which patient and technical factors lead to optimal surgical outcomes. Methods: A retrospective review was conducted of 144 abdominal wall reconstructions using AHDM over a 33-month period. Data were recorded and analyzed. Results: Fifty-three percent were women. The average age was 55 years, with an average body mass index of 35 kg/m2. Thirty percent were smokers at the time of repair, and 24% had diabetes. Forty-three percent of the operative fields had some degree of contamination. The indication for operation in half the patients was to reconstruct a previously failed hernia repair. The recurrence rate was 27.1%. The significant factors that affected the recurrence rate were female gender (P = .02), reconstructing a failed prior repair (P = .025), and high body mass index (P = .004). An underlay mesh placement trended to a lower recurrence rate (P = .053). Average follow-up time was 23 weeks (range, 0-100 weeks). Conclusions: Three patient factors contributed significantly to the recurrence rate in this study: gender, above-normal body mass index, and repairing a recurrent hernia. Placing the matrix as an underlay appears to decrease recurrence rates. Long-term follow-up is needed to further determine the durability of hernia repairs with AHDM. AHDM offers a viable option with acceptable morbidity in complex abdominal wall reconstructions in high-risk patient populations.

AB - Background: Acellular human dermal matrix (AHDM) has mechanical properties suitable for complex abdominal wall reconstructions and physiologic properties that allow more resistance to infection in contaminated fields. The purpose of this study was to determine which patient and technical factors lead to optimal surgical outcomes. Methods: A retrospective review was conducted of 144 abdominal wall reconstructions using AHDM over a 33-month period. Data were recorded and analyzed. Results: Fifty-three percent were women. The average age was 55 years, with an average body mass index of 35 kg/m2. Thirty percent were smokers at the time of repair, and 24% had diabetes. Forty-three percent of the operative fields had some degree of contamination. The indication for operation in half the patients was to reconstruct a previously failed hernia repair. The recurrence rate was 27.1%. The significant factors that affected the recurrence rate were female gender (P = .02), reconstructing a failed prior repair (P = .025), and high body mass index (P = .004). An underlay mesh placement trended to a lower recurrence rate (P = .053). Average follow-up time was 23 weeks (range, 0-100 weeks). Conclusions: Three patient factors contributed significantly to the recurrence rate in this study: gender, above-normal body mass index, and repairing a recurrent hernia. Placing the matrix as an underlay appears to decrease recurrence rates. Long-term follow-up is needed to further determine the durability of hernia repairs with AHDM. AHDM offers a viable option with acceptable morbidity in complex abdominal wall reconstructions in high-risk patient populations.

KW - Abdominal wall reconstruction

KW - Acellular human dermal matrix

UR - http://www.scopus.com/inward/record.url?scp=64749090632&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=64749090632&partnerID=8YFLogxK

U2 - 10.1016/j.amjsurg.2008.12.022

DO - 10.1016/j.amjsurg.2008.12.022

M3 - Article

C2 - 19393352

AN - SCOPUS:64749090632

VL - 197

SP - 599

EP - 603

JO - American Journal of Surgery

JF - American Journal of Surgery

SN - 0002-9610

IS - 5

ER -