The use of Permacol® biological mesh for complex abdominal wall repair

BACKGROUND: Complex abdominal wall repair (CAWR) remains challenging, especially in contaminated fields where the use of a synthetic mesh is associated with prohibitively complication rates. Consequently, biological mesh has been proposed as an alternative. The aim of our study was to evaluate the safety and efficacy of using Permacol (R) in patients who had CAWR. METHODS: We retrospectively reviewed the files of patients who had CAWR using the Permacol (R) mesh. Analysis included patients' preoperative characteristics, procedural parameters, and early and late post-operative complications in- cluding mainly recurrence. A multivariate regression model was performed to determine factors that influence 24-months recurrence rate. RESULTS: Between January 2009 and December 2018, 75 patients. The most common indication was hernia in a con- taminated field (48.0%) and abdominal wall defect greater than 10 cm in diameter (36%). Overall, 44% of our patients were Centers for Disease Control (CDC) class II or III and 81.3% fall into category II or III according to the Ventral Hernia Working Group (VHWG) classification. Recurrence rate of our series was 9.3%. Complete fascial closure was achieved in 60 patients (80%). Upon univariate analysis complete fascial closure, posterior component separation, se- roma drainage, BMI>30 kg/m2 and age >65 years, VHWD grade >2, DINDO CLAVIEN class >2 affected the recurrence rate at 2 years follow-up. When subcutaneous drains are placed prophylactically, recurrence rates drop from 38.7% (5/14) to 3.3% (2/61 patients) when drains are placed at the time of operation (P=0.02). Only fascial closure affected the 24-months recurrence rate on multivariate analysis (P<0.001). CONCLUSIONS: Permacol (R) surgical implant use for CAWR is safe with a relatively low rate of hernia recurrence at 2 years. Prophylactic subcutaneous drain placement may reduce the risk of hernia recurrence. The presence of contami- nated fields does not appear to influence hernia recurrence when Permacol (R) is used, in fact, the only factor that affects recurrence rate at 24-months on multivariate analysis is completeness of the fascial closure.