Long-Term Outcomes after Abdominal Wall Reconstruction with Acellular Dermal Matrix

• Published in: Journal of the American College of Surgeons Vol. 224; no. 3; pp. 341 - 350
• Main Authors: Garvey, Patrick B., MD, FACS, Giordano, Salvatore A., MD, PhD, Baumann, Donald P., MD, FACS, Liu, Jun, PhD, Butler, Charles E., MD, FACS
• Format: Journal Article
• Language: English
• Published: United States 01.03.2017
• Subjects: Abdominal Wall - surgery; Abdominal Wound Closure Techniques; Acellular Dermis; Adult; Aged; Female; Hernia, Ventral - surgery; Herniorrhaphy; Humans; Logistic Models; Male; Middle Aged; Proportional Hazards Models; Recurrence; Retrospective Studies; Surgery; Surgical Mesh; Time Factors; Treatment Outcome; CS; abdominal wall reconstruction; OR; surgical site occurrence; component separation; hazard ratio; ADM; acellular dermal matrix; HR; odds ratio; AWR; SSO
• DOI: 10.1016/j.jamcollsurg.2016.11.017
• ISSN: 1072-7515

Background Long-term outcomes data for hernia recurrence rates after abdominal wall reconstruction (AWR) with acellular dermal matrix (ADM) are lacking. The aim of this study was to assess the long-term durability of AWR using ADM. Study Design We studied patients who underwent AWR with ADM at a single center in 2005 to 2015 with a minimum follow-up of 36 months. Hernia recurrence was the primary end point and surgical site occurrence (SSO) was a secondary end point. The recurrence-free survival curves were estimated by Kaplan-Meier product limit method. Univariate and multivariable Cox proportional hazards regression models and logistic regression models were used to evaluate the associations of risk factors at surgery with subsequent risks for hernia recurrence and SSO, respectively. Results A total of 512 patients underwent AWR with ADM. After excluding those with follow-up less than 36 months, 191 patients were included, with a median follow-up of 52.9 months (range 36 to 104 months). Twenty-six of 191 patients had a hernia recurrence documented in the study. The cumulative recurrence rates were 11.5% at 3 years and 14.6% by 5 years. Factors significantly predictive of hernia recurrence developing included bridged repair, wound skin dehiscence, use of human cadaveric ADM, and coronary disease; component separation was protective. In a subset analysis excluding bridged repairs and human cadaveric ADM patients, cumulative hernia recurrence rates were 6.4% by 3 years and 8.3% by 5 years. The crude rate of SSO was 25.1% (48 of 191). Factors significantly predictive of the incidence of SSO included at least 1 comorbidity, BMI ≥30 kg/m2 , and defect width >15 cm. Conclusions Use of ADM for AWR was associated with 11.5% and 14.6% hernia recurrence rates at 3- and 5-years follow-up, respectively. Avoiding bridged repairs and human cadaveric ADM can improve long-term AWR outcomes using ADM.