Short-term outcomes with small intestinal submucosa for ventral abdominal hernia

Hypothesis: A bioabsorbable tissue scaffold of porcine submucosal small intestine extracellular matrix (Surgisis Gold [SIS]; Cook Biotech Inc, West Lafayette, Ind) mesh is safe and effective for ventral hernia repair. Design: Retrospective case series at a university teaching hospital. Patients: Fifty-three consecutive patients having 8-ply SIS mesh repair of ventral abdominal hernias. Main Outcome Measures: Early complications, reoperation, hernia recurrence, mesh or wound infection, or reaction. Outcomes reported and compared on an intention-to-treat basis. Results: Patients were stratified by wound class: clean, clean-contaminated and contaminated, or dirty. Median follow-up was 14 months (range, 2-29 months) during which there were 22 complications (41 %), 17 early reoperations; (32 %), 13 partial dehiscences (21 %), 6 mesh reactions (11 %), and 9 recurrent hernias (17 %). Seven recurrent hernias (78 %) in critically ill, patients with dirty wounds had the SIS mesh removed owing to infection or reoperation. In patients without SIS mesh removal or debridement, 1 (2.2 %) of 44 developed a recurrent hernia at 6 months. Patients with dirty wounds were more likely to need early reoperation (P < .001), develop a complication (P < .01), partial wound dehiscence (P < .05), or recurrent hernia (P < .01) compared with patients with clean wounds. Critically ill patients were more likely to have hernia recurrence (P < .05), early reoperation (P < .00 1), and postoperative complications (P < .05). Conclusions: Eight-ply SIS mesh is safe in clean and clean-contaminated hernia repair with satisfactory short-term Outcomes. However, delayed wound infection, repeated operation, and mesh debridement warrant cautious use of SIS mesh in critically ill patients and those with dirty wounds.