Durability of biologic implants for use in hernia repair: a review

In the past 10 years, hernia repair has evolved from primarily using suture closure to using mesh repair. Synthetic mesh implants were the initial gold standard, but the rate of complications such as infection, adhesions, and erosion was higher with synthetics than has been observed with newer biologic implants. As efforts to develop the ideal implant continue, the advantages of biologics for hernia and other soft-tissue repair become increasingly apparent. Animal-sourced biologics have the potential advantage over human dermis of being more amenable to standardization, and porcine dermal collagen architecture closely resembles that of human dermis. Cross-linking the collagen adds strength and durability to the implant that facilitates healing of surgical wounds, just as endogenous collagen, which is cross-linked, has innate durability that enhances natural wound healing. This review defines and assesses durability of the acellular collagen (biologic) implant options available for hernia repair. The factors that affect wound healing-and hernia repair--are summarized. Additionally, the particular features that enhance durability are described, and durability-related clinical outcomes discussed in the literature are cited to aid clinicians in making informed surgical choices.