Biologic mesh for repair of ventral hernias in contaminated fields: long-term clinical and patient-reported outcomes
Related Experiment Video
Updated: Mar 19, 2026
Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh
Published on: September 11, 2021
Amin Madani1,2, Petru Niculiseanu3, Wanda Marini3
1Department of Surgery, McGill University Health Centre, 1650 Cedar Avenue, Rm D6-257, Montreal, QC, H3G 1A4, Canada. amin.madani@mail.mcgill.ca.
Background:
Guidelines recommend biologic prosthetics for ventral hernia repair (VHR) in contaminated fields, yet long-term and patient-reported data are limited. We aimed to determine the long-term rate of hernia recurrence, and other clinical and patient-reported outcomes following the use of porcine small intestine submucosa (PSIS) for VHR in a contaminated field.
Methods:
Consecutive patients undergoing open VHR with PSIS mesh in a contaminated field from 2004 to 2014 were prospectively evaluated for hernia recurrence and other post-operative complications. Multivariate logistic and Cox regression analyses identified predictors of hernia recurrence and surgical site infection. Patient-reported outcomes were evaluated using SF-36, Hernia-Related Quality-of-Life Survey (HerQLes) and Body Image Questionnaire instruments.
Results:
Forty-six hernias were repaired in clean-contaminated [16 (35 %)], contaminated [11 (24 %)] and dirty [19 (41 %)] fields. Median follow-up was 47 months [interquartile range: 31-79] and all patients had greater than 12-month follow-up. Sixteen patients (35 %) were not re-examined. Incidence of surgical site events and surgical site infection were 43 % (n = 20) and 56 % (n = 25), respectively. American Society of Anesthesiologists score 3 or greater was an independent predictor of surgical site infection (odds ratio 5.34 [95 % confidence interval 1.01-41.80], p = 0.04). Hernia recurrence occurred in 61 % (n = 28) with a median time to diagnosis of 16 months [interquartile range 8-26]. After bridged repair, 16 of 18 patients (89 %) recurred, compared to 12 of 28 (43 %) when fascia was approximated (p < 0.01). Bridged repair was an independent predictor of recurrence (odds ratio 10.67 [95 % confidence interval 2.42-76.08], p < 0.01). Patients with recurrences had significantly worse scores on the SF-36 mental health component and self-perceived body image, whereas HerQLes scores were similar.
Conclusions:
Hernia recurrences and wound infections are high with the use of biologic PSIS mesh in contaminated surgical fields. Careful consideration is warranted using this approach.
Insights
Ventral hernia repair using porcine small intestine submucosa (PSIS) in contaminated fields shows high recurrence and infection rates. Bridged repair significantly increases recurrence risk, necessitating careful consideration of this technique.
Area of Science:
- Surgical Innovation
- Biomaterials in Medicine
- Hernia Repair Techniques
Background:
- Biologic prosthetics are recommended for ventral hernia repair (VHR) in contaminated fields.
- Limited long-term and patient-reported data exist for these applications.
- Porcine small intestine submucosa (PSIS) is a biologic prosthetic used in VHR.
Purpose of the Study:
- To determine long-term hernia recurrence rates after VHR using PSIS in contaminated fields.
- To evaluate clinical and patient-reported outcomes.
- To identify predictors of hernia recurrence and surgical site infection.
Main Methods:
- Prospective evaluation of consecutive patients undergoing open VHR with PSIS mesh in contaminated fields (2004-2014).
- Assessment of hernia recurrence, post-operative complications, and patient-reported outcomes (SF-36, HerQLes, Body Image Questionnaire).
- Multivariate logistic and Cox regression analyses to identify recurrence predictors.
Main Results:
- High incidence of surgical site events (43%) and infections (56%).
- Hernia recurrence rate was 61%, with bridged repair being an independent predictor (OR 10.67, p<0.01).
- Patients with recurrence reported worse mental health and body image scores.
Conclusions:
- High rates of hernia recurrence and wound infections observed with PSIS mesh in contaminated VHR.
- Bridged repair is a significant risk factor for recurrence.
- Careful consideration is advised when using PSIS mesh in contaminated surgical fields.
