E. Vo1, C. Y. Chai1,2, D. S. Lee1,2, N. N. Massarweh1,2, K. Makris1,2, L. W. Chiu1,2, H. S. Tran Cao1,2, N. S. Becker1,2, S. S. Awad2 1Baylor College Of Medicine,Houston, TX, USA 2Michael E. DeBakey Veterans Affairs Medical Center,Houston, TX, USA
Introduction:
Acellular dermal matrices have been used since the 1990s for incisional hernia repairs in patients who are considered high risk for surgical site infections (SSI). Porcine dermal matrix is currently the most commonly used biologic mesh. Recently, an acellular matrix derived from decellularized whole porcine liver has been FDA-approved as a new biologic matrix alternative. No studies exist regarding its outcomes. Our objective was to describe our early experience and to compare the short-term outcomes of acellular porcine liver matrix (APLM) with acellular porcine dermal matrix (APDM).
Methods:
Patients undergoing retrorectus incisional hernia repairs were identified from Jan 2013 to Jul 2016 and case-matched in a 2:1 APDM to APLM ratio. Baseline demographics, comorbidities, ventral hernia working group (VHWG) grade, and outcomes such as seroma, hematoma, SSI, dehiscence, length of stay (LOS) were collected. Results were compared between APLM and APDM using univariate analysis with significance set at p<0.05.
Results:
Sixty patients were identified: 20 APLM and 40 APDM with an overall median follow-up of 13.9 months. Cohorts were well-matched in age (APLM 58.6±11.7 vs. APDM 61.5±7.7 years, p=0.26) and BMI (APLM 31.1±6.3 vs. APDM 30.3±5.9, p=0.56). Median VHWG grade (APLM 2.5 vs. APDM 2.0) and ASA (APLM 3 vs. APDM 3), were not statistically significant (both p>0.05). No significant differences in comorbidities were found. Thirty day follow-up demonstrated no difference in SSIs (25% vs. 25%, p=1.00) or readmissions (APLM 10% vs. APDM 17.5%, p=0.70). There was no clinically significant seroma requiring intervention in either cohort. Although LOS was shorter (median APLM 5 (IQR 3-10) days vs. APDM 7 (IQR 6-11) days, p=0.12] and hematoma rates lower (APLM 0% vs. APDM 5%, p=0.60) with the use of APLM, this was not statistically significant.
Conclusion:
There were no significant differences between APLM and APDM with respect to seroma, hematoma, SSI, and LOS. APLM appears to be a safe and feasible alternative for complex ventral hernia repairs. Further study on long-term outcomes is warranted.