Background. Large defects of the abdominal wall caused by incisional hernia
still represent a challenging problem in plastic, reconstructive, and
abdominal surgery. For their successful tension-free repair a proper
selection of reconstructive material is essential. In the last decades, the
use of synthetic meshes was dominant while biological autodermal grafts were
rarely used. The aim of the study was to comparatively analyse efficacy and
safety of autodermal graft and polypropylene mesh in surgical treatment of
large abdominal wall defects. Methods. This prospective comparative clinical
study enroled 40 patients surgically treated for large incisional hernia
repair in a 10-year period. The patients were divided into two equal groups
consisting of 20 subjects and treated either by biological autodermal graft
or by synthetic polypropylene mesh. The surgical techniques of
reconstruction, duration of surgery, the occurrence of early, minor, and
major (severe) and delyed complications and hospital stay were analyzed. The
average follow-up took 2 years. Results. Statistically significant
differences in demographic characteristics of patients and in size of defects
were not found. The surgical technique of reconstruction with an autodermal
graft was more complicated. The duration of surgery in patients treated with
autodermal grafts was significantly longer. There was no statistically
significant difference regarding occurrence of early, minor postoperative
complications and hospital stay in our study. Two severe complications were
registered in the synthetic mesh group: intestinal obstruction and
enterocutaneous fistula. The recurrence rate was 10% in the autodermal graft
group and 15% in the group with a synthetic mesh. Conclusion. Tension-free
repair of large incisional hernia with autodermal grafts was unjustly
neglected despite the fact that it is safe and effective. It can be applied
in all cases where synthetic mesh are not indicated (presence of infection,
immunodeficient patients, after radiotherapy). They are especially important
in war surgery and in lack of funds when commercial grafts cannot be
purchased.
Initial experience of double-layer tension free reconstruction of abdominal wall defects with porcine acellular dermal collagen implant and polypropylene mesh
