Abstract: Objective:To investigate the clinical efficacy of porcine small intestine submucosa-derived (SIS) mesh and polypropylene (PP) mesh applied in anterior abdominal wall incisional hernia repair.
Methods:The retrospective cohort study was conducted. The clinical data of 59 patients who underwent anterior abdominal wall incisional hernia repair in the First Affiliated Hospital of Sun Yat-Sen University between January 2012 and December 2017 were collected. Of 59 patients, 22 undergoing anterior abdominal wall incisional hernia repair with SIS mesh and 37 undergoing anterior abdominal wall incisional hernia repair with PP mesh were respectively allocated into the SIS group and PP group. Surgeons selected surgical procedures according to hernia ring situations of patients. Observation indicators: (1) intra and postoperative recovery situations; (2) follow-up. follow-up using outpatient examination and telephone interview was performed to detect longterm complications of patients including foreign body sensation or pain in abdominal wall and hernia recurrence up to May 2018. Measurement data with normal distribution were represented as ±s, and comparison between groups was done using t test. Measurement data with skewed distribution were described as M (range), and comparison between groups was done using MannWhitney U test. Comparison of count data was analyzed using the chisquare test or Fisher exact probability.
Results:(1) Intra and postoperative recovery situations: patients of the SIS group and PP group underwent successfully anterior abdominal wall incisional hernia repair. There were 2, 3, 3, 14 and 5, 26, 1, 5 patients undergoing open Onlay repair, open Sublay repair, laparoscopic intra-peritoneal onlay mesh repair, laparoscopic combined with open mesh repair in the SIS group and PP group respectively. The volume of intra-operative blood loss, cases of postoperative incisional seroma and surgical site infection were (23±11)mL, 7, 5 in the SIS group and (30±13)mL, 3, 1 in the PP group respectively, with statistically significant differences between groups (t=-2.238, P<0.05). (2) follow-up: patients of the SIS group and PP group were respectively followed up for 29.3 months (6.0-66.0 months) and 31.0 months (7.0-76.0 months), with no statistically significant difference between groups (Z=-1.388, P>0.05). During the follow-up, foreign body sensation or pain in abdominal wall and hernia recurrence were detected in 6, 6 patients in the SIS group and 4, 2 patients in the PP group respectively, with a statistically significant difference in hernia recurrence between groups (P<0.05) and with no statistically significant difference in foreign body sensation or pain in abdominal wall between groups (P>0.05).
Conclusion:Compared with polypropylene mesh, anterior abdominal wall incisional hernia repair using SIS mesh has higher incidence rate of postoperative incisional seroma, surgical site infection and hernia recurrence, but fewer volume of intra-operative blood loss.