Use of Surgisis for Abdominal Wall Reconstruction in Children with Abdominal Wall Defects
19 May 2013
16 July 2013
05 September 2013 (online)
Aim Abdominal wall defects in children can present a challenge to the pediatric surgeon. Despite the development of new materials and modifications of surgical technique, no single approach has been established. The purpose of this study was to evaluate the authors experience using porcine small intestine submucosa for abdominal closure.
Patients and Methods A retrospective review of all patients with abdominal wall defects who underwent reconstruction with Surgisis at the authors' institution from 2004 to 2011 was performed. Patient demographics, cause of defect, recurrence, rate of infection, and length of follow-up were reviewed.
Results A total of 24 patients were identified as having Surgisis implanted for abdominal wall defects. The most common etiology of abdominal defect was omphalocele. All patients went on to heal wounds. Four patients developed postoperative seroma formation and another two had wound infection. Two recurrences in the form of incisional hernia were observed. Both resolved spontaneously without intervention during the follow-up. The median follow-up period was 5 years (range 2–9 y). No significant predictors of complications were identified.
Conclusions Surgisis is an effective adjunct in the repair of abdominal wall defects in children. Complication rates remain low. In addition, recurrence may disappear spontaneously as the patch absorbed and replaced by scar tissues. Further studies are warranted.
- 1 Beale EW, Hoxworth RE, Livingston EH, Trussler AP. The role of biologic mesh in abdominal wall reconstruction: a systematic review of the current literature. Am J Surg 2012; 204 (4) 510-517
- 2 Bellows CF, Smith A, Malsbury J, Helton WS. Repair of incisional hernias with biological prosthesis: a systematic review of current evidence. Am J Surg 2013; 205 (1) 85-101
- 3 Badylak S, Meurling S, Chen M, Spievack A, Simmons-Byrd A. Resorbable bioscaffold for esophageal repair in a dog model. J Pediatr Surg 2000; 35 (7) 1097-1103
- 4 Hodde J, Hiles M. Constructive soft tissue remodelling with a biologic extracellular matrix graft: overview and review of the clinical literature. Acta Chir Belg 2007; 107 (6) 641-647
- 5 Pu LL ; Plastic Surgery Educational Foundation DATA Committee. Small intestinal submucosa (Surgisis) as a bioactive prosthetic material for repair of abdominal wall fascial defect. Plast Reconstr Surg 2005; 115 (7) 2127-2131
- 6 Edelman DS. Laparoscopic herniorrhaphy with porcine small intestinal submucosa: a preliminary study. JSLS 2002; 6 (3) 203-205
- 7 Oelschlager BK, Barreca M, Chang L, Pellegrini CA. The use of small intestine submucosa in the repair of paraesophageal hernias: initial observations of a new technique. Am J Surg 2003; 186 (1) 4-8
- 8 Franklin Jr ME, Gonzalez Jr JJ, Glass JL. Use of porcine small intestinal submucosa as a prosthetic device for laparoscopic repair of hernias in contaminated fields: 2-year follow-up. Hernia 2004; 8 (3) 186-189
- 9 Ueno T, Pickett LC, de la Fuente SG, Lawson DC, Pappas TN. Clinical application of porcine small intestinal submucosa in the management of infected or potentially contaminated abdominal defects. J Gastrointest Surg 2004; 8 (1) 109-112
- 10 Beres A, Christison-Lagay ER, Romao RL, Langer JC. Evaluation of Surgisis for patch repair of abdominal wall defects in children. J Pediatr Surg 2012; 47 (5) 917-919
- 11 Karpelowsky JS, Thomas G, Shun A. Definitive abdominal wall closure using a porcine intestinal submucosa biodegradable membrane in pediatric transplantation. Pediatr Transplant 2009; 13 (3) 285-289
- 12 Ansaloni L, Cambrini P, Catena F , et al. Immune response to small intestinal submucosa (surgisis) implant in humans: preliminary observations. J Invest Surg 2007; 20 (4) 237-241
- 13 Yamamoto S, Maeda T, Uchida Y , et al. Open tension-free mesh repair for adult inguinal hernia: eight years of experience in a community hospital. Asian J Surg 2002; 25 (2) 121-125
- 14 Gupta A, Zahriya K, Mullens PL, Salmassi S, Keshishian A. Ventral herniorrhaphy: experience with two different biosynthetic mesh materials, Surgisis and Alloderm. Hernia 2006; 10 (5) 419-425
- 15 Franklin Jr ME, Gonzalez Jr JJ, Michaelson RP, Glass JL, Chock DA. Preliminary experience with new bioactive prosthetic material for repair of hernias in infected fields. Hernia 2002; 6 (4) 171-174
- 16 Badylak SF, Kokini K, Tullius B, Whitson B. Strength over time of a resorbable bioscaffold for body wall repair in a dog model. J Surg Res 2001; 99 (2) 282-287