Biologic mesh in ventral hernia repair: Outcomes, recurrence, and charge analysis

Surgery. 2016 Dec;160(6):1517-1527. doi: 10.1016/j.surg.2016.07.008. Epub 2016 Aug 12.


Background: Biologic mesh choice in ventral hernia repair is challenging due to lack of prospective data. This study examines long-term, single-center biologic mesh outcomes.

Methods: Prospective operative outcomes data was queried for open ventral hernia repair with biologic mesh. Univariate and multivariate analysis were used to compare mesh outcomes.

Results: In the study, 223 patients underwent open ventral hernia repair with biologic mesh, including 40 with Alloderm, 23 AlloMax, 70 FlexHD, 68 Strattice, and 22 Xenmatrix. Overall, 9.8% had an American Society of Anesthesiology classification of 4, 54.6% with a classification of 3, and 35.6% with a classification of 1 or 2. Operative time averaged 241 minutes with estimated blood loss of 202 mL. Hernia defects averaged 257 ± 245 cm2 with mesh size 384 cm2. Biologic mesh was used as a fascial bridge in 19.6%, component separation was performed in 47.5%, and 82% had concomitant procedure. Inpatient mortality was 1.4%. Hernia recurrence varied significantly by mesh type: 35% Alloderm, 34.5% AlloMax, 37.1% FlexHD, 14.7% Strattice, and 59.1% Xenmatrix (P = .001). The mean follow-up was 18.2 months. After multivariate analysis comparing to Strattice, AlloMax had a 3.4 higher odds ratio for recurrence, FlexHD a 2.9 odds ratio, and Xenmatrix a 7.8 odds ratio. The rate of mesh infections requiring explantation was <1%. Total hospital charges averaged $131,004 ± $143,320. Mean charges varied significantly between meshes; Xenmatrix was the most expensive and AlloMax was the least expensive (P < .05).

Conclusion: In 223 ventral hernia repair performed with biologic mesh at a tertiary care institution, Strattice, a porcine acellular dermal mesh, had significantly lower odds of hernia recurrence compared with AlloMax, FlexHD, and Xenmatrix. Choice of biologic mesh affects long-term postoperative outcomes in ventral hernia repair.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acellular Dermis / economics
  • Aged
  • Biocompatible Materials / economics*
  • Collagen / economics
  • Cost-Benefit Analysis
  • Female
  • Hernia, Ventral / economics
  • Hernia, Ventral / surgery*
  • Herniorrhaphy / economics*
  • Herniorrhaphy / instrumentation*
  • Hospital Charges*
  • Humans
  • Male
  • Middle Aged
  • Recurrence
  • Retrospective Studies
  • Surgical Mesh / economics*
  • Treatment Outcome


  • AlloMax
  • Alloderm
  • Biocompatible Materials
  • FlexHD
  • strattice
  • Collagen