Long-Term Outcome of Complex Abdominal Wall Reconstructions With Cross-Linked Acellular Dermal Matrix – A 23 Year Single Centre Experience

Abstract Aim To review the clinical outcomes of complex abdominal wall reconstructions (AWR) with cross-linked acellular dermal matrix1 (CADM) implants over 23 years and how the indications to its use may have changed overtime. Materials and Methods Retrospective analysis of patients who underwent complex abdominal wall hernia surgeries with the use of CADM between September 2000 to June 2023, including elective and emergency procedures. Results 95 procedures were performed in 88 patients. 24% of patients had 1 or 2 comorbidities, 66% had at least 3 comorbidities. BMI was 30 or above in 75% of patients. Overall, 27 (31%) procedures were performed as an emergency, 73% of which were performed since 2020. Fascial closure was achieved in 60% of patients; however, in the emergency group, fascial closure was 10%. Postoperative events occurred in 62% of cases. Postoperative mortality was 3%. 81 patients were available for long-term follow up, the median length of which was 64 months (range 0–214 months). Clinical recurrence was present in 25 (28%) patients and in all cases it presented in the first 2 years. Twenty-one patients had died of unrelated causes during follow up. Two patients required further intervention for unrelated causes and no adverse mesh related events were recorded in the long-term. Conclusions CADM biologic implants for AWR are safe and early results appear to be maintained overtime without long-term adverse events. CADM seems to perform well in particularly challenging situations like emergencies which appears to be becoming its main clinical application.