Case–control comparison of separation of component retrorectus urinary bladder extracellular surgical device hernia repair with acellular dermal matrix underlay and prosthetic mesh overlay hernia repair

PURPOSE: The purpose of this study is to compare the complication rates and recurrence rates of two types of incisional hernia repairs by a single surgeon. MATERIALS AND METHODS: The medical records of all patients undergoing incisional hernia repair by the senior author were reviewed. Patients who underwent the biologic mesh underlay/synthetic mesh overlay (BUSO) “sandwich” repair and separation of components with retrorectus mesh (SOCRM) repair were assessed. Only Grades I, II, and III incisional hernias were included. The two groups were matched for age, sex, hernia size, and body mass index. The groups were compared for any 30-day complication, any adverse event in the follow-up period, and any recurrence as determined by physical examination or imaging. RESULTS: Fifty-six patients were successfully matched. There were no differences in the type of suture used, skin closure, dressing, or drain use. There was no difference in 30-day postoperative complications or discharge status. The BUSO group had a 29% recurrence rate, compared to 4% in the SOCRM group (P = 0.0248). However, the follow-up was longer in the BUSO group. CONCLUSIONS: The results of this study suggest that for incisional hernias not amenable to primary closure, SOCRM repair may be superior to even a two-mesh layer bridging repair.