PURPOSE: Historically, the repair of ventral hernias has been hampered with the problem of recurrence.  Techniques that have evolved to address this issue include myofascial flap repair, polymer mesh repair, and more recently biological matrix repair.  A combined approach to the ventral hernia, using both a separation of components technique and an on lay of biological matrix, has been described.  The purpose of this retrospective study is to compare this combined on lay technique to traditional myofascial repair regarding recurrence and infection rates. METHOD: After obtaining approval from the Institutional Review Board, charts of patients undergoing ventral hernia repair with component separation were reviewed.  Dates reviewed were from January, 1999 through December, 2007.  Patients were sorted in to two groups:  component separation alone and component separation with biologic matrix on lay.  Age, comorbidities, body mass index, recurrence rates, and infection rates were evaluated.  Superficial surgical site infections responding to oral antibiotics and seromas were considered minor complications; abscess formation requiring drainage and recurrence were considered major complications.  A Fisher’s exact test was applied for analysis to compare the data between the two groups.
RESULTS: Thirty six patients were identified as having only component separation.  Of these patients, four had recurrence and one had an infection requiring drainage.  Thirty eight patients received an on lay of biological mesh in addition to component separation.  Materials used in this group included acellular bovine pericardium, acellular cadaveric dermal graft, and acellular porcine collagen matrix.  This group had five recurrences and three infections requiring drainage.  No statistical significance was found regarding recurrence (p=0.29) or infection (p=0.32).  Regarding minor complications, five patients from the on lay group had wound infections requiring only antibiotics, compared to ten from the group with component separation alone (p=0.1).  Five patients from the on lay group  had seroma occurrence as compared to three patients from the group with component separation alone (p=0.38).
CONCLUSION:   With the advent of the biological mesh, the technique of mesh placement as an on lay to buttress ventral hernia repair by component separation has arisen.  A review of the data from our institution suggests that while use of an on lay does not alter seroma or  infection rates, there is no decrease in recurrence rates achieved by using the biological matrix on lay technique when compared to myofascial repair alone.