open complex ventral incisional hernia repair using biosynthetic material for midline fascial closure reinforcement

Conditions: Ventral Incisional Hernia

Summary: prospective, multicenter, observational study to evaluate performance of gore® bio-a® tissue reinforcement when used to reinforce midline fascial closure in single-staged open complex ventral incisional hernia repair.

the study will evaluate the performance of the biosynthetic mesh when used to reinforce the midline fascial closure in single-staged open complex ventral incisional hernia repair. it is designed to test the null hypothesis that the two year recurrence rate associated with the device is greater than or equal to 50% vs the alternative hypothesis that the two year recurrence rate is less than 50%.

Eligibility criteria:
inclusion criteria: * subjects will be informed about the study, and will have read; understood and signed the informed consent and authorization to use their phi, as applicable * subjects willing and able to submit to postoperative follow-up evaluations including quality of life assessments up to 24 months after surgery * subjects of either gender that are at least the age of 18 years * subjects will have a body-mass index (bmi) of \< 40 * subjects will be undergoing single-staged open complex ventral incisional hernia repair with the retrorectus or intraperitoneal placement technique of the gore® bio-a® tissue reinforcement * subjects in which intraoperatively their surgical field/wound is characterized either a type 2 or type 3 in table 1 in section 12.0 * subjects with a hernia defect \> 9 cm2 large when measured intraoperatively * subjects in which the required mobility for midline fascial closure without excessive tension to reapproximate the rectus abdominis muscle intraoperatively can be achieved * subjects in which one unit of gore® bio-a® tissue reinforcement will adequately reinforce the midline fascial closure with at least 4 cm of overlap laterally exclusion criteria: * subjects who, in the surgeon's opinion, would have a difficult time comprehending or complying with the requirements of the study * subjects with a bmi \> 40 * subjects with evidence of pre-existing systemic infections * subjects with cirrhosis or are currently being treated with dialysis * subjects with a wound-healing disorder * subjects with autoimmune disorder requiring \> 10mg of a corticosteroid per day * subjects who are immunocompromised such as, with hiv or transplant, or receiving chemo or radiation therapy * subjects with a hernia defect \< 9 cm2 large when measured intraoperatively * subjects with a hernia defect requiring more than one unit of gore® bio-a® tissue reinforcement * subjects in which intraoperatively there is an inability to achieve retrorectus or intraperitoneal placement of the device * subjects in which a midline fascial closure without excessive tension cannot be achieved * subjects in which intraoperatively their surgical field/wound is characterized either a type 1 or type 4 in the table 1 in section 12 * subjects in need of concomitant surgical procedures other than indicated in the protocol as acceptable * subject in which their complex ventral incisional hernia repair requires more than one operation to reduce hernia and close fascia, including serial excision procedures - requiring subsequent surgery to complete their hernia repair * subjects with a hernia repair requiring an emergent procedure, such as strangulated bowel * subjects in which intraoperatively untreated cancer was found

Keywords: complex ventral incisional hernia repair reapproximation of the rectus abdominis muscle retrorectus or intraperitoneal placement technique mobility for midline fascial closure