The biological prosthesis is a viable option for abdominal wall reconstruction in pediatric high risk defects

•A series of 23 pediatric patients is presented, including 17 neonates.•Most suffered from congenital abdominal wall defects.•22 wounds were infected or contaminated, including 9 with open bowel.•5 types of prostheses were used. Prosthesis was exposed without skin coverage in 11 cases.•Complication rate was 30% and hernia recurrence rate was 17%.

BackgroundOur aim was to explore the indications for and outcome of biological prostheses to repair high risk abdominal wall defects in children.MethodsA retrospective chart review was performed of all cases of abdominal wall reconstruction in a single institution between 2007 and 2015. Demographic and clinical variables, technique and complications were described and compared between prosthesis types.ResultsA total of 23 patients underwent abdominal wall reconstruction using a biological prosthesis including 17 neonates. The main indication was gastroschisis (17 patients) followed by ruptured omphalocele and miscellaneous conditions. Alloderm™ was most commonly used followed by Surgisis™, Strattice™, Flex-HD™ and Permacol™. In 22 cases wounds were contaminated or infected. Open bowel/stomas were present in 9 cases. Skin was not closed in 11 cases. Post-operative complication rate was 30% and hernia recurrence rate was 17% after a mean follow-up time of 16 months.ConclusionsThe use of a biological prosthesis may offer advantages over a synthetic mesh in pediatric high risk abdominal wall defects. The surgeon should be ready to consider its use in selected cases.