Objective:

To evaluate long-term outcomes of complex ventral incisional hernia repair using urinary bladder matrix (UBM) graft reinforcement, focusing on complications, recurrence rates, radiographic assessments, histological evaluations, and patient-reported symptoms, particularly in relation to synthetic materials.

Key Findings:

• The study included patients with a follow-up period extending to January 2018, highlighting the duration of monitoring.
• A subset of patients underwent imaging to assess the radiographic appearance of the repaired fascia, indicating the thoroughness of the assessment.
• Histological evaluations were conducted on biopsies from patients who required abdominal exploration for unrelated issues, providing insight into the graft's integration.

Interpretation:

UBM graft reinforcement may provide a durable solution for complex ventral incisional hernia repairs, with potential benefits over synthetic materials in terms of infection resistance and tissue remodeling, warranting further comparative studies.

Limitations:

• Retrospective design may introduce selection bias, potentially affecting the generalizability of the results.
• Incomplete follow-up for some patients, including deceased individuals, may limit the reliability of recurrence and complication rates.

Conclusion:

This study suggests that UBM graft reinforcement in complex ventral incisional hernia repairs shows promise in terms of long-term outcomes, but further studies are needed to confirm these findings, particularly randomized controlled trials comparing UBM to synthetic materials.