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Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh
Published on: September 11, 2021
Comparative analysis of biologic versus synthetic mesh outcomes in contaminated hernia repairs
Arnab Majumder1, Joshua S Winder2, Yuxiang Wen1
1Case Comprehensive Hernia Center, Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH.
Background:
Contaminated operative fields pose significant challenges for surgeons performing ventral hernia repair. Although biologic meshes have been utilized increasingly in these fields, recent evidence suggests that synthetic meshes represent a viable option. We analyzed the outcomes of biologic and synthetic mesh utilized in patients undergoing major ventral hernia repair in clean-contaminated/contaminated fields.
Methods:
We conducted a multicenter, retrospective review of patients undergoing open ventral hernia repair in clean-contaminated/contaminated fields using biologic or synthetic mesh. Patient and hernia details were characterized. Primary outcomes included 90-day surgical site event, surgical site infection, and hernia recurrence.
Results:
A total of 126 patients undergoing major ventral hernia repair in clean-contaminated/contaminated fields (69 biologic and 57 synthetic meshes) were analyzed. Groups were similar in both patient and hernia characteristics. There were 13 (22.8%) surgical site events in the synthetic cohort compared to 29 (42.0%) in the biologic cohort, P = .024. Similarly, surgical site infections were less frequent in the synthetic group, with 7 (12.3%) vs 22 (31.9%), P = .01. With a mean follow-up of 20 months, there were more recurrences in the biologic group: 15 (26.3%) vs 4 (8.9%) in the synthetic group, P = .039.
Conclusion:
The choice of mesh for clean-contaminated/contaminated ventral hernia repair remains debatable. We demonstrated that using synthetic sublay mesh resulted in a significantly lower wound morbidity and more durable outcomes versus a similar cohort of biologic repairs. This is likely secondary to improved bacterial clearance and faster integration of macroporous synthetics. Overall, our findings not only support suitability of synthetic mesh in contaminated settings but also challenge the purported advantage of biologics in clean-contaminated/contaminated ventral hernia repairs.
Insights
Synthetic mesh in ventral hernia repair shows better outcomes in contaminated fields. This study found synthetic mesh led to fewer complications and recurrences compared to biologic mesh, challenging traditional views.
Area of Science:
- Surgical Innovation
- Biomaterials Science
- Hernia Surgery
Background:
- Contaminated operative fields present challenges in ventral hernia repair.
- Biologic meshes are increasingly used, but synthetic options are emerging.
- This study compares outcomes of biologic versus synthetic mesh in contaminated ventral hernia repair.
Purpose of the Study:
- To analyze and compare the outcomes of biologic and synthetic mesh in ventral hernia repair within clean-contaminated/contaminated surgical fields.
- To evaluate surgical site events, infections, and hernia recurrence rates between the two mesh types.
Main Methods:
- A multicenter, retrospective review of 126 patients undergoing open ventral hernia repair in contaminated fields.
- Patients were grouped based on the use of either biologic (69) or synthetic (57) mesh.
- Outcomes assessed included 90-day surgical site events, surgical site infections, and hernia recurrence.
Main Results:
- Synthetic mesh group had significantly fewer surgical site events (22.8% vs 42.0%, P=.024) and infections (12.3% vs 31.9%, P=.01) compared to biologic mesh.
- Hernia recurrence was lower in the synthetic group (8.9% vs 26.3%, P=.039) after a mean follow-up of 20 months.
- Patient and hernia characteristics were similar between the groups.
Conclusions:
- Synthetic sublay mesh demonstrates superior outcomes in contaminated ventral hernia repair compared to biologic mesh.
- Findings suggest synthetic mesh is suitable for contaminated settings, with lower wound morbidity and better durability.
- The study challenges the presumed advantage of biologic meshes in clean-contaminated/contaminated ventral hernia repairs.
