Absorbable Polyglactin vs. Non-Cross-linked Porcine Biological Mesh for the Surgical Treatment of Infected Incisional...

Area of Science:

• Abdominal surgery
• Surgical materials science

Background:

• Contaminated or infected incisional hernia (IH) repair using absorbable meshes is linked to high complication and recurrence rates.
• Biological meshes may offer a better alternative, but existing data are from heterogeneous studies.

Purpose of the Study:

• To compare the efficacy of absorbable versus biological meshes for treating contaminated or infected IH.
• To evaluate outcomes in a homogeneous patient series using a standardized surgical technique.

Main Methods:

• Retrospective review of patients (2008-2015) undergoing IH repair with absorbable (Vicryl®) or biological (Strattice®) mesh.
• Comparison of patient demographics, infectious complication rates, and recurrence-free outcome (RFO).
• Application of propensity score methodology and Cox regression to adjust for baseline differences.

Main Results:

• Biological mesh group (n=24) had fewer early (33.3% vs 61.4%) and late (8.3% vs 31.2%) infectious complications compared to the absorbable mesh group (n=57).
• Recurrence-free survival rates at 36 months were significantly higher for biological meshes (82%) versus absorbable meshes (24%).
• Biological mesh use was independently associated with prolonged RFO (HR=0.091).

Conclusions:

• Biological meshes appear superior to absorbable meshes for contaminated or infected incisional hernia repair.
• Results suggest improved outcomes regarding infection and recurrence with biological mesh use.
• Further validation through prospective randomized trials is recommended.