Comparison of biosynthetic versus synthetic mesh in clean and contaminated ventral hernia repairs

Abdominal hernias are an increasingly common presentation due to obesity, ageing and prevalence of prior abdominal surgery. Mesh repair is the mainstay of treatment; however, mesh selection remains largely subjective. There are little data available to assess the performance of biosynthetic meshes against synthetic meshes across all wound types. This study assessed the 6-month outcomes of a single surgeon's cohort of ventral hernia repairs performed with either GORE BIO-A (BioA) or Parietex ProGrip (ProGrip).

Retrospective case cohort study across two centres with patients undergoing repair by a single surgeon (KS) between January 2014 and April 2018 was conducted. All hernia repairs were performed with either BioA (n = 55) or ProGrip mesh (n = 60). Outcomes were monitored for 6 months post repair. Wounds were classified according to the Centre for Disease Control Wound Status. Outcomes measured were length of stay, general complications, wound complications and hernia recurrence.

The overall complication rate and length of stay were similar for both groups. In clean wounds, the complication rate was equivalent for BioA and ProGrip (34% versus 22%, P = 0.22). There was a significant difference in complication rates in contaminated wounds - BioA 17% versus ProGrip 100% (P = 0.004). BioA performed equivocally in clean and contaminated wounds (34% versus 17%, P = 0.178), whereas ProGrip performed worse in contaminated wounds (22% versus 100%, P = 0.016).

Our results suggest that BioA is a suitable, if not preferable, choice for contaminated hernia repair. In this cohort, BioA was also demonstrated as safe and equivalent to ProGrip mesh in clean hernia wounds.