Outcomes of biosynthetic absorbable mesh use in high risk CDC Class I ventral hernia repair: a single surgeon series

Biosynthetic absorbable meshes have emerged as suitable alternatives to permanent synthetic and biologic meshes in complex ventral hernia repair in contaminated wounds. Evidence regarding the use of these products in clean wounds is currently scant. This paper presents a large single surgeon series using GORE^®BIO-A^® (W.L. Gore & Associates, Newark, DE) (Bio-A) tissue reinforcement in high risk patients with predominantly CDC Class I wounds.

Retrospective review of a prospectively maintained database of consecutive patients who underwent open ventral hernia repair with biosynthetic absorbable mesh was conducted. Ventral Hernia Working Group (VHWG) classification based on patient demographics and Centers for Disease Control (CDC) wound type were collected prospectively. All patients were followed up for a minimum of 12 months post-operatively.

155 patients were included with a mean post-operative follow up of 29 months (range 12-62 months). Mean age was 61.8 years with an average BMI of 33.5 kg/m². 147 patients (94.9%) were classified as VHWG 2 or 3 based on comorbidities or surgical field contamination. 69% (n = 107) of wounds were designated CDC Class I. Mean hernia size was 119.7cm² with recurrent defects comprising 32.3% (n = 50). Retrorectus mesh repair was achieved in 84.5% of patients (n  = 131). Post-operative wound events occurred in 19.3%. No mesh was explanted. Hernia recurrence rate was 9.0% with a mean time to recurrence of 14 months. There was no significant difference in recurrence rates between clean and contaminated wounds.

This study supports the use of Bio-A in high risk ventral hernias, demonstrating a safe and durable repair across all wound classes. Ongoing follow-up continues to monitor for late complications and recurrence.