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Permanent vs Absorbable Mesh for Ventral Hernia Repair in Contaminated Fields: Multicenter Propensity-Matched
Jorge Humberto Rodriguez-Quintero1, Gustavo Romero-Velez2, Diego L Lima1
1From the Department of Surgery, Montefiore Medical Center, Bronx, NY (Rodriguez-Quintero, Lima, Sreeramoju).
Background:
Traditionally, the use of absorbable mesh in contaminated fields aimed to reduce postoperative morbidity at the expense of increased hernia recurrence. This dogma has recently been challenged in randomized trials that demonstrate the advantages of permanent mesh in this setting. Although these studies are of high quality, their reproducibility across institutions is limited. We sought to compare the outcomes between permanent and absorbable mesh in a multicentric cohort from the Abdominal Core Health Quality Collaborative.
Study Design:
Patients who underwent elective ventral hernia repair in class II and III surgeries from January 2013 to December 2021 were identified within the Abdominal Core Health Quality Collaborative. Outcomes were compared among permanent (P), absorbable synthetic (AS), and biologic (B) mesh at 30 days and 1 year using a propensity score-matched analysis.
Results:
A total of 2,484 patients were included: 73.4% P, 11.2% AS, and 15.4% B. Of these, 64% were clean-contaminated and 36% contaminated interventions. After propensity score-matched analysis, there was no significant difference between groups regarding surgical site occurrence (P 16%, AS 15%, B 21%, p = 0.13), surgical site infection (P 12%, AS 14%, B 12%, p = 0.64), and surgical site occurrence requiring procedural intervention at 30 days (P 12%, AS 15%, B 17%, p = 0.1). At 1 year, the recurrence rate was significantly lower among the permanent group (P 23%, AS 40%, B 32%, p = 0.029).
Conclusions:
In this multicentric cohort, permanent mesh has equivalent 30-day outcomes and lower rates of hernia recurrence at 1 year after hernia repair in contaminated fields.
Insights
Permanent mesh shows equivalent short-term outcomes and lower recurrence rates for hernia repair in contaminated surgical fields compared to absorbable mesh. This multicentric study challenges previous beliefs about mesh choice in such cases.
Area of Science:
- Surgical Innovation
- Hernia Repair Techniques
- Biomaterials in Surgery
Background:
- Traditionally, absorbable mesh was used in contaminated fields to minimize morbidity, despite higher recurrence rates.
- Recent trials suggest permanent mesh may be advantageous in contaminated settings.
- Limited institutional reproducibility of prior studies necessitates further investigation.
Purpose of the Study:
- To compare outcomes of permanent versus absorbable mesh in ventral hernia repair within contaminated surgical fields.
- To evaluate short-term (30-day) and long-term (1-year) outcomes, including recurrence rates.
- To assess surgical site occurrences and infections across different mesh types.
Main Methods:
- A multicentric cohort study of 2,484 patients undergoing elective ventral hernia repair (January 2013-December 2021).
- Inclusion criteria: class II and III surgeries with contaminated or clean-contaminated interventions.
- Propensity score-matched analysis comparing permanent, absorbable synthetic, and biologic mesh outcomes at 30 days and 1 year.
Main Results:
- No significant differences in 30-day surgical site occurrence, infection, or need for procedural intervention among permanent, absorbable synthetic, and biologic mesh groups.
- At 1 year, permanent mesh demonstrated a significantly lower hernia recurrence rate (23%) compared to absorbable synthetic (40%) and biologic (32%) mesh (p=0.029).
Conclusions:
- Permanent mesh offers equivalent 30-day outcomes in contaminated fields for hernia repair.
- Utilizing permanent mesh is associated with reduced hernia recurrence rates at one year.
- Findings support the use of permanent mesh in contaminated fields, challenging prior surgical dogma.
