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Long-Term Outcomes in Complex Abdominal Wall Reconstruction Repaired With Absorbable Biologic Polymer Scaffold

Joseph F Buell1, Alexandros N Flaris2, Sukreet Raju2

  • 1From the Department of Surgery, Mission Health, HCA North Carolina, MAHEC, University of North Carolina, Asheville, NC.

Annals of Surgery Open : Perspectives of Surgical History, Education, and Clinical Approaches
|August 28, 2023
PubMed
Summary
This summary is machine-generated.

Poly-4-hydroxybutyrate (P4HB) mesh shows superior long-term outcomes in complex abdominal wall reconstruction compared to porcine grafts. This absorbable biologic mesh offers significant cost savings and reduced reherniation rates, proving its value beyond its resorption period.

Keywords:
abdominal wall reconstructionbiologic meshbiosynthetic meshpolymer mesh

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Area of Science:

  • Surgical Innovation
  • Biomaterials Science
  • Gastroenterology

Background:

  • Absorbable biologic mesh for abdominal wall reconstruction showed initial promise.
  • Concerns exist regarding the long-term durability of these meshes post-resorption.
  • Poly-4-hydroxybutyrate (P4HB) is an absorbable polymer scaffold used in such reconstructions.

Purpose of the Study:

  • To compare the 5-year outcomes of poly-4-hydroxybutyrate (P4HB) mesh versus porcine cadaveric mesh for complex abdominal wall reconstruction.
  • To evaluate long-term clinical performance, complication rates, recurrence rates, and cost-effectiveness.

Main Methods:

  • A 5-year follow-up analysis comparing P4HB mesh (n=31) with porcine cadaveric mesh (n=42).
  • Clinical outcomes assessed using statistical analysis with Stata 14.2 and Excel 16.16.23.
  • Multivariate logistic regression identified risk factors for complications and recurrence.

Main Results:

  • P4HB mesh demonstrated significantly lower reherniation rates (12.9% vs 38.1%, P=0.017) after 5 years.
  • Smoking, African American race, and porcine grafts were identified as risks for complications.
  • Smoking and porcine grafts were risks for recurrence; P4HB offered a $10,595 cost saving per case.

Conclusions:

  • Absorbable biologic P4HB scaffold provides superior clinical performance and value-based benefits in abdominal wall reconstruction, persisting beyond its 2-year resorption.
  • Porcine cadaveric grafts were independently associated with increased complications and recurrences.
  • P4HB mesh represents a durable and cost-effective alternative for complex abdominal wall repairs.