Hernia Recurrence and Complications After Abdominal Reconstruction With Reinforced Versus Nonreinforced Biologic Mesh

Area of Science:

• Surgical Innovation
• Biomaterials Science
• Abdominal Wall Reconstruction

Background:

• Biologic and synthetic meshes are used for abdominal wall reconstruction, with biologics favored in contaminated settings due to incorporation.
• Synthetic meshes offer lower long-term recurrence but higher complication rates.
• Reinforced biologic mesh (Ovitex) combines biologic incorporation with synthetic strength.

Purpose of the Study:

• To evaluate the hypothesis that reinforced biologic mesh has similar complication rates but decreased long-term hernia recurrence compared to nonreinforced biologics.
• To compare outcomes of reinforced versus nonreinforced biologic mesh in abdominal wall reconstruction.

Main Methods:

• Single-center retrospective review of 254 patients undergoing abdominal wall reconstruction with biologic mesh from January 2013 to January 2022.
• Comparison of baseline characteristics, 90-day complications, and recurrence rates between reinforced (Ovitex) and nonreinforced biologic mesh groups.
• Statistical analysis using chi-squared, Wilcoxon rank sum, univariate, and multivariate logistic regression.

Main Results:

• Reinforced biologic mesh did not significantly impact 90-day complication or hernia recurrence rates on univariate or multivariate analysis.
• Previous mesh infection was a risk factor for recurrence; nonreinforced biologics were more common in infected cases, stoma takedowns, and bowel resections.
• Reinforced biologics were more frequently used for recurrent hernias not due to infection; high BMI (>35) was a risk factor for complications.

Conclusions:

• Reinforced and nonreinforced biologics demonstrate comparable risk profiles and recurrence rates in primary abdominal wall reconstruction.
• Nonreinforced biologics may be suitable for contaminated cases (infection, stoma takedown, bowel resection) with no difference in outcomes.
• Reinforced biologics may offer benefits in recurrent hernia repair where additional reinforcement is needed, with no difference in outcomes observed.